Post-Sexual Bleeding: Causes and When to Seek Medical Advice

Postcoital bleeding

I would like to ask the doctor: I have an internal hemorrhoid.
Since mid-last year, after having anal intercourse with my partner (we always prepare with lubrication), I did not experience any anal fissures or bleeding.
However, this year, I have been experiencing bleeding every time after anal intercourse (the bleeding location varies between the internal hemorrhoid and the anal opening).
Prior to mid-last year, I suspected I had gonorrhea (my partner had a burning sensation at the urethral opening, and the doctor diagnosed it as gonorrhea).
I later sought medical treatment and took antibiotics.
I would like to know if it is possible for gonorrhea to recur? (My partner and I have had anal intercourse several times, and he has not shown any symptoms.) I have also had blood tests three times in the past six months, and no other sexually transmitted infections were reported.
Should I see a doctor for a rectal examination? If so, what is the approximate cost for such an examination? Thank you.

Lu Dan, 20~29 year old female. Ask Date: 2021/03/28

Dr. Ke Fangxu reply Surgery

This situation likely indicates a higher possibility of hemorrhoidal bleeding.
Gonorrhea typically involves infection at the urethral location, and I have not heard of cases involving anal infections.
An anoscopy can be arranged by a physician, and it should be covered by health insurance, so out-of-pocket expenses should not be necessary.

Reply Date: 2021/03/28

More Info

Post-sexual bleeding can be a concerning symptom, especially when it occurs consistently after anal intercourse. Based on your description, there are several factors to consider regarding the bleeding you are experiencing.

Firstly, the presence of internal hemorrhoids (内痔) can contribute to bleeding during or after anal intercourse. Hemorrhoids are swollen veins in the rectal area that can become irritated or ruptured during sexual activity, leading to bleeding. The fact that you have noticed blood coming from different locations, including the hemorrhoid and the anal opening, suggests that the bleeding could be related to these hemorrhoids. It is essential to ensure that the hemorrhoids are managed properly, as they can become more problematic with continued irritation.

Secondly, your history of suspected gonorrhea (淋病) raises the question of whether there could be a recurrence or another sexually transmitted infection (STI) at play. While you have had blood tests that did not indicate any other STIs, it is important to remember that some infections can be asymptomatic, especially in partners. If your partner has not been tested or treated, there is a possibility of reinfection. Gonorrhea can lead to complications if left untreated, including pelvic inflammatory disease (PID) in women, which can cause various symptoms, including bleeding.

Given your symptoms and history, it is advisable to seek medical attention. A healthcare provider can perform a thorough examination, including a digital rectal exam and possibly a flexible sigmoidoscopy or anoscopy, to visualize the rectal area and assess for any abnormalities, such as fissures, hemorrhoids, or signs of infection. The cost of such procedures can vary widely depending on your location, insurance coverage, and the specific healthcare facility. In the United States, a flexible sigmoidoscopy can range from $500 to $2,000, but it is best to check with your healthcare provider for an accurate estimate.

In addition to a physical examination, your doctor may recommend further testing for STIs, including gonorrhea and chlamydia, especially if you have had unprotected anal intercourse. It is crucial to communicate openly with your healthcare provider about your sexual history and any concerns you have regarding STIs. This information will help them provide you with the best care possible.

In summary, the bleeding you are experiencing after anal intercourse could be related to your internal hemorrhoids, but it is also essential to rule out any underlying infections or other causes. Seeking medical advice is the best course of action to ensure your health and address any potential issues. Remember to discuss all your symptoms and concerns with your healthcare provider to receive appropriate care and treatment.

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