Post-Anal Intercourse Bleeding: Symptoms and Concerns

Symptoms and bleeding after anal intercourse inquiry?

Medical History: Frequent gastroesophageal reflux, underwent gastroscopy one year ago revealing a gastric ulcer.
Recently undergoing treatment for syphilis (reported).
Inquiring about rectal bleeding after anal intercourse; for the past week, the first stool has had slight blood, but no further bleeding occurred.
Recently attempted to clean the anus and inserted a finger to check for any protrusions (felt none).
When the finger was inserted deeply, there was a slight oozing of bright red blood (2-3 drops).
During the cleaning, there was mild pain on the left side.
Is this indicative of an issue with the intestinal mucosa or hemorrhoids? The last anal intercourse was three months ago, and it was still quite uncomfortable.
After experiencing discomfort, I have been hesitant to engage in it again due to bleeding and slight difficulty in bowel movements.
The syphilis infection was treated about a month ago, and the infectious disease doctor mentioned that after the injection, I should wait for symptoms to subside or resolve before testing.
The anal cleaning was done two days ago, with a significant gap since the last time.
I am concerned about the internal structure of the colon and rectum and whether I may have caused any damage.

Yi You, 20~29 year old female. Ask Date: 2023/05/01

Dr. Ke Fangxu reply Surgery

This phenomenon is more akin to mild hemorrhoidal bleeding.
It is unlikely that the internal structure of the colon and rectum is damaged, especially since it has been three months since the last anal intercourse.
I recommend that you avoid inserting your fingers into the anus to prevent injury to the rectal mucosa.

Reply Date: 2023/05/01

More Info

When it comes to post-anal intercourse bleeding, there are several factors to consider, especially given your medical history and recent activities. Based on your description, it seems you are experiencing some concerning symptoms, including fresh red blood after anal penetration and slight pain during cleaning.
Firstly, it's important to understand that the rectal area is sensitive and can be easily injured, especially if there is insufficient lubrication or if the penetration is forceful. The presence of fresh red blood after anal intercourse could indicate a few potential issues:
1. Anal Fissures: These are small tears in the lining of the anus, often caused by trauma during anal intercourse. They can lead to bleeding and pain during bowel movements. Given that you mentioned discomfort and slight bleeding when probing, this could be a possibility.

2. Hemorrhoids: These are swollen veins in the rectum or anus that can become inflamed and bleed, especially after straining during bowel movements or after anal intercourse. If you have a history of constipation or straining, this could be a contributing factor.

3. Rectal Trauma: If the penetration was not gentle or if there was a lack of lubrication, it could cause trauma to the rectal mucosa, leading to bleeding.
4. Infections or Inflammatory Conditions: Given your recent treatment for syphilis, it's crucial to consider that infections can sometimes lead to inflammation or other complications in the anal area.
5. Underlying Conditions: Since you have a history of gastrointestinal issues, such as gastroesophageal reflux disease (GERD) and a previous gastric ulcer, it’s essential to consider that any gastrointestinal bleeding should be evaluated carefully. Although the blood you see is likely from the anal region, any gastrointestinal bleeding should be ruled out.

Regarding your symptoms, the fact that you experienced bleeding after attempting to check for abnormalities and that you felt slight pain suggests that there may be some irritation or injury to the anal area. It’s also worth noting that if you have been experiencing blood with your bowel movements, even if it’s just at the beginning, this should be taken seriously.

Given your concerns and the potential for various causes of your symptoms, it is advisable to seek medical attention. A healthcare provider can perform a thorough examination, which may include a digital rectal exam or even a colonoscopy if deemed necessary, to rule out any serious conditions.
In the meantime, here are some recommendations:
- Avoid Anal Intercourse: Until you have been evaluated by a healthcare provider, it may be wise to refrain from anal intercourse to prevent further injury.

- Use Lubrication: If you decide to engage in anal intercourse in the future, ensure that you use plenty of lubrication to minimize the risk of tearing.

- Monitor Symptoms: Keep track of any changes in your symptoms, such as increased pain, changes in the nature of the bleeding, or any new symptoms like fever or significant changes in bowel habits.

In conclusion, while there are several potential explanations for your symptoms, it is crucial to consult with a healthcare professional who can provide a proper diagnosis and treatment plan. Your health and safety should always come first, especially when dealing with sensitive areas of the body.

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