Abnormal Bleeding During Urination and Intercourse in Women

Blood clots are expelled during urination when straining in the abdominal area?

Married and trying to conceive since September of this year, hoping to become pregnant with my first child.
Earlier this year, I had a Pap smear that returned normal results.
My menstrual cycle has always been regular, and aside from occasional lower back pain during my period, I have never experienced any discomfort.
Occasionally, during intercourse, I notice a brownish, thick discharge (which also occurs occasionally in daily life), and there have been very few instances of slight bleeding, but both partners have not experienced any pain or discomfort; this situation has persisted for about a year, even when using contraception.

From November 1-8, aside from the previously mentioned situation during intercourse, I experienced a sensation of one or two clots resembling menstrual blood when straining during urination almost daily (with the exception of November 9-12).
Starting on the 13th, I began to notice occasional blood discharge from the abdomen without straining, so I intermittently used sanitary pads as needed.
From November 9-12, there was no bleeding, but from the 13th to the 18th, the bleeding during urination continued.
My period started on the 19th and lasted until the 22nd, with continued bleeding during intercourse and urination, along with some thick clots that felt like menstrual blood.

On December 1-2 and 5-6, there was no bleeding, but from December 3-4, the bleeding during urination persisted.
Since December 7, I have experienced four consecutive days of blood discharge during urination, with the amount gradually increasing (approximately 10%-20% of a typical menstrual flow).
My period is expected to start on the 23rd of this month.
I am concerned about the frequent bleeding since November and the situation during intercourse.
Could you please provide insights into the possible causes or explanations for these symptoms? Thank you!

Amy, 30~39 year old female. Ask Date: 2015/12/11

Dr. Lin Manying reply Obstetrics and Gynecology

Please cherish our online medical resources.
When asking the same question, please specify only one physician or nutritionist.
Based on the description, it is most likely dysfunctional uterine bleeding (caused by hormonal imbalance), but please visit the outpatient clinic for relevant examinations.

Reply Date: 2015/12/11

More Info

Abnormal bleeding during urination and intercourse can be a concerning symptom for many women, and it is essential to understand the potential causes and implications of these symptoms. Based on your description, it seems that you have been experiencing unusual bleeding patterns, particularly during urination and after sexual intercourse, which has raised concerns about your reproductive health.

Firstly, it is important to note that the presence of blood during urination, especially when accompanied by a feeling of pressure or discomfort in the abdomen, may indicate several possible conditions. One common cause could be a urinary tract infection (UTI), which can lead to irritation and inflammation of the urinary tract, resulting in bleeding. However, since you mentioned that this bleeding occurs alongside sexual activity and is associated with the sensation of passing clots or thick blood, it may suggest a more complex issue related to your reproductive system.

Another potential cause of your symptoms could be related to hormonal imbalances. Hormonal fluctuations can lead to irregular bleeding patterns, including spotting between periods or bleeding during ovulation. This is often referred to as ovulatory bleeding and can occur due to the sudden drop in estrogen levels that happens when an egg is released from the ovary. Given that you have a regular menstrual cycle, it is possible that these fluctuations are affecting your cycle, leading to the symptoms you are experiencing.

Additionally, conditions such as endometriosis or uterine fibroids could also be contributing factors. Endometriosis occurs when the tissue that normally lines the inside of the uterus grows outside of it, leading to pain and abnormal bleeding. Uterine fibroids are non-cancerous growths in the uterus that can cause heavy bleeding, pain, and pressure symptoms. Both conditions can lead to increased bleeding during urination or after intercourse, especially if the fibroids or endometrial tissue are located near the bladder or urethra.

It is also crucial to consider the possibility of cervical or uterine issues, especially since you have had a normal Pap smear earlier this year. However, changes can occur, and it is advisable to follow up with your healthcare provider for further evaluation. This may include a pelvic ultrasound or additional imaging studies to assess the uterus and ovaries for any abnormalities.

Given your concerns about potential pregnancy, it is also worth noting that any bleeding after intercourse could be related to implantation bleeding if you are indeed pregnant. However, since you mentioned that you are not currently pregnant, this may not apply to your situation.

In summary, the symptoms you are experiencing could be attributed to several factors, including hormonal imbalances, infections, or structural issues within the reproductive system. It is essential to consult with a healthcare provider who can perform a thorough evaluation, including a physical examination and possibly imaging studies, to determine the underlying cause of your symptoms. Early diagnosis and treatment are crucial in managing any potential health issues and ensuring your reproductive health remains optimal. Please do not hesitate to seek medical advice, as it is the best way to address your concerns and receive appropriate care.

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