Bleeding after sex, or post-coital bleeding, can be scary and traumatizing. But if you know the right questions to ask your doctor, it doesn’t have to be. Here is a list of some possible causes:
🌹Tissue tear. Sometimes with tissue stretching, there can be a little tear in the vaginal tissue. These can bleed a lot, bright red, but for a short time, and quickly heal. It may or may not hurt when it happens. They are common at the opening of the vagina, called the introitus where the hymenal tissue is. If it doesn't heal all the way, it can keep opening, and keep bleeding.
🌹Hormonal changes, mostly a decrease in estrogen. This usually occurs during lactation and peri/menopause. The lower estrogen levels cause the vaginal walls and vulvar skin to lose some of its elasticity and lubrication, increasing the chance for tearing.
🌹Cervical abrasions. If there is some trauma to the surface of the cervix, which is directly exposed in the vagina, there can be bleeding. Pap smears or other office procedures can cause this. Also, after going through labor, the anatomy of the cervix can change. The cervical canal tissue, which is more vascular and fragile than the outside, can appear on the outside. This is called an ectropion. This may be a reason you have new onset bleeding after having a baby.
🌹Less common, there can be something in the uterus itself that is causing the bleeding. During an orgasm, the uterus can contract. If there is something in the uterus, like a benign polyp or little fibroid, that contraction can irritate it and cause a little bleeding. It should be short lived. But if your doctor has checked for all of the other things, an ultrasound or biopsy of the uterus may help find the cause.
🌹Remember, always ask your LOR or Yoetzet if this bleeding puts you into niddah. Most bleeding that is obviously not from the uterus will not but often needs an exam to determine this.
TIPS AND TRICKS THAT MAY HELP:
Here are a few tips to help with bleeding after sex…
💥1) Wait for a tear/cut to heal. This sounds obvious, but sometimes you just end up having sex again because you feel fine, even though the tear isn’t completely healed. One way you may be able to tell if it’s more external is how easy it is to get blood on a tissue. Sometimes based on where the blood is on the tissue, it can give you a clue as to where the bleeding is coming from. If all you need to do is dab the outside and it’s on one spot of the tissue, it may be right at the opening. If you don’t get blood on the tissue unless you wipe higher up internally, it may be higher up or from the cervix. Also, take a mirror and look! (I don’t want these suggestions to get you into issues with staining that may put you into niddah, so always ask if you aren’t sure!)
💥2) Using lubrication during sex to decrease friction and minimize trauma to the tissues. Using “plain” lubricants, rather than ones with scents, flavors, or warming effects may pose less of a chance of vaginal wall irritation. Experiment with different brands. You may not always need to use it. Around ovulation you may have more of your own lubrication, but closer to your period, you may feel drier and feel the need to use store-bought lubricants more often. Estrogen creams can also be helpful when lubricants don’t work.
💥3) Cautery using either heat or a chemical, to seal fragile blood vessels so they don’t continuously open and bleed. These are quick, easy things your gynecologist should be able to do in the office after a thorough exam.
💥4) Rarely, to address the last cause, a minor procedure under sedation to remove something inside the uterus that may be causing the bleeding, can be performed.