Bleeding after sex: when to worry

Bleeding after intercourse can be surprising. The postcoital bleeding are, in the majority of cases, mild and not serious. Losing a little blood on the rare occasions isn't necessarily worrying. On the other hand, if the bleeding appears regularly and is accompanied by pain or burning, an appointment with the gynecologist is necessary, because this could be a sign of more serious causes that must be quickly taken care of. Odile Bagot, obstetrician-gynecologist, explains the various factors that can explain this bleeding.

A sexually transmitted infection (STI)

Sexually transmitted infections can cause many unpleasant symptoms, and bleeding after sex is certainly one of them – especially if the infection results in inflammation of the cervix, called cervicitis, explains Dr. Bagot. STIs such as chlamydia, gonorrhea, and trichomoniasis can cause inflammation of the cervix. "The gynecologist will take bacteriological samples to verify this hypothesis ", she adds. You may have contracted an STI without showing any noticeable symptoms, which is why it is important to see a doctor when you have a symptom such as abnormal bleeding. You will be prescribed appropriate treatment to overcome the infection.

A polyp

Some polyps cause bleeding after sex. Most of the time, they are benign (non-cancerous). Their size can vary from a few millimeters to a few centimeters. During intercourse, they can be touched and rubbed, which causes bleeding. It should be noted that polyps are more common in older women, usually 40 years and older. A gynecological examination will establish a diagnosis. Polyps can be removed if they cause bothersome symptoms.

Ectropion, a common cause

"An ectropion at the level of the neck is sometimes involved", notes Odile Bagot. "The tissue that lines the inside of the cervix will rather lie outward, so it will come in contact with vaginal secretions. This tissue is not covered with skin lining, so small vessels can bleed ", specifies the specialist. Ectropion of the uterus is a benign condition that resolves spontaneously in the majority of cases. If it is too bothersome, treatment is prescribed.

Cracks in the vestibule

"Cracks in the vestibule can cause bleeding, but they are usually accompanied by pain and burning", says the gynecologist. A gynecological examination will see if cracks are present.

Cervical cancer, the most worrying hypothesis

The most serious cause of bleeding after sex is cancer of the cervix. " Postcoital bleeding can be a sign of cervical cancer, although this is very rare »Reassures Odile Bagot. If you have continuous or persistent abnormal bleeding, you should see your gynecologist. "He will take a close look at your cervix and make sure you are up to date on your Pap smears and HPV tests", says the expert. Regular gynecological follow-up makes it possible to identify cancer at the first symptoms and to treat it as effectively as possible.

Vaginal dryness

If your vagina is not sufficiently lubricated, penetration can cause painful friction, which tears vaginal tissue and causes bleeding. Your doctor may suggest different options that are effective for vaginal dryness that include vaginal lubricants, moisturizers, and estrogen, depending on the cause of the dryness. In addition, this drought could be linked to an underlying problem, such as inadequate contraception.

Bleeding after intercourse: when to consult?

Bleeding after intercourse can be more or less profuse and has several origins. "If we did our screening smear on time and we just have a little bleeding from time to time, there is, a priori, nothing to worry about", says Dr Bagot. Repeated bleeding should be reported to his doctor, general practitioner or gynecologist, to find the cause and seek treatment.

Recall : The first smear is recommended by the HAS (Haute Autorité de Santé) at the age of 25, followed by a second a year later. If no abnormalities are found after these two normal smears carried out one year apart, the recommended rate isa smear every three years. After 30 years, the sample is used as the basis for the HPV test (detection of the presence of high-risk papillomavirus DNA in cells), now recommended as first-line treatment, and no longer for cytological examination. The interval between two HPV tests is 5 years.

What treatment?

The management obviously depends on the cause.

• If the post-sex bleeding is due to an infection, the gynecologist will prescribe an appropriate treatment.
• In case of vaginal dryness, a diagnosis is necessary to identify the cause (menopause, hormonal imbalance …). A treatment, using eggs, creams, and lubricant during intercourse, may then be prescribed.
• The polyps and ectropions can be removed by the doctor if they cause bothersome symptoms.