Bleeding after sex (postcoital bleeding)

Why do I have bleeding after sex?

Bleeding after sex, or post-coital bleeding (PCB) can be fairly common, but should be checked out by a gynaecologist as it may be a sign of something wrong. Some causes include:

• Cervical polyps or ectropion
  Cervical polyps are small growths that can occur on the cervix. Majority are non-cancerous and can be removed in the clinic. Ectropion is where cells that line the inside of the cervix grow on the outside – these are more sensitive and can bleed on contact.

• Infections
  These can range from vaginal infections to sexually transmitted infections (STIs) causing pelvic inflammatory disease (PID) to genital warts.

• Pelvic organ prolapse
  This refers to a drooping of the uterus, bladder or rectum beyond the vagina, and is more common in older women with previous childbirth.

• Friction during sex
  Lack of foreplay, rough sex or sex toys can result in insufficient vaginal lubrication.

• Pregnancy changes
  During pregnancy, there is increased blood supply to the cervix and bleeding can occur more easily after sex.

• Vaginal atrophy
  Women who have menopaused have low estrogen which causes thin and dry vaginal skin that cracks easily.

• Cervical cancer
  This is rare, but is usually associated with a lack of cervical screening.

What tests do I need?

Your gynaecologist will take a detailed medical history and perform a pelvic examination to check your cervix and uterus. Depending on your symptoms, you may require an ultrasound scan, vaginal swabs, Pap smear/HPV test, biopsy of the womb lining or blood tests.

How to treat bleeding after sex?

This depends on what the cause is. You should speak to your gynaecologist about the treatment options suitable for your condition. These may include:

• Removal of cervical polyps
• Antibiotics: for infection
• Pelvic floor exercises, vaginal ring pessaries, surgery: for pelvic organ prolapse
• Sex lubricants
• Hormonal vaginal creams or tablets: topical vaginal estrogens for vaginal atrophy