Bleeding during and after Sex: Causes, what’s normal & how to prevent it
Iona Nelson
Dr. Danielle Perro
Follows NC° Editorial Policy
At Natural Cycles, our mission is to empower you with the knowledge you need to take charge of your health. At Cycle Matters, we create fact-checked, expert-written content that tackles these topics in a compassionate and accessible way. Read more...
Key takeaways:
- Bleeding during or after sex can have several causes, including hormonal changes, injury, or infections
- While not always serious, it is essential to understand the cause of your bleeding
- Seek medical advice for unexplained bleeding, whether that’s after sex or otherwise
Noticing blood on your sheets, yourself, or your partner during or after sex can be a worrisome experience, and there are several reasons this may be happening. This article will explain why you might experience bleeding during sex (and after), some tips to prevent it, and when to seek medical advice.
Why am I bleeding during sex?
Bleeding during sex can feel like an isolating experience, but it is more common than you might think. Up to 9% of menstruating women experience post-sex bleeding [1], and up to 63% of post-menopause women [2]. Sometimes bleeding during sex can be accompanied by pain, and other times, there is no pain at all.
Whilst it may be somewhat common, it is crucial to understand why bleeding during sex happens. A one-off experience may be down to a lack of arousal or lubrication, and can often be nothing to worry about. But regular or heavy bleeding after sex may be caused by an infection or medical condition that requires further investigation.
What causes bleeding during sex?
Vaginal dryness and insufficient lubrication
Lubrication is key to healthy sex; the lack of which can cause irritation, itching, and bleeding [3]. Your vagina produces arousal fluid via the two pea-sized glands, called the Bartholin Glands, when you are sexually aroused [4]. This arousal fluid is one type of vaginal wetness, or discharge, and it acts as a natural lubricant.
Many factors influence the amount of arousal fluid you produce. You may be experiencing low libido or not feel in the mood for sex for a variety of reasons, such as stress or relationship problems. Even if you are in the mood for sex, you may not have experienced enough foreplay to allow your body to produce its arousal fluid before penetrative sex.
Low estrogen levels can also cause vaginal dryness. Low estrogen can be caused by pregnancy, menopause, and breastfeeding (more on this below), or by external medications such as cancer treatments [5, 6]. Similarly, your estrogen levels change throughout your menstrual cycle, and therefore vaginal dryness can vary depending on which stage of your cycle you are in [7].
Trauma or injury
Vaginal injury can be a difficult subject to think about, but one that is important to acknowledge. Around 80% of vaginal injuries occur due to sex, whether consensual or not [8]. Rough or enthusiastic sex can cause tears that lead to bleeding. This extends to all types of sex and foreplay, too. Clear communication with your partner and adequate lubrication can help reduce the risk of injury.
A word on consentIt is important to note that physical arousal does not equal consent. Verbal, explicit consent is the most critical factor when determining if you (and your partner) are ready for a sexual encounter. |
Remember that even if you have given consent to begin with, you can change your mind at any time. If you have experienced non-consensual sex and would like someone to speak to, the RAINN hotline is a free, confidential hotline open 24 hours per day. If you are based in the UK, you can contact Rape Crisis England and Wales or Rape Crisis Scotland.
Sexually Transmitted Infections
Bleeding during sex with no pain can sometimes indicate the presence of a sexually transmitted infection (STI). A symptom of chlamydia, for example, is bleeding after sex (no pain) or bleeding between periods [9]. Other symptoms of an STI (or other vaginal infection) include unusual discharge, a rash, sores, and pain when urinating. If you believe you may have an STI, book an appointment with your doctor or sexual health clinic.
Menopause
During menopause and perimenopause, several physical changes occur to the vagina, vulva, and urinary tract, called the Genitourinary Syndrome of Menopause (GSM). Two of the symptoms of GSM are bleeding after sex and spotting during sex. Additional symptoms of GSM include vaginal dryness and decreased lubrication that, as we mentioned above, can also contribute to bleeding during sex [2].
GSM symptoms are a result of the reduction in estrogen in menopause. The vagina, vulva, and surrounding area have estrogen receptors. The lack of estrogen reaching these receptors causes tissue changes in the vaginal region, which can lead to these uncomfortable symptoms. [2]
Pregnancy and postpartum
If you are pregnant, bleeding during or after sex can be a troubling experience. While it is a relatively common experience and can be caused by cervical changes during pregnancy, it may also indicate a more serious problem [10]. It is essential to consult your healthcare provider or midwife to rule out any potential complications with your pregnancy right away.
For those who are postpartum and breastfeeding, high levels of prolactin – the hormone responsible for the production of breast milk – lead to reduced levels of LH and FSH, the primary hormones for inducing menstruation [11]. In those who have high prolactin levels, this may cause a decrease in estrogen levels and vaginal dryness, which in turn can cause bleeding during sex [12].
Your body may also still be healing after giving birth, especially if you have had a perineal tear [13]. Whilst some healthcare providers recommend waiting 6 weeks before having sex after pregnancy, it is a very personal decision. You may feel ready sooner than this or might prefer to wait longer. Be sure to communicate with your partner if it feels too soon to have sex or if you’re finding sex uncomfortable or painful during this time. You can also request a checkup with your healthcare practitioner to make sure any tears have fully healed before commencing sex again.
Bleeding during sex and endometriosis
Endometriosis is a chronic inflammatory condition that affects around 1 in every 10 women of reproductive age [14]. It is diagnosed when tissue similar to the uterus lining grows outside of the uterus. These extra growths can cause abnormal bleeding between periods, as well as heavier menstrual bleeding. Other symptoms include fertility difficulties, pain when urinating or with bowel movements, and pain during sex, also known as dyspareunia [15]. Talk to your healthcare provider if you experience any of these symptoms or think endometriosis may be the cause of unexplained bleeding.
Other medical conditions
Vaginal bleeding, particularly if it is recurring, may indicate a medical condition that needs to be investigated. Some conditions, such as vaginitis, carry symptoms of irregular bleeding but are easily treatable [16]. Other conditions that cause bleeding during or after sex may be more serious, such as pelvic inflammatory disease (PID) or, in some cases, cancer. While this topic can feel daunting, the first step is to seek medical advice. Your doctor will guide you through diagnosis and treatment options.
Is bleeding after sex with no pain serious?
The occasional light bleeding after sex, with no pain, may not be serious. For example, you may be experiencing spotting if your period is due soon. However, it is crucial to track your symptoms and seek help if bleeding during or after sex is unexplained.
When to see a doctor
Though it is common, always reach out to your healthcare provider or sexual health clinic if you have any concerns or questions surrounding bleeding during sex, especially if you:
- Regularly bleed during or after sex
- Have heavy bleeding during or after sex
- Experience pain alongside bleeding
- Have recently had unprotected sex or suspect you may have an STI
- Are pregnant or post-partum
How to prevent bleeding during sex
Preventing bleeding during sex depends on what is causing your bleeding in the first place. Sufficient lubrication may help you avoid friction and irritation that can lead to bleeding. Communication regarding your wants and needs during sex can help with sexual arousal, as well as plenty of foreplay.
In some cases, you may prefer to use additional lubrication. If you are trying to conceive, consider using a fertility-safe lubricant [17]. For those using condoms, avoid oil-based lubricants as they can deteriorate the condom and increase your risk of an unwanted pregnancy or STI. Instead, opt for water or silicone-based lubricants, which are more compatible with condoms [18].
Speaking of condoms, practising safe sex can reduce your likelihood of getting an STI or other vaginal infection that can cause bleeding during sex. If you have any concerns about your sexual health, speak with your doctor about booking a sexual health checkup.
If you are bleeding during sex, are going through perimenopause, or are postmenopausal, you may wish to speak to your doctor about potential treatments, which may include lubricants or a topical estrogen cream, amongst others. Similarly, if you believe you have endometriosis, talk to your doctor or a support group about help with managing your condition.
Track bleeding and know your body better with NC°
Tracking your symptoms can help you feel in control of your sexual health and wellbeing. Natural Cycles is the first FDA-cleared birth control app, offering a non-hormonal, non-invasive way to prevent pregnancy. Designed to support your wider reproductive journey, you can also use Natural Cycles to plan, follow, and recover from pregnancy. Our newest app experience, NC° Perimenopause, decodes the hormonal shifts of this transition, helping you navigate the next phase. Click “get started” to learn how Natural Cycles can support you.
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