How dangerous is bleeding after sex? reviews the common causes of postcoital bleeding (PCB), prevention, and treatment options for women who have identifiable sources for their bleeding.
The incident of postcoital bleeding refers to spotting or bleeding that occurs after intercourse and is not related to your menstruation.
Postcoital bleeding has been reported to be around 5-6 %. Women with HIV had incidences ranging from 5-32%, and women with pelvic prolapse had a 3% incidence. Among menstruating women, postcoital bleeding is from 0.7 to 9.0%.
Causes Of Bleeding After Sex
So how dangerous is bleeding after sex?
The most serious cause of postcoital bleeding is cervical cancer. Cervical cancer is the second most common cancer in women throughout the world. About 11% of women with cervical cancer complain about postcoital bleeding. Whereas annual global death estimates in the year 2000 were 233,400 deaths and 470,600 cases.
The most important risk factor for cervical cancer includes women who have been infected with a high-risk strain of the human papillomavirus (HPV). However, the good news is that the level of women with postcoital bleeding from cervical cancer has significantly decreased due to improved screening.
A polyp coming from the cervical canal may bleed only when the cervix is touched. This could include sex toys, fingers, or a penis. Cervical polyps account for up to 12.5% of bleeding after sex. Fortunately, most cervical polyps can be easily seen during a speculum exam. This makes it easier for the gynecologist to remove it during the exam.
Vaginal cancer is another gynecologic malignancy for which postcoital bleeding may be a symptom. Many women with vaginal cancer are asymptomatic. However, most women report postcoital spotting and unusual vaginal discharge.
Endometrial polyps or uterine fibroids are tiny noncancerous growths. They grow on the lining of the cervix or uterus, particularly in menstruating people. These polyps can cause pain and bleeding.
Vaginal dryness is a common cause of postcoital bleeding. When the skin is dry it becomes extremely vulnerable to damage. Mucus-producing tissues, such as those in the vagina, become vulnerable.
Pregnancy, childbirth, and breastfeeding cause major hormonal changes which can make your vaginal tissues prone to damage. Hence, minor bleeding during or after intercourse is common. Though, in cases when the bleeding is heavy, continuous, and into late pregnancy, talk with your doctor. Since it is possible this can be a sign of preterm labour.
If you are a postmenopausal woman not using any form of estrogen, you may have postcoital bleeding. In this scenario, your vaginal tissues can become very thin and easily distressed – even with the use of lubricants. This type of postcoital bleeding is identified with spotting, pain with intercourse, and a sensation of vaginal dryness.
An infection of the cervix makes it easier for your cervix to bleed. For instance, gonorrhea and chlamydia can produce bleeding from the cervix. Then again while bacterial vaginosis was classified as a significant finding in 5% or 6% of women with postcoital bleeding, it is not identified as a cause for vaginal bleeding.
Furthermore, gonorrhea and chlamydia that infect the cervix can also infect the lining of the uterus. This can cause irregular bleeding as well as bleeding after sex.
Spotting and bleeding are common side effects of hormonal forms of birth control. Also, if you have a history of missed periods, your uterine lining may be thickened. In that instance, spotting after sex can be due to some lining shedding off. Unfortunately, a thickened uterine lining provides a setting for precancerous cells.
When You Need To See A Doctor
Talk with your doctor any time postcoital bleeding is severe, frequent, or continues for more than a few hours after intercourse. Or includes the following:
- vaginal burning or itching
- unusual discharge
- intense abdominal pain
- nausea, vomiting, or lack of appetite
- stinging when urinating or during intercourse
- lower back pain
- strange tiredness and weakness
- headaches or lightheadedness
- bladder or bowel symptoms
In many cases, there is no single clear cause of postcoital bleeding, so there is no direct course of treatment.
Cancer should be evaluated and treated
Patients who are found to have genital tract cancer such as vaginal or cervical cancer should be referred to a gynecologic oncologist for further evaluation and treatment.
Surgical removal of polyps
Clinicians should consider the removal of symptomatic polyps or when there are concerns for malignancy. All polyps that are removed should be evaluated for malignancy. Furthermore, if you have a concern for endometrial polyps, then you will be referred to operative hysteroscopy with possible dilation and curettage.
Vaginal moisturisers and lubricants
Postcoital bleeding linked to vaginal dryness may first be treated with vaginal moisturisers and lubricants which can be used prior to and during intercourse. Although these methods may assist with reducing discomfort during intercourse, they do not have any direct effect on improving atrophic changes.
If you continue to experience postcoital bleeding despite lubricants, you may require vaginal estrogen therapy. Estrogen therapy is one of the most effective treatment options for vaginal atrophy. This is because it thickens the vaginal epithelium and decreases dryness.
Low-dose vaginal estrogen therapy should be the first-line treatment for postmenopausal women with only vaginal complaints as it is more effective and also prevents possible side effects of systemic treatment.
Special considerations should be made with the use of estrogen therapy for women who have breast cancer and/or cardiovascular disease.
Infection treatment options
If you find any evidence of genital tract infection, you should be treated immediately to prevent long-term effects. Treatment options should be based on laboratory and microscopy findings.
You can prevent bleeding after sex by staying hydrated. In addition, certain actions can reduce immensely the severity and frequency of your bleeding. It may also be beneficial to consume foods rich in plant estrogens or phytoestrogens, such as flax, lentils, oats, walnuts, olive oil, apples, grapes, carrots, seeds, and alfalfa.
In the final analysis, how dangerous is bleeding after sex? This can be summarised in two ways. First, bleeding after sex is an annoying complaint from patients. Second, it is a worrisome symptom for health providers due to the risk of underlying malignancy. There is also the issue of diversity among gynecologists in the treatment of postcoital bleeding.
While most women with postcoital bleeding do not have an underlying malignancy. Nonetheless, health care providers must pay close attention to ensure that appropriate screening tests are up-to-date.
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