Dr. Kate,

I am 28 and have been dating my boyfriend for over a year and at least once a month, I bleed after sex. Sometimes it is a little bit and sometimes it is a lot and I need to wear a tampon afterward. I have been to my gyno twice telling her how nervous I am, and she says that everything looks normal. I am realizing that it usually happens when I am on top. Any advice?

--Wanting Cuddles Not Kotex


Dear WCNK,

Nothing kills a post-sex high like bleeding in the bathroom (or in bed). I don't worry when a patient has one episode of post-coital bleeding, but you've been bleeding like this for quite a while. There are multiple reasons why we may bleed after the deed:
  • Infections. Chlamydia, gonorrhea, trich, even a wicked yeast infection can cause enough inflammation in your cervix or vagina to cause bleeding. Your gyno can test you for all of these with a pelvic exam.
  • Trauma. Small scratches or lacerations can be caused with really vigorous sex, especially with toys, fingernails, or not enough lube. Try to see your gyno the day after a bleeding episode for her to rule this out.
  • Polyps. These are fleshy overgrowths in your cervix or uterus--think skin tags the size of a golf pencil--that can cause irregular bleeding. Your gyno can often pick these up on an ultrasound.
  • Hormonal imbalance. Abnormalities of your thyroid or prolactin hormone can cause irregular bleeding, and can be checked by a blood test.
  • Cervical dysplasia. It's unusual, but post-coital bleeding can point to pap smear abnormalities--make sure your pap is up to date.
  • Fibroids and endometriosis. Also unusual. These are usually present with other symptoms, too, that your gyno will pick up in your history.
  • Period jump-start. If you're seeing bleeding in the days before your period starts, it may be the first signs of menses (sex can "shake loose" the first drops). Similarly, if it's in the day or so after your period ends, it may be the leftover blood that you see.

If your gyno has ruled all of these out, your bleeding may remain a mystery for now...but try not to worry. If none of these causes show up, your gyn health is clearly excellent, and something to celebrate.

Have any of you had bleeding after sex?



4 Comments

Cancer Free said:

Yup. I did, for about 4 months before I got worried enough to go to the Dr. It started with a pap, then a colposcopy, then a leep and finally a hysterectomy where the dysplasia wasn't the worst but the tumour in my uterus was.

Wow. And the only clue I had was the after sex bleeding.

said:

I bleed after sex, almost every time, but it doesn't start until about 18 hours post-sex. My gyno said it was cervical irritation -- she put a solution on it (which itself made it bleed) and it got better for a while, but then started up again. I was tested for everything, and nothing showed up - she also said something about blood vessels very close to the front of my cervix. I've pretty much given up on making it stop, at this point ...

Elise said:

Not really bleeding per se, but, well...

I had a really small vaginal opening. I broke my hymen in gymnastics at eight years old, but I still had trouble with large tampons.

Then I married a guy whose penis is bigger around than my wrist. Seriously, he's huge. Within the first month of our having sex regularly, I started tearing around the opening-- radial fissures in the skin that re-opened with each bout of sex. There are about seven of them, and they still re-open regularly.

We use tons of lube, and.. well.. you don't abstain from sexual intercourse during a two-year relationship without knowing your way around foreplay. Still, every time we do it, I dread the initial pain of penetration, which is a major drag on our otherwise awesome sex life.

I talked to a gyno about it, and she said that I just had 'minor irritation and lacerations' from rough sex, and that I should probably use more lube. Since we're going through a good-sized bottle a month, I doubt that's the problem. Does this kind of thing ever heal, or am I just going to have to get used to the sting?

Dr. Kate said:

Elise, you certainly sound like you're doing the right thing in terms of foreplay and lubricant. So I think that something else may be going on with your vulva - the fissures you're describing aren't normal, especially in light of plenty of lubricant. (The vulva/vagina can stretch to fit a baby, so they should be able to accommodate your guy no matter how large he is.)

I'm concerned that you may have a skin condition that's causing you to tear. The only way to know for sure, unfortunately, is a skin biopsy. But if you do have something going on, treatment will make you feel much better. If your gyno doesn't take your concerns seriously, think about seeing another one.

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Em & Lo, more formally known as Emma Taylor and Lorelei Sharkey, are the self-proclaimed Emily Posts of the modern bedroom.

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