What causes postcoital (after sexual intercourse) vaginal bleeding?

From the Guidelines

Postcoital vaginal bleeding is most commonly caused by cervical issues, and if you experience it, especially if it's recurrent or accompanied by other symptoms, you should consult a healthcare provider promptly to rule out serious conditions such as cervical or endometrial cancer. The causes of postcoital vaginal bleeding can be varied, including:

• Cervical ectropion, cervical polyps, or cervical inflammation, which can lead to bleeding after intercourse due to the fragility of these tissues 1
• Infections such as chlamydia, gonorrhea, or bacterial vaginosis, which may cause inflammation and bleeding
• Vaginal dryness, often related to hormonal changes during menopause, breastfeeding, or certain medications, can lead to small tears during intercourse
• Trauma from rough intercourse or inadequate lubrication can also cause bleeding
• More serious causes include cervical or endometrial cancer, although these are less common

If you experience postcoital bleeding, your healthcare provider will likely perform a pelvic examination, possibly take swabs for infection testing, and may recommend a Pap smear or colposcopy to examine the cervix more closely 1. While occasional light bleeding might not be concerning, persistent bleeding requires medical evaluation to rule out serious conditions. It's essential to consult a healthcare provider promptly to determine the cause of the bleeding and receive appropriate treatment.

From the Research

Causes of Postcoital Vaginal Bleeding

• Postcoital bleeding refers to spotting or bleeding that occurs after intercourse and is not related to menstruation 2.
• The causes of postcoital bleeding can be benign, such as cervicitis or cervical polyps, but can also be a sign of a more serious condition like cervical cancer 2, 3, 4.
• Studies have shown that women with postcoital bleeding are at a higher risk of cervical dysplasia and cancer, especially if they have a history of abnormal PAP smears or are nulliparous 3, 5.
• Other factors that may increase the risk of postcoital bleeding include smoking, advancing age, and certain comorbidities such as cervical erosion, ectropion, and vaginitis 5, 6.

Common Causes of Postcoital Bleeding

• Cervicitis: an inflammation of the cervix that can cause bleeding after intercourse 2, 3.
• Cervical polyps: growths on the cervix that can cause bleeding after intercourse 2, 3.
• Cervical dysplasia: abnormal cell growth on the cervix that can cause bleeding after intercourse 3, 5.
• Cervical cancer: a type of cancer that can cause bleeding after intercourse 2, 3, 4, 5.
• Vaginitis: an inflammation of the vagina that can cause bleeding after intercourse 6.
• Vulvovaginitis: an inflammation of the vulva and vagina that can cause bleeding after intercourse 6.

Risk Factors for Postcoital Bleeding

• Age: advancing age can increase the risk of postcoital bleeding, especially for cervical cancer 4, 5.
• Smoking: smoking can increase the risk of postcoital bleeding, especially for cervical dysplasia and cancer 5.
• Abnormal PAP smears: a history of abnormal PAP smears can increase the risk of postcoital bleeding, especially for cervical dysplasia and cancer 3, 5.
• Nulliparity: women who have never given birth may be at a higher risk of postcoital bleeding, especially for cervical dysplasia and cancer 3.
• Certain comorbidities: such as cervical erosion, ectropion, and vaginitis can increase the risk of postcoital bleeding 6.