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There are many women who experience vaginal bleeding after sex. This is also known as post-coital bleeding. According to a research study, around 9 per cent of menstruating women will have vaginal bleeding after sex . On the other hand, up to 63 per cent of post-menopausal women will experience vaginal dryness, itching, spotting or bleeding during or after sex due to the hormonal changes that affect the elasticity of vaginal tissues  .
The cervix is the part from where the bleeding occurs. However, women who have attained menopause, the source of bleeding can be from the cervix, uterus, urethra, and labia.
While vaginal bleeding before or after sex might not be of concern, sometimes it could hint a serious problem. Read on.
Causes Of Bleeding After Sex
1. A bacterial or yeast infection
A bacteria or yeast infection in the vagina causes inflammation in the tissues that line the vagina and cervix which ultimately leads to bleeding. Bleeding is a common symptom of bacteria and yeast infection and you can understand when you see the changes in urine colour and vaginal discharge. When the cervix is infected and inflamed, you will spot blood after sex.
It is estimated that three out of four women will experience a bacteria or yeast infection at least once in her lifetime .
2. Cervical polyps
Cervical polyps form in the reproductive tract on the cervix or inside the uterus  . These polyps are benign and their size ranges from a few millimetres to two centimetres and nearly affects 12.6 per cent of women  . These polyps look like small bulbs that hangs down from the cervix into the vagina, where they might get disturbed and start bleeding during sex. These polyps contain many blood vessels which are the reason they bleed, so you would notice blood spotting after intercourse.
3. Vaginal dryness
The most frequent cause of bleeding after sex is vaginal dryness. Vaginal dryness can be caused due to many reasons including the genitourinary syndrome of menopause (GSM), removal of your ovaries, childbirth and breastfeeding, chemotherapy, having sex without getting aroused, douching, and certain medicines like asthma medications, antidepressants, antioestrogen drugs, cold or flu medicines, etc.
4. Sexually transmitted infection
Sexually transmitted infection causes post-sex bleeding as well, especially when the infection has led to an inflammation of the cervix. While having sex, the cervix might get irritated and start bleeding. Sexually transmitted infections include gonorrhoea, chlamydia, and trichomoniasis that causes inflammation which leads to spotting of blood after sex  .
The symptoms of sexually transmitted infections are pelvic pain, itching, and painful urination.
5. Side effects of birth control
If you have been having contraceptive pills, it can also be the cause of spotting during or after intercourse  . Post-coital bleeding can happen in young teenagers or adolescents who have just started taking birth control pills. The blood spots can continue for months whenever you have sex.
6. Rough sex
Having vigorous and rough sex can sometimes cause bleeding too. Rough sex can cause small cuts or scrapes in the vagina. Indulging in sex in deeper positions leads to tearing of the vaginal tissues and these tissues are prone to bleeding. This causes pain while having sex and you should immediately stop it.
7. Cervical cancer
The primary symptom of cervical cancer is bleeding after intercourse  . The tumours vary depending on which type of cancer you have like cervical, vaginal or uterine cancer. These tumours are filled with blood vessels and as these tumours grow, the blood vessels are strained and tend to burst during the friction caused by having sex.
According to the American Pregnancy Association, bleeding post sex is common in the first trimester because a woman's cervix is tender and sensitive during pregnancy. While you are pregnant, if you notice bleeding after sex you should immediately stop as you don't want to risk irritating or damaging the cervix.
9. Cervical ectropion
Cervical ectropion is a condition which causes the glandular cells from the inside of the cervical canal to grow abnormally outside of the cervix. This leads to cervical tissues to cause inflamed blood vessels as a result, post-coital bleeding is common. This non-cancerous condition is common in adolescents, pregnant women and women taking birth control pills .
This condition causes the endometrial tissues lining the uterus to grow outside of the uterine cervix which leads to inflammation in the pelvic region and lower abdomen. When you are having intercourse, there is an added strain and pressure placed on the fragile endometrial tissues, and as a result, you bleed after sex .
The fibroid is a benign overgrowth of the glandular and muscular tissues. The shape of a fibroid can range from as small as a pea or larger than a grapefruit. It causes bleeding during sex when they are all filled within the uterine cavity and contain a lot of blood which gets irritated while you have sex.
It is estimated that around 75 per cent of women will have fibroids in their reproductive age  .
12. Cervical dysplasia
It is a precancerous condition in which the cells grow abnormally on the surface lining of the cervix - the lower part of the uterus that leads to the vagina. As these cells overgrow, it can irritate and damage the surrounding tissues of the cervix, especially during sex.
Bleeding during or after sex should be taken seriously. If you notice it, consult a gynaecologist immediately to understand the cause behind the bleeding. Remember an early diagnosis and treatment can reduce the chances of a much greater risk in the future.
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-  Seval, M. M., Cavkaytar, S., Atak, Z., & Guresci, S. (2013). Postcoital bleeding due to cervical endometriosis.BMJ case reports,2013, bcr2012008209.
-  De Vries, C. J., Wieringa-de Waard, M., Vervoort, C.-L. A., Ankum, W. M., & Bindels, P. J. (2008). Abnormal vaginal bleeding in women of reproductive age: a descriptive study of initial management in general practice. BMC Women’s Health, 8(1).