You are in the throes of amazing, passionate and exciting sex all leading up to a simultaneous orgasm! Well that is how the story is meant to go down and then it happens…your partner pulls out of your vagina and you both look at each other in complete horror when you see blood all over the sheets. It may be reassuring to know spotting or bleeding after sex is common and can come from the vagina, cervix or urinary tract.  It occurs most commonly in women 20-40years old.

Common Causes of Spotting after Sex

• Cervical Cancer-A very rare cause of spotting.Yearly pap smears will ensure this is not the cause.
• Cervical “Ectropion”-Also known as cervical eversion, is a normal physiological change of the cervix causing inflammation on the surface of the cervix.
• Cervical Polyps-Benign cervical polyps commonly occur in women over 20 years old.
• Menstrual Bleeding-An early or unexpected period can happen due to environmental or hormonal causes.
• Pregnancy
• Sexually Transmitted Infections (STI’s)-Chlamydia and gonorrhea cause vaginal bleeding after sex.
• Trauma to the Vagina or Cervix-A larger or thicker penis and a smaller vaginal opening can create lacerations in the vagina.  Cervical bleeding can also occur with deeper penetration.
• Vaginal Atrophy-Another form of vaginal dryness occurring in menopausal women who are not taking hormone replacement therapy causing dry, thin and fragile vaginal tissue.
• Vaginal Dryness-Often caused by inadequate foreplay or vaginal lubrication.
• Vaginitis-Yeast and Gardnerella infections create inflammation and swelling in the vagina and cervix.

Tests to Be Done

Taking a proper history, performing a pelvic exam, Pap smear, vaginal cultures to rule out STI’s and vaginal infections and a pregnancy test will help determine the majority of causes of bleeding or spotting after sex.

Once the cause is identified, treatment can be determined. Bleeding or spotting after sex is terrifying.  It’s most likely nothing to worry about but seeing your health care provider is recommended just to make sure everything checks out ok.