Painless bleeding after sex with an IUD

An IUD does not prevent every non-pregnancy cause of postcoital bleeding. New, unexplained, or recurring episodes should be checked rather than attributed to the device automatically.

An IUD can alter menstrual bleeding, particularly after insertion, but bleeding triggered by sex may arise from the cervix or vaginal wall instead of the uterus. Dryness, friction, cervical inflammation, a polyp, or chlamydia are possible explanations. Genitourinary syndrome of menopause may make vaginal tissue fragile even when an IUD remains in place.

A displaced or partly expelled IUD can cause unexpected bleeding, although some people have no pain. Cervical dysplasia, cervical cancer, and vaginal cancer can also present with postcoital bleeding; the symptom alone cannot show which cause is present.

If you were taught to check the IUD threads, notice whether they feel different from usual, but do not pull them or try to reposition the device. Use backup contraception and seek advice if the threads cannot be felt, seem much longer or shorter, or you can feel hard plastic. Follow the specific instructions given for your IUD.

Arrange an appointment to review the bleeding. The clinician may check the cervix, test for infection and pregnancy, and assess IUD position with an examination or ultrasound. Bring the insertion date, IUD type if known, bleeding pattern, and cervical screening history.

Get urgent medical help for heavy bleeding, fainting, severe dizziness, severe or one-sided abdominal pain, shoulder-tip pain, or a positive pregnancy test. Pregnancy with an IUD in place requires prompt assessment to locate the pregnancy.

Request prompt clinical advice for fever, unpleasant-smelling discharge, pain that develops, inability to feel previously detectable threads, or a device that seems to be coming out. Bleeding after menopause should also be assessed without delay.

Ask whether the IUD is correctly positioned, whether you need temporary backup contraception, and whether pregnancy or infection testing is appropriate. Also clarify whether cervical screening is due and what symptom changes should trigger emergency assessment.