Bleeding after intercourse around or after menopause

Hormonal changes can leave vaginal and vulval tissues thinner, drier, and easier to injure during penetration. Other causes include a cervical or uterine polyp, infection, skin conditions, pelvic organ prolapse, or changes affecting the cervix or womb lining. An examination is needed to distinguish among them.

During perimenopause, changing hormone patterns can make periods unpredictable, so it may be difficult to tell whether blood came from the vagina, cervix, uterus, urinary tract, or rectum. After periods have stopped, any vaginal bleeding warrants a clinical check rather than being attributed to menopause alone.

Vaginal dryness may cause soreness, burning, or small surface tears with sex. Pelvic organ prolapse can present with a vaginal bulge, pressure, or tissue rubbing that bleeds. Cervical and uterine conditions may cause bleeding without pain, which is why the absence of discomfort does not remove the need for assessment.

Arrange an appointment and note whether the blood appeared during sex, immediately afterwards, or later; whether penetration was painful; and whether there is discharge, odour, itching, pelvic pressure, urinary symptoms, or bleeding at other times. Tell the clinician about medicines, hormone therapy, and any previous cervical screening results.

Until assessed, pause penetration if it triggers pain or bleeding. A water-based lubricant may reduce friction, but it should not replace evaluation. The clinician may inspect the vulva, vagina, and cervix, take swabs, check whether cervical screening is due, or arrange imaging or a closer look at the womb lining.

Seek urgent medical care for heavy bleeding, severe pelvic or abdominal pain, fainting, marked dizziness, breathlessness, fever with worsening pain, or feeling acutely unwell. These features require prompt assessment because blood loss or infection may need immediate treatment.

Contact a healthcare service promptly for any bleeding after periods have stopped, repeated bleeding after intercourse, blood-stained discharge, a new pelvic lump or pressure, or persistent pain with sex. Do not wait for another episode before booking the assessment.

Ask which tissue appears to be bleeding, whether tests of the cervix or womb lining are appropriate, and when results should be expected. If dryness is contributing, ask about moisturisers, lubricants, and whether local hormonal treatment is suitable alongside your health history and current medicines.