Bright red bleeding after sex: causes and next steps

Possible explanations include friction or dryness, inflammation, a cervical ectropion, a cervical polyp, or an infection such as chlamydia. Less commonly, cervical or vaginal cell changes can present with bleeding after sex, so the colour alone cannot identify the cause.

Bleeding linked to dryness may occur with soreness or pain during penetration, particularly around menopause, after childbirth, or during breastfeeding. An infection may also cause unusual discharge, pelvic discomfort, pain when passing urine, or bleeding between periods, although it can cause no other symptoms.

Cervical dysplasia and cervical cancer can present with bleeding after sex, but this symptom has many non-cancerous causes. Vaginal cancer can also present with unexpected bleeding, particularly after menopause. An examination is needed to distinguish these possibilities without reversing the relationship between a symptom and a diagnosis.

Arrange an appointment with a gynaecologist, primary-care clinician, or sexual health clinic even if the bleeding stops. Note whether it followed pain, dryness, a new partner, discharge, a missed period, or bleeding at other times. Mention pregnancy possibility, medicines, contraception, and when cervical screening was last completed.

Assessment may include a pregnancy test, infection testing, and an examination of the vagina and cervix. Depending on the findings, the clinician may recommend cervical screening if due, colposcopy, ultrasound, or another targeted test. Avoid vaginal douching because it can irritate tissue and interfere with the normal vaginal environment.

Get urgent medical help if you have missed a period or could be pregnant and bleeding occurs with lower abdominal or pelvic pain; an ectopic pregnancy must be excluded. Emergency assessment is also needed for heavy ongoing bleeding, severe pain, fainting, marked dizziness, weakness, shoulder-tip pain, or difficulty staying awake.

Any bleeding after menopause should be assessed promptly, even if it happens once or is only a small amount. Fever, worsening pelvic pain, or foul-smelling discharge warrants timely review because these features may accompany infection.

Ask whether the bleeding appears to come from the vaginal wall or cervix, which infection tests are appropriate, and whether your cervix needs closer examination. If a visible change is found, ask what it is, whether a biopsy is needed, how results will be communicated, and what symptoms should bring you back sooner.