IUD and bleeding after intercourse: what to know

Bleeding after intercourse with an IUD can result from cervical irritation, hormonal spotting, infection, or another gynaecological cause and should be assessed if it persists or is accompanied by pain. An IUD does not make every episode of post-coital bleeding expected. A clinician can check the cervix, test for infection when appropriate, and confirm that the device is in the correct position.

Light spotting can occur after a hormonal IUD is fitted while the uterus adapts to the device and its hormone. Friction during sex may also irritate the cervix or vaginal tissue, particularly when there is dryness. Bleeding can instead reflect an infection, cervical inflammation, a cervical polyp, or a condition affecting the uterus. Bleeding after sex is a symptom, not a diagnosis; it does not by itself show that the IUD has moved or that you have a serious condition.

If bleeding is new after a period without symptoms, follows a difficult insertion, or happens with pelvic pain, unusual discharge, fever, or pain during sex, arrange a medical review. A missed period or pregnancy symptoms also warrant prompt advice because pregnancy with an IUD needs assessment.

Note when the bleeding occurs, how long it lasts, whether it follows penetration, and whether you have cramps, discharge, or pain. Use a pad if you need to observe the amount; avoid inserting anything into the vagina until bleeding or discomfort settles. Do not pull or reposition the IUD strings. If you can no longer feel the strings, they feel markedly different, or you feel hard plastic at the cervix, use backup contraception and contact a clinician.

A clinician may ask about the IUD type and insertion date, examine the vagina and cervix, and offer pregnancy or infection testing. If the bleeding is recurrent, they may consider other causes such as uterine fibroids, endometriosis, or changes around perimenopause.

Seek urgent medical care for heavy or rapidly increasing bleeding, severe or one-sided pelvic pain, faintness, shoulder-tip pain, fever, or feeling very unwell. Seek prompt assessment for bleeding with a positive pregnancy test, because an ectopic pregnancy must be excluded. Contact a clinician soon if post-coital bleeding keeps returning, occurs after menopause, or is accompanied by a foul-smelling discharge or pain during sex.

Ask: Could the bleeding be from the cervix, an infection, dryness, or the IUD position? Do I need a pregnancy test, infection tests, or a cervical examination? Should I use backup contraception while the strings or position are checked? What symptoms should make me seek urgent care?