What should you know about menstrual bleeding after sex?

Bleeding after sex may come from friction, dryness, a small tear, inflammation, infection, or a sensitive area on the cervix. Chlamydia and other infections can cause bleeding, sometimes with discharge, pelvic pain, or pain when urinating. Changes in cervical cells, including cervical dysplasia, can also present with bleeding after sex; cervical or vaginal cancer is less common but needs consideration when symptoms persist or other warning signs occur.

The timing matters. Bleeding during a period can be difficult to distinguish from bleeding caused by sex, while bleeding after menopause needs specific assessment. Pregnancy is another reason to seek advice about unexpected bleeding and pelvic pain.

Make a note of when the bleeding happened, its amount and colour, whether sex was painful, and any discharge, odour, fever, pelvic pain, or urinary symptoms. Arrange a clinician review if it happens again, continues, follows sex regularly, or has no clear explanation. The assessment may include a pelvic examination, infection testing, pregnancy testing, or cervical screening according to your circumstances.

Until you are assessed, use gentle lubrication if dryness contributes, avoid sex that causes pain or bleeding, and do not douche. If an infection is possible, avoid sex or use barrier protection until you have received advice and any recommended treatment.

Seek urgent help for heavy bleeding, severe pelvic or abdominal pain, faintness, shoulder-tip pain, fever, or feeling very unwell, especially if pregnancy is possible. Prompt assessment is also needed for bleeding after menopause or bleeding accompanied by persistent unusual discharge or pain.

Ask whether you need infection or pregnancy tests, an examination of the cervix and vagina, or further investigation. Tell the clinician about contraception, medicines, pregnancy possibility, cervical screening history, and whether a partner has symptoms.