What should you know about severe bleeding after sex?

Bleeding after sex can come from friction, dryness, a small vaginal or cervical injury, inflammation, infection or changes on the cervix. It can also occur with cervical dysplasia or conditions related to menopause, such as [Genitourinary Syndrome of Menopause](/conditions/genitourinary-syndrome-of-menopause/). Less commonly, bleeding is a presentation of [Cervical Cancer](/conditions/cervical-cancer/) or [Vaginal Cancer](/conditions/vaginal-cancer/). The symptom does not establish the cause, so examination is needed.

Stop sex and note the amount, colour and duration of bleeding, along with pain, discharge, fever, missed periods and medicines that affect clotting. Arrange a prompt gynaecology or primary-care appointment, even if the bleeding settles when it is severe, repeated or unexplained. The assessment may include a pregnancy test, examination, infection testing, cervical screening review or imaging. Do not use tampons or resume penetration while bleeding heavily.

Seek urgent care for bleeding that is heavy or ongoing, faintness, dizziness, shortness of breath, severe pelvic pain, fever, shoulder-tip pain or possible pregnancy. These warning signs can indicate significant blood loss, infection or a pregnancy-related emergency. Contact a clinician promptly for any bleeding after sex after menopause.

Ask whether the bleeding could be related to dryness, infection such as [Chlamydia](/conditions/chlamydia/) or a cervical change, and whether you need further tests. If a cervical area needs closer assessment, ask what a [Cone Biopsy](/treatments/gynaecological-surgery/cone-biopsy/) involves and why it is being considered.