Too much bleeding after sex: what to know

Bleeding after sex, also called postcoital bleeding, can happen when vaginal or cervical tissue is irritated or inflamed. Dryness, a small tear, infection such as chlamydia, or changes linked with menopause can contribute. Cervical dysplasia and cervical cancer can also present with bleeding after sex, so persistent or unexplained bleeding should not be self-diagnosed. Vaginal cancer is uncommon but is another condition a clinician may consider when symptoms warrant examination.

Assessment may include questions about timing, amount, pain, discharge, contraception, pregnancy possibility and menstrual history. Depending on your age and screening history, examination, swabs or cervical testing may be recommended. A cone biopsy is a procedure used in selected situations to remove and examine an area of abnormal cervical tissue; it is not the first step for every episode of bleeding.

Arrange an appointment if the bleeding happens again, follows sex repeatedly, occurs after menopause or comes with pelvic pain or unusual discharge. Note when it started, whether it followed penetration, how long it lasted and any medicines or contraception you use. Avoid sex until severe pain or active heavy bleeding has been assessed, and ask about testing for infections if there is a new partner or discharge.

Seek urgent help for heavy or rapidly worsening bleeding, dizziness, faintness, severe pelvic or abdominal pain, fever, or possible pregnancy with pain or bleeding. Emergency assessment is especially important if you feel weak or short of breath. Do not wait for a routine screening appointment when these warning signs are present.

What could explain this bleeding in my situation? Do I need an examination, swabs or cervical testing? Am I up to date with screening? Could dryness, menopause or an infection be contributing? What symptoms mean I should attend urgent care? If an abnormal area is found, what would the next test be?