Ask Dr. Dweck: “My vagina always bleeds after intercourse or an exam from a doctor and I’m not really sure why or if that’s normal…I feel awkward bringing it up with my doctor.”

First things first; when it comes to talking to your gynecologist, there is no such thing as awkward! We gynos are a thick skinned, tolerant, and non-judgmental group. And we are all too accustomed to dealing with everything gyno—from sensitive and sexy subjects to the seemingly totally taboo. We are here to help and reassure.  

So now that we have that out of the way….

Bleeding after intercourse or even after a genital exam is, in many cases, nothing serious but surely deserves a look-see, especially if it happens over and over again. Consensual rough sex or an overly aggressive exam are obvious and preventable causes, but all too often women experience abnormal bleeding without these inciting factors and are rightfully concerned. So what gives in this situation?

You have likely heard of the hymen, a thin piece of tissue that partially covers the vaginal opening. Most of us are born with a hymen. During your sexual debut, it’s possible to have bleeding when this tissue is stretched and in some cases torn. Blood is usually bright red and scant, but can cause minor panic nonetheless. The good news is that the hymen only breaks once. It goes without saying, if very heavy or prolonged bleeding occurs or significant pain is present, a visit to the gyno is in order.

A genital infection can cause bleeding after intercourse or with a genital exam. The usual suspects include STIs like gonorrhea, chlamydia, and trichomonas. In some cases, yeast and bacterial vaginosis (BV) can also be culprits. Infection causes irritation and inflammation of the vaginal and cervical tissues, causing them to be delicate, easily traumatized, and even bleed with just gentle manipulation. A physical exam and cultures can diagnose infections, most of which are easily treatable.

HPV (human papilloma virus) can cause pre-cancer and in some cases invasive cancer of the cervix, the opening to the uterus.  This in turn leads to a delicate and friable cervix that, when touched during intercourse or a gynecologic exam, can bleed. In the case of bleeding after sex, your doctor will likely conduct a pap smear (a swab sampling the cells of the cervix). A pap smear screens for cervix pre-cancer and cancer.

Many women will experience bleeding after sex or a digital exam during pregnancy, especially in the first trimester when the cervix and vagina have a super rich blood supply. This can be especially frightening. While any bleeding during pregnancy requires medical evaluation, this is in fact somewhat common.

Vaginal dryness is not reserved for older women.  Dryness is an incredibly common cause of bleeding with intercourse or even following a gentle exam. Dryness is often due to low estrogen levels, which can occur during nursing, from using certain medications(e.g. the pill or antihistamines), or as a result of perimenopause or menopause. A little lube goes a long way in this case. From time to time, your doctor may recommend a vaginal estrogen supplement.

The moral of the story here is clear. Unexplained bleeding after sex or an exam can be startling, but is likely easily explained and treatable.  Speak to your gyno; he or she has most likely heard it before.

Featured image by Lucaxx Freire

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