Post-Coital Bleeding

Post-coital bleeding refers to vaginal bleeding that occurs after sexual intercourse. It can range from light spotting to heavier bleeding and may happen occasionally or repeatedly. While often not serious, it should always be evaluated to rule out underlying conditions.

• Bright red or brown spotting/blood after sex.
• Pain or discomfort during or after intercourse.
• Associated symptoms (if caused by infection or other conditions):
  • Unusual vaginal discharge (e.g., foul-smelling, yellow/green).
  • Pelvic pain, itching, or burning.
  • Painful urination.

Possible Causes

1. Cervical Issues:
   1. Cervical ectropion (sensitive cells on the cervix surface).
   1. Cervical polyps (benign growths).
   1. Cervicitis (inflammation, often due to infections like chlamydia or gonorrhoea).
   1. Cervical cancer (rare but requires prompt evaluation).
2. Vaginal Causes:
   1. Vaginal dryness (e.g., menopause, hormonal changes).
   1. Trauma (e.g., friction, rough intercourse, or foreign objects).
3. Infections:
   1. Sexually transmitted infections (STIs).
   1. Pelvic inflammatory disease (PID).
4. Uterine Conditions:
   1. Endometrial polyps or fibroids.
   1. Endometriosis or adenomyosis.
5. Other:
   1. Bleeding disorders (rare).
   1. Side effects of hormonal contraceptives.

Diagnosis

1. Medical History: Discuss bleeding patterns, sexual activity, and other symptoms.
2. Pelvic Exam: Check for cervical polyps, inflammation, or tenderness.
3. Tests:
   STI screening: Swabs for chlamydia, gonorrhoea, or other infections.
   Pap smear: To detect cervical cell changes.
   Transvaginal ultrasound: Assess uterus, ovaries, or fibroids.
   Colposcopy: Closer examination of the cervix if abnormalities are suspected.
   Biopsy: If cervical or endometrial cancer is a concern.

Treatment & Management

1. Infections: Antibiotics for STIs or PID.
2. Cervical Issues:
   Polyps: Minor surgical removal.
   Ectropion: Cauterization or cryotherapy (freezing) if symptomatic.
3. Vaginal Dryness:
   Water-based lubricants during sex.
   Topical oestrogen creams (for postmenopausal individuals).
4. Hormonal Imbalances: Adjust contraceptive methods (e.g., switch birth control pills).
5. Cancer: Referral to a specialist for further management (e.g., surgery, chemotherapy).

Self-Care & Prevention

• Use lubricants during intercourse if dryness is an issue.
• Practice safe sex to reduce STI risk.
• Avoid harsh soaps, douches, or irritants in the genital area.
• Communicate with your partner about gentle techniques if discomfort occurs.
• Track bleeding episodes in a diary to share with your doctor.

Frequently asked Questions:

Q. How common is postcoital bleeding?

Up to 9% of women experience it at some point. Most cases are benign, but cancer must be ruled out in persistent cases.

Q. Can infections cause postcoital bleeding?

Yes. STIs like chlamydia or gonorrhoea can inflame the cervix (cervicitis), leading to bleeding.

Q. Can menopause cause postcoital bleeding?

Yes. Low oestrogen levels in menopause thin vaginal tissues, increasing dryness and fragility. 

Q. Can it affect fertility?

Most causes (e.g., infections, polyps) don’t impact fertility if treated early. Untreated STIs or PID may lead to scarring and complications.

eGynaecologist Advice:

• Post-coital bleeding is not normal and should never be ignored, especially if recurrent. You must seek gynaecological consultation as early diagnosis is key.
• You should seek gynaecological consultation if you are suffering from recurrent episodes of post coital bleeding(≥3 times) or have heavy bleeding.