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Nothing kills the mood quite like seeing blood on your sheets. Unless you have your period, and therefore a clear idea of why you’d be bleeding during sex, your mind may spiral as you wonder WTF is going on.
But finding a little blood on your sheets during or even after sex (a.k.a. postcoital bleeding) is common: It affects up to 9% of women, and in most cases it’s no biggie—especially if things got rough. “Generally, it’s not a cause for concern,” Jacques Moritz, MD, an ob-gyn and medical director of Tia Clinic in New York City, tells SELF.
That said, there are important clues that can help you figure out what’s causing you to bleed—like where you are in your cycle and how often you notice blood—and whether sex-related bleeding could be a sign of a health condition. Below, ob-gyns explain why you might experience some spotting during sex and when blood on your bed warrants a check-in with your doctor.
Is it normal to bleed during or after sex?
If you haven’t yet hit menopause, sporadic, light bleeding after sex is usually nothing to worry about. The truth is, there are a handful of things that can make you more prone to bleeding during your reproductive years.
For starters, you may have a cervix that’s especially sensitive to touch (which is more common in young people) or be approaching your period. “If you’re close to the period, two or three days before, [some bleeding is] kind of to be expected,” Dr. Moritz says. “The uterine lining gets so thick, and when the uterus moves around a lot during intercourse, some cells will come off.”
Simply taking hormonal birth control can also make you more susceptible to bleeding a bit during vaginal intercourse—especially if the sex is particularly enthusiastic. The reason: Some contraceptives, like the pill, may cause vaginal dryness, and when you’re lacking moisture down there, added friction can cause the skin to break and bleed.
But there are some cases where the blood can be a sign of a larger issue. If bleeding is heavy, persists well after your post-sex pee, or happens every time you have sex, it can be a sign of a more serious issue like a tear, fibroid or polyp, or, rarely, cancer.
Bleeding during sex becomes less normal once you hit menopause. During your reproductive years, there are many likely (and very common) explanations for it. But when you’re no longer menstruating or taking birth control, the list of potential causes of bleeding dwindles, and there’s a greater chance that something more serious—like endometrial or cervical cancer—is to blame. So your doctor will want to know about any bleeding before or after sex (or in general) ASAP so they can decide if more testing is needed. Yes, even if it happened only one time and was short-lived.
That’s not to say bleeding postmenopause is always due to cancer. The more likely scenario is that you’re dealing with vaginal dryness, Sherry A. Ross, MD, an ob-gyn in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period, tells SELF. Vaginal dryness in this age group (thanks, hormones!) can cause tears and sometimes bleeding after sex, Dr. Ross explains. A quick visit with your ob-gyn can help you determine what’s going on and ensure that you detect any health issues early on.
Can hitting the cervix cause bleeding?
The short answer: Yes, definitely. The long answer: During sex, your partner’s penis, finger, or sex toy may hit your cervix, the narrow passage that sits at the back of your vaginal canal and connects it to the uterus. For some people, this feels pleasurable—but it can also be painful (and a little bit bloody), especially if the penetration was rough or deep.
Some people just have extra-sensitive cervixes. Hormonal birth control can exacerbate this, plus, the cervix tends to naturally be more touchy at certain times of the month: “During ovulation, [your cervix] can be more sensitive, causing spotting during intercourse,” Dr. Ross says. (Ovulation typically happens in the middle of your menstrual cycle, around day 14 or so in a 28-day cycle.)
Dr. Moritz also adds that younger people tend to have more sensitive cervixes that can bleed easily from something like rough sex or even a procedure like a Pap smear or pelvic exam. The name for this common issue is cervical ectropion. “If you touch the cervix with anything, it starts bleeding,” Dr. Moritz says. Luckily, it’s very treatable—your doctor may try switching up your birth control or cauterizing the bleeding-prone cells with a quick out-patient procedure.
Is bleeding during sex a sign of pregnancy?
It’s not uncommon to experience light bleeding during or after sex when you’re pregnant. In fact, spotting in general can be an early sign of pregnancy. This type of bleeding, known as implantation bleeding, occurs when the fertilized egg implants (attaches) in the uterus about 10 to 14 days after conception. (It’s considered a very normal part of pregnancy, though not every pregnant person experiences it.) So if you happen to have sex around this time, you may notice some droplets on your sheets.
For some, this experience persists throughout pregnancy. During this time, your body is changing to support a growing fetus. Part of that includes developing more blood vessels in areas like your cervix—which can boost sensitivity and lead to a little bleeding during or after sex, Dr. Moritz says.
In most cases, light bleeding during pregnancy is not a cause for concern, especially if you only notice a few drops of blood (and you know something was just repeatedly hitting your cervix). “It’s so common; pretty much everyone will experience it during pregnancy,” Dr. Moritz says. That being said, seeing any amount of blood when you’re pregnant can be off-putting, so never hesitate to contact your doctor if you’re concerned or just need some peace of mind. And if you ever experience unexpected bleeding that is heavy or persistent enough that you need to use a pad or liner, give your ob-gyn a call.
Can bleeding during sex be a sign of a tear?
Extra-rough sex can certainly cause vaginal tears and postcoital bleeding, Dr. Ross says. These tears may not always be painful, she adds, though some can make your vagina sore. In general, tearing is more common among people who are new to sex or were recently abstinent. (It’s also worth noting that this kind of vaginal injury, bleeding, and pain can happen after sexual trauma and assault.)
Superficial tears that cause light bleeding will likely heal on their own, typically within a few days, but any tears that are accompanied by severe pain and heavy bleeding may need medical attention. Many people put off contacting their doctor out of shame or embarrassment, but it’s worth giving your ob-gyn a call if your symptoms don’t subside. They may ask you to come in for a pelvic exam to make sure the tear isn’t too severe and that it will heal properly on its own.
If you’re experiencing these symptoms after sexual trauma, resources such as Planned Parenthood and RAINN can help you get the physical and mental care that you need.
Other potential causes of bleeding during sex and postcoital bleeding
If bleeding after sex happens persistently and doesn’t stop relatively soon after (within a day or so) or is heavy, it could be a sign of an infection, Dr. Ross says. You may be dealing with vaginitis, inflammation or infection of the vagina; or cervicitis, inflammation or infection of the cervix. “If you have inflammation in the cervix, it becomes more sensitive,” she explains.
Inflammation can be caused by a whole host of things, and you’ll want to get checked for sexually transmitted infections (STIs) like chlamydia and gonorrhea, which are oftentimes asymptomatic and can lead to a condition called pelvic inflammatory disease (PID). PID happens when an infection in the pelvis causes inflammation in the reproductive organs. If left untreated for too long, it can cause permanent damage and lead to infertility and chronic pelvic pain.
Regular postcoital bleeding can also be a sign that something is growing on the cervix, Dr. Moritz says. “It can range anywhere from a small cervical polyp to cancer,” he says. Your doctor may conduct a physical exam, Pap smear, or colposcopy, a diagnostic procedure in which the cervix and vagina are examined to get a better idea of what’s going on. The odds that bleeding is due to cancer are low (there’s a 1 in 1,000 chance of the mass being malignant); it’s more likely to be a polyp, which is just a benign growth that can be easily removed, Dr. Moritz says.
Endometriosis happens when tissue similar to the endometrium (the tissue that lines the inside of the uterus) grows elsewhere in the abdominal cavity, most commonly the ovaries, fallopian tubes, and tissue lining the pelvis. Endometriosis can be really painful, especially around the time of your period and during or after sex. It can also cause heavy periods and bleeding in between periods. A similar condition called adenomyosis, which occurs when the endometrial lining grows into the uterine wall, can also cause pelvic pain and abnormal bleeding.
Doctors don’t yet understand why these conditions can cause postcoital bleeding, Dr. Moritz says. But recent research shows this is a potentially common yet underreported symptom.
When to see a doctor for bleeding during or after sex
If you haven’t hit menopause yet and you’re bleeding often after sex, the bleeding continues for more than a day, or the bleeding is heavy (like, more than 10 drops, Dr. Moritz says) or accompanied by other symptoms like pain, it’s worth talking to your doctor to make sure nothing else is going on.
If you’re postmenopausal, you should always tell your doctor about any post-sex bleeding—even if it’s just a small amount. Once they’ve ruled out other potential health concerns, your doc may suggest ways to moisturize the area (if dryness seems to play a role), with products like OTC vaginal moisturizers, prescription vaginal estrogen creams, and different types of lube you can use during sex to alleviate any discomfort and related bleeding in the future.
No matter your age, it’s important to listen to your instincts. If you think like you have a good explanation for what’s causing your spotting or bleeding during or after sex but are still concerned or could use some reassurance, make an appointment with your ob-gyn just to be sure.
Related:
- Why Does It Burn When I Pee After Sex?
- What Does ‘Normal’ Vaginal Discharge Usually Look and Smell Like?
- 6 Sneaky Uterine Fibroid Symptoms You Really Shouldn’t Ignore
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