Question:

Is bleeding after sex normal?

Answered by Melissa Mathes, MD, obstetrician and gynecologist:

Bleeding or spotting after sex is not necessarily normal but can occur for a variety of reasons. Heavy bleeding or bleeding that lasts several days is not normal and should be evaluated. 

Reasons for spotting include benign anatomic problems of the vulva, introitus, vagina, cervix and uterus or benign lesions on the inside lining of the uterus or cervix. First-time intercourse may cause small tears of the introitus that could result in spotting. An IUD may occasionally cause bleeding but may be a sign of a mispositioned intrauterine device. Pregnant women may also have spotting after intercourse. However, bleeding is not necessarily a sign of pregnancy. If you are pregnant and experience bleeding, you should reach out to your obstetrician for further recommendations.

Postmenopausal women may experience bleeding due to dryness of the vagina. With menopause, there is a drop in estrogen which causes the tissue of the vagina to become less flexible. Using a good lubricant before intercourse may help reduce vaginal dryness. 

Less common reasons for spotting include vaginal or cervical endometriosis, which are both rare. Bleeding can also be a sign of something more concerning such as cancer of the uterus or cervix, an infection, or trauma to the genital tract. 

If you are experiencing frequent spotting or bleeding and are concerned, it is always a good idea to get evaluated by a health care professional. All vaginal bleeding in postmenopausal women should be evaluated.