Sex is messy, thanks to all the bodily fluids involved. It’s an inevitable fact that things are going to get a little wet when you’re doing the deed. But blood should not be on that list of bodily fluids making a regular appearance in the bedroom.
Vaginal bleeding during sex is sometimes NBD, but other times it can be a sign of a health problem—like an infection or even cancer—that needs to be addressed. (Note: We’re talking about vaginal intercourse specifically here. Anal is a topic for another day.)
A few factors can help you determine if your postsex bleeding is cause for concern, like where you are in your cycle, how much blood there is, how often it happens, if you had really rough sex, and if you’re postmenopausal.
Generally, if you haven’t yet hit menopause, bleeding a little after sex on rare occasions is probably nothing to worry about.
“If it’s close to the period, two or three days before, and it’s rough sex, [some bleeding is] kind of to be expected,” Jacques Moritz, M.D., an ob-gyn at NewYork-Presbyterian and Weill Cornell Medicine, tells SELF. “The uterine lining gets so thick, and when the uterus moves around a lot during intercourse, some cells will come off.” If you’re having rough sex and you notice a drop or two of blood, that’s not a big deal.
“Vigorous sex can cause spotting,” Sherry A. Ross, M.D., an ob-gyn in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SELF. “But I’ve also seen some bad vaginal tears during aggressive sex,” she says. They may not always be painful, but they can cause more than just one errant drop of blood.
If you notice a little blood postsex and you’re in the middle of your cycle, it’s not necessarily a problem, as long as it happens rarely. Midcycle spotting can happen when you’re ovulating, and that’s totally normal, especially for women taking hormonal birth control. “During ovulation, [your cervix] can be more sensitive, causing spotting during intercourse,” Ross says. Again, it’s more likely if the sex is rough. (You have to be the judge of that.)
Moritz also adds that younger women have more sensitive cervices that can bleed easily from something like rough sex or even a procedure like a Pap smear. Pregnancy also makes the cervix sensitive. While bleeding with no identifiable cause during pregnancy is something you should call your ob-gyn about, bleeding that happens right after sex is usually nothing to worry about.
If you experience postcoital bleeding often or it lasts for more than a day, it’s worth checking in with your ob-gyn.
If bleeding after sex happens persistently, doesn’t stop relatively soon after, or is heavy, it could be a sign of an infection, Ross says. “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 STDs like chlamydia and gonorrhea, which are oftentimes asymptomatic and can lead to a condition called pelvic inflammatory disease. 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.
Regular postcoital bleeding can also be a sign that something is growing on the cervix, Moritz says. “It can range anywhere from a small cervical polyp to cancer,” he says. It’s more likely to a polyp, which is just a benign growth and can be easily removed. “If someone had a Pap smear recently, [within the past three years], the chances of it being cervical cancer are very, very low,” he adds.
If you’re postmenopausal, you should tell your doctor about any postsex bleeding.
Doctors are most concerned about bleeding after sex when you’re postmenopausal “because you shouldn’t be bleeding,” Ross says. Before menopause, there are many likely explanations for it. But when you’re no longer menstruating, doctors will want to check for cervical and endometrial cancer—both of which can cause bleeding after sex—to rule them out right away. Yes, even if it happened only one time and was short-lived.
Ross also notes that vaginal dryness in this age group (thanks, hormones!) can cause tears and sometimes bleeding after sex. Your doc can suggest ways to moisturize the area, with products like OTC vaginal moisturizers (and lube during sex), and alleviate some of this discomfort.