Dear Alice,

I had not had intercourse for over a year, and then recently I had intercourse and experienced vaginal bleeding. What could be the cause of this?

Dear Reader,

Rest assured that many have experienced vaginal bleeding associated with penetration or sex. Most vaginal bleeding is considered normal and typically doesn’t require medical treatment, especially if you’re pre-menopausal and have normal results on routine Pap smears and pelvic exams. What’s more, not having had sex in over a year could have very well played a part in the bleeding. Have you had penetrative sex since? If so, did you experience any bleeding? Here are some common causes of bleeding that can occur after penetration:

  • Spotting throughout the menstrual cycle not associated with sex, especially when using hormonal contraceptives
  • Friction caused by the penis or an object rubbing on the cervix
  • Vaginal dryness including inadequate foreplay or lubrication before penetration
  • Normal cervical changes throughout sexual development and menopause
  • Irritated or inflamed vaginal tissue due to excessive or vigorous penetration or vaginal trauma
  • Irritation of the labia (outer or inner lips) that can be mistaken for bleeding from the vagina
  • Sexually transmitted infections (STIs), such as chlamydia, gonorrhea, syphilis, trichomoniasis, or genital herpes
  • Urinary tract infections (UTIs), which can be accompanied by blood in the urine
  • Vaginitis, which can be caused by conditions such as bacterial vaginosis or a yeast infection
  • Cervical polyps, if vaginal bleeding is bright red in color
  • Cervical cancer

The good news is that in many cases the bleeding will resolve on its own (depending on the cause). However, bleeding is sometimes indicative of more serious conditions, especially for those who are post-menopausal. If you’re concerned about vaginal bleeding, believe you've been exposed to an STI, or have other symptoms, an appointment with a health care provider or gynecologist is a good next step. They will ask you for details about the bleeding, including questions about the color and flow of blood. They'll also likely examine you to determine whether the bleeding is coming from your vagina, cervix, vaginal walls, inner lips, or urethra. This and other information helps your provider determine or rule out other possible causes, get an appropriate diagnosis, and treatment for you.

Take care,

Alice!

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