Is Bleeding After Sex Normal?

Two months ago I started spotting bright red blood after intercourse. I am 29 years old, have normal pap results and am monogamous with my husband. Is this normal and what are the possible causes?

Question:

Bleeding after sex, especially if it is a new onset, as you describe, is something that needs to get checked out. Although your pap has been normal, if it hasn't been done since the bleeding started, it needs to be repeated. And potentially, you need a culposcopy (a look at the cervix with a magnifying "telescope") to see if the cervix looks normal. Cultures or a "wet smear" to look for infection would also be helpful.

The usual causes of bleeding following intercourse are a "friable" cervix (one that has delicate skin so it bleeds easily), frequently a result of infection or inflammation of some sort. This can be allergic, systemic (like lupus or other immune system disorder), infectious (chlamydia, trichomonas, condyloma, gonorrhea, bacterial vaginosis, etc.), or rarely dysplasia (precancer) or cancer. Another possible cause is bleeding from the inside of the uterus -- from a fibroid or cervical or uterine polyp (a growth of the lining of the cervix or uterus). Or finally, bleeding from the vagina -- perhaps even small tears from intercourse, which is especially common with lack of adequate lubrication.

It is very important that you schedule a visit with your health care provider to find out why you are bleeding after sex. Since these symptoms have the potential of being serious, you need to be evaluated soon. What you are experiencing may not be dangerous but it is not normal. Don't put it off hoping it will get better on its own.

Finally, as a cynical old codger, the fact that you are monogamous is only half the possibility. I have the highest hopes that you are both faithful and have no reason to question that, but I would not be complete in answering your question without considering the possibilities that I mentioned above, some of which would be difficult to get without help from others.

For now, visit your health care provider. If they can't find anything, a course of antibiotics is worth trying (zithromax or vibramycin and/or flagyl) and some birth control pills. After that, I would consider freezing the cervix to see if that would help. Good luck.

by Fred Coleman

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