Dear Dr Murage,
I am 28 years old, and have recently been experiencing bleeding after sexual intercourse. This sometimes occurs as spotting, but occasionally as a light bleed. Is this normal?
Bleeding after sexual intercourse is unusual. For the majority, it is usually an innocent symptom with no serious underlying illness. However, it’s prudent to get checked out if you ever experience any bleeding with sex.
The symptoms may range from just spotting to frank bleeding. There may be some associated pelvic pain. The more the amount of bleeding, the greater the likelihood of an underlying explanation. Nevertheless, even spotting should not be ignored, especially if it’s a recurrent occurrence with every sexual encounter.
Your gynaecologist will do a systematic assessment to try and identify the cause. The bleeding may originate anywhere from the external genitalia (vulva), to the cervix. You will be asked if you have other underlying medical conditions, and whether you are up to date with your screening for cervical cancer.
Coincidental bleeding in early pregnancy is not unusual, hence a pregnancy test may be requested. An internal examination is often necessary to look for potential causes in the vulva, vagina and the cervix. You may also be asked to do additional tests to exclude possibilities of silent genital infections and other conditions in the pelvis.
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Most women will get re-assured that nothing serious is causing the bleeding. In such cases, no specific treatment is warranted. Subsequent further spotting should not cause undue concerns, but must be rechecked after an agreed interval. Some will have a specific diagnosis.
There may be lesions in the vulva, vagina or the cervix that may require treatment. Rarely, a serious disease will be diagnosed, like cancer of the cervix. This is however very unlikely in those whom cervical cancer screening is up to date, as any changes are detected pretty early and treated in good time before cancer develops.
Women in menopause have very low female hormones. This predisposes to vaginal dryness, which can cause difficulties with sexual intercourse. Spotting can occur due to easy bruising on thinned vaginal walls. Using a vaginal lubricant usually helps. Some may also benefit from hormone replacement therapy, aiming to replenish deficient female hormones.
The younger you are, the more likely that your bleeding is just innocent. But make arrangements to get checked by your gynaecologist. Keep up to date with cervical cancer screening intervals. Take all necessary precautions to avoid sexually transmitted infections. And use effective contraception if not planning a pregnancy. Once reassured nothing serious is the matter, go on and enjoy your sexual life.
— Dr Alfred Murage is a consultant obstetrician and gynaecologist
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