Women's Health Community

Dear Anon: There are two basic culprits that can cause bleeding after sex: problems with the cervix, and things that create bleeding from the uterine lining. If the spotting after bowel movements is from the vagina the following may apply. If the spotting is from the rectum we can discuss that after vaginal causes,OK?

Bleeding coming from the cervix could come from a cervical lesion---if one has had a recent normal PAP smear this is unlikely. An infection of the cervix (eg "cervicitis" from Chlamydia) can make the cervix more easier to bleed. In some women there is a normal enlargement of the area of glandular type tissue. These women can have bleeding when the cervix is sampled for a PAP smear. A polyp coming from the cervical canal may bleed only when the cervix is touched. Endocervical polyps of this type may be readily seen during a speculum exam. The spotting from polyps tends to be more random than the spotting from a cervical infection.

If the uterine lining ("endometrium") is easily destabilized, having sex can prompt spotting or breakthough bleeding. Some women will have this type of spotting if sex occurs during ovulation or right before menstrual flow is slated to begin. Women using hormonal forms of birth control may also have less endometrial stability. (I realize this is not the case for you.) Infections (eg Gonorrhea, Chlamydia) can destabilize the uterine lining causing erratic bleeding and bleeding after sex. Endometrial polyps or uterine fibroids can create a focus for unstable uterine lining. If a woman has a history of missed periods, her uterine lining may be very thickened. In that situation spotting can represent small amounts of the lining being shed---just off the top layer (doubt this in your case since there are regular periods).

Other, much less common causes for bleeding include small tears in vaginal tissue. This is more likely if the woman is postmenopausal, and her vaginal tissues have marked thinning.

In terms of rectal bleeding after vaginal sex or bowel movements there are fewer causes. Some of these could include: internal or external hemorrhoids, anal fissures, endometriosis of the large bowel (would appear around menstruation), or some other bowel issue.

Given the multiple causes of bleeding after sex, I would urge you to see a GYN or your local family planning clinic since the spotting has been ongoing for a year.

Yours,
Jane

I have the same problem. The first time I reported it to the GYN nurse practitioner who basically ignored me and did nothing about it and did not tell the doctor. The next year, I saw the doctor. She thought she felt fibroids but they did not show up in the ultrasound. I then had a biopsy that came back negative. Mind you, my Pap smear was negative, and I do not nor ever had and STDs or HPV. So this year, being the third year I bring it up at my annual visit, the doctor decided to do a hysteroscopy and a D&C. I indeed had 2 fibroids embedded in the uterine wall that are the size of golf balls. Don't let the symptoms go ignored, be persistent with the doctor to keep searching for answers until they find out what is going on with your uterus as vaginal bleeding during bowel movements are not normal. Best Wishes to you!

Dear PrettiPeaches: Thank you SO much for writing with your experience. Hopefully other women will benefit from your input as they find this post on an internet search.

Yours,
Jane