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    Bleeding After Sex
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    An_248467 posted:
    I am a healthy 24 year old female, but a few weeks ago I bled after having sex. It was only drop or two, but still worried me. The next time we had sex, it happened again and this time I was sore afterward. I am only sore around my hymen, but I did not recently lost my virginity. When I look up post coital bleeding, the only things that pop up are about the cervix, but I know it's my hymen that's hurt and bleeding a few drops. This has been going on for a week and is now causing pain when he pushes inside of me.

    I don't know why this is happening. Is it possible that my hymen is just ripping further and is this normal?
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    avatar
    Jane Harrison Hohner, RN, RNP responded:
    Dear An: A very brief review first, OK? There are two basic culprits that can cause bleeding after sex: problems with the cervix and things that create bleeding from the uterine lining. 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 "friable" (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.

    If the uterine lining is easily destabilized, having sex can prompt spotting or breakthrough 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. 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.

    An_248467, you seem pretty convinced that there is no other possible source for the bleeding except around the vaginal opening--because that's where the pain is. IF that is truly the only source then some possible causes might include: tiny skin fissures due to an undetected yeast infection, a linear herpes lesion which can look like a scratch, low estrogen effects, a small vaginal tear (this seems less likely if this is your usual partner and no rough sex), or even vaginismus. There are also some dermatology conditions (eg lichen sclerosus) which can make the skin in the lower vaginal opening very thin and fragile.

    Although the amount of bleeding is scant, that you are have pain with entry mandates a vulvar exam. Your GYN or local family planning clinic should be able to evaluate for all the possible vaginal opening problems.

    Yours,
    Jane


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