Dear Bonnie: 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 from Chlamydia) can make the cervix easier to bleed. Yet if you are in a monogamous relationship this is not going to apply to you! 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 a less stable uterine lining. Polyps of the lining, or uterine fibroids, can create a focus for unstable uterine lining. These tend to be more common in midlife women 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.
Other, much less common causes for bleeding include small tears in vaginal tissue. If the spotting is after the first time having intercourse there can be spotting from tissues at the vaginal opening.
In your specific case Bonnie, the culprit MIGHT be an unstable lining from being on birth control pills and having it be close to your "Pill period". Having complete penetration MIGHT have contributed some spotting as well.
Given the multiple causes of bleeding after sex, one should go see a GYN if the spotting persists or is recurrent.
Yours,
Jane