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    Bleeding after sex
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    An_250285 posted:
    Hi, I'm 29 yrs old. I've been dating this guy for about 3 month's now, after being in a 12 yr relationship. In my previous relationship we hardly had sex, and I never bleed after sex. However, with this new guy his is a bit larger than my ex, and we do use lube, and somehow i bleed during sex. Not always, but most of the time. What can we do differently, or is something wrong with me.
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    Jane Harrison Hohner, RN, RNP responded:
    Dear An: As you may have read, 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 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.

    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 stability of the uterine lining. 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, yet these are more common in older 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. This is more common in women with low estrogen (eg breastfeeding or after menopause). If the spotting is after the first time having intercourse there can be spotting from tissues at the vaginal opening.

    In your specific case it MIGHT be a new infection (only because he is a new partner), an unstable lining if you are using hormonal birth control, or even a new cervical polyp that he can easily bump if he is larger than your prior partner. I would really urge you to see your GYN or local family planning clinic and have them do an evaluation. It could give you peace of mind even if nothing significant is found.

    Yours,
    Jane


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