Bleeding outside of menstruation is one of the common reasons women consult a gynecologist. Sometimes it is a single episode that is not related to any serious condition. However, recurrent bleeding between periods or after sexual intercourse requires evaluation to determine the cause. In medicine, such bleeding is classified as abnormal uterine bleeding.
Why Can Bleeding Occur After Sex?
Bleeding after sexual intercourse is called postcoital bleeding. Possible causes include cervical ectropion, cervical polyps, sexually transmitted infections, vaginal dryness, and trauma to the vaginal mucosa. During perimenopause and postmenopause, changes in the mucosa associated with reduced estrogen levels can also cause bleeding.
Much less commonly, postcoital bleeding can be associated with precancerous or malignant changes of the cervix. Therefore, bleeding after sex does not automatically mean cancer, but if the episodes recur, the symptom should not be ignored.
What If Bleeding Occurs Between Periods?
Intermenstrual bleeding can occur for various reasons. These include ovulatory disorders, the use of hormonal contraception, endometrial or cervical polyps, uterine fibroids, adenomyosis, pregnancy and its complications, and certain endocrine disorders. During perimenopause, irregular and acyclic bleeding also becomes more common due to changes in ovulation.
Light spotting may also occur during the first few months after starting certain forms of hormonal contraception. However, if the bleeding persists, becomes heavier, or appears after a period of stable menstrual cycles, the cause should be evaluated.
What Examinations Are Necessary?
There is no single set of tests that is appropriate for every woman. The doctor considers the patient's age, the characteristics of the bleeding, the possibility of pregnancy, the contraceptive method being used, medications, and previous cervical screening results. Depending on the situation, a gynecological examination, pregnancy test, testing for infections, pelvic ultrasound, and, when indicated, evaluation of the endometrium may be necessary.
The need for cervical examination and Pap smear and HPV testing is determined by age and previous screening results.
When Should You Definitely See a Doctor?
You should consult a gynecologist if bleeding after sex recurs, occurs between periods without an obvious reason, becomes heavier, or is accompanied by pain. Any bleeding after menopause requires evaluation, even if it was minimal and occurred only once.
In cases of very heavy bleeding, significant weakness, dizziness, fainting, severe pain, or bleeding in the context of a possible pregnancy, urgent medical attention may be required.
In most cases, the cause of bleeding is benign. However, it is impossible to determine the cause based on the characteristics of the bleeding alone. Therefore, if episodes recur, it is better to undergo an evaluation rather than start treatment on your own.