BLEEDING after sexual intercourse is medically known as post-coital bleeding. This is a symptom that often causes significant anxiety for women and their partners. While it may not always serious, it should never be ignored, particularly when it occurs repeatedly.

As a gynaecologist I frequently see women who delay seeking care because the bleeding is painless, light, or stops on its own. Others assume it is related to their menstrual cycle or recent sexual activity. Unfortunately, this delay can sometimes allow treatable conditions to progress.

A common clinical scenario

Consider a 34-year-old woman who presents to my office reporting light spotting after intercourse for the past three months. She has no pain, no abnormal discharge, and her periods are regular. She is otherwise healthy and feels well. Because the bleeding is mild, she initially dismissed it. However, during her examination a cervical polyp is identified, which is an entirely non-cancerous growth from the cervix that can easily bleed with contact. The polyp is removed in the office, and her symptoms resolve completely.

This is a reassuring outcome but it highlights an important point: post-coital bleeding is a symptom, not a diagnosis, and the cause must always be identified.

What causes bleeding after sex?

Post-coital bleeding can originate from the vagina, cervix, uterus, or surrounding tissues. Common causes include:

1) Cervical conditions

•Cervical polyps

•Cervical ectropion (a harmless condition common in younger women, pregnancy, or those on hormonal contraception)

•Cervicitis (inflammation or infection of the cervix)

2) Vaginal causes

•Vaginal dryness, particularly in breastfeeding or menopausal women

•Vaginal infections or inflammation

•Small tears due to friction or insufficient lubrication

3) Uterine causes

•Endometrial polyps

•Fibroids that extend into the cervical canal

•Hormonal imbalances affecting the uterine lining

4) Sexually transmitted infections (STIs)

Chlamydia, gonorrhoea, and trichomoniasis can inflame delicate tissues and lead to bleeding after intercourse

5) Cervical cancer

In Jamaica , cervical cancer is the second most common cancer in women. In advanced disease there is usually heavy bleeding after intercourse. There may also be an associated foul-smelling discharge with or without weight loss. This is usually the most feared cause of post-coital bleeding. With Pap smears, human papillomavirus (HPV) testing and HPV vaccination, the incidence of cervical cancer is significantly reduced.

How is post-coital bleeding evaluated?

A proper assessment includes:

•A detailed history (timing, frequency, pain, discharge, contraceptive use)

•A pelvic examination

•Pap smear and HPV testing, if due

•STI screening where appropriate

•Pelvic ultrasound if a uterine cause is suspected .

In some cases, additional procedures such as colposcopy or hysteroscopy may be required to fully assess the cervix or uterine cavity.

Treatment depends on the cause

There is no single treatment for post-coital bleeding because management is cause-specific:

•Cervical or endometrial polyps can be safely removed

•Infections are treated with appropriate antibiotics

•Vaginal dryness may respond to lubricants, vaginal oestrogen, or hormonal adjustment

•Hormonal causes can be managed with medication

•Precancerous or cancerous changes require prompt specialist care.

Early diagnosis almost always leads to simpler, more effective treatment.

When should you see a doctor?

You should seek medical attention if:

•Bleeding occurs more than once

•Bleeding happens outside of your period

•There is associated pain, discharge, or foul odour

•You are post-menopausal

•You are overdue for cervical screening.

The take-home message

Post-coital bleeding is common but it is not normal. While many causes are benign and easily treated, the only way to know is through proper evaluation. Women should feel empowered to seek care early, without fear or embarrassment.

Your body often gives subtle signals when something is wrong. Listening to those signals and acting on them can make all the difference.

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician. He is located at 3D Gynaecology Limited, 23 Tangerine Place, Kingston 10. Feel free to contact Dr Daley at ddaley@3dgynae.com.

Dr Daryl Daley.