Bleeding after sex
Dear Dr Mitchell,
I had intercourse with my husband after returning from a month abroad and realised afterward that I was bleeding quite heavily, with some clotting, and bright red blood, which scared me. This went on for two days. This would have been a week after my period ended. My husband says it’s because I hadn’t had sex for a while, but this doesn’t seem to make sense. I was lubricated, so that wasn’t the issue. I have booked an appointment to get a Pap smear done because a Google search made me believe the bleeding was serious. What do you say?
The problem with bleeding after sexual activity is a serious problem that needs to be dealt with urgently. The significant concern with bleeding after sexual activity is that of cervical cancer. Other possible causes include an infection in the cervix, uterus, or vagina. An abnormal growth on the cervix such as a polyp can also cause bleeding after sexual activity. A cancerous growth in the vagina can also contribute to bleeding after sexual activity.
It is most unlikely that vaginal dryness from lack of lubrication before sexual activity is the possible cause of such significant bleeding. This extent of dryness tends to be seen in women who are above 51 years and menopausal. This usually presents with painful sexual activity, a burning sensation in the vagina, and a pink discharge since the extent of bruising is usually minimal.
It is extremely important for you to have a complete physical examination including a Pap smear to determine the underlying cause of the bleeding after sexual activity. The entire vagina, cervix, uterus, ovaries, and fallopian tubes need to be examined. Cervical swabs should also be done to determine if there is any significant sexually transmitted infection such as chlamydia or gonorrhoea. A Pap smear should also be done at the same time if there is no active bleeding.
A pelvic ultrasound should be done to check the uterus, ovaries, and fallopian tubes for any problems that could contribute to the abnormal bleeding. Any infections should be treated promptly and if there is an abnormal growth on the cervix or vagina, a biopsy should be taken. A detailed screening for sexually transmitted infections including syphilis and human immunodeficiency virus (HIV) should be done. Your spouse should also have a complete screening for sexually transmitted infections especially if there is evidence of an infection in the cervix, vagina, or pelvis.
If you have not been vaccinated against the human papilloma virus (HPV) that causes cervical cancer then you should discuss this with your doctor especially if you are 65 years old or younger. This will significantly reduce your risk of cervical cancer in the future.
Consult your doctor who will advise your further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
