Bleeding during sex may be noticed in the course of, or after intercourse (post-coital bleeding). It is not a normal phenomenon and warrants medical attention. If you notice that you tend to bleed after making love, consult a doctor at the earliest.

The most serious cause of post-coital bleeding is cervical cancer or early cancerous changes in the cervix.

Some common causes of bleeding during sex

The causes of post coital bleeding can be broadly divided into four groups:

• Cancerous or precancerous conditions 

               *    Cervical cancer

               *    Cervical dysplasia

               *    Vaginal cancer 

• Trauma or injury

               *    A cut or sore in the vagina

               *    Vigorous sex resulting in injury

               *    Vaginal dryness resulting in injury during normal sex

               *    Intrauterine devices can cause bleeding from irritation and friction

               *    Lowered estrogen level as in perimenopausal or post menopausal woman.

               *    Drying and narrowing of the vagina

               *    Hymen rupture during first intercourse — this is normal and should not cause

                    worry

• Infections

               *    Chlamydia infection

               *    Gonorrhea infection

               *    Vaginitis or cervicitis

               *    Trichomonas vaginalis

               *    Vaginal yeast infection

• Abnormal growths

               *    An abnormal growth in the vagina or cervix such as polyps

               *    Endometritis or adenomyosis

               *    Uterine polyps

               *    Fibroid tumors

Diagnostic tests

Your doctor may need to do a few tests to determine the cause of bleeding.

• Physical examination
• Pap smear
• Vaginal or cervical swab
• Vaginal speculum examination
• Pregnancy test
• Colposcopy
• Dilatation and curettage
• Endometrial sampling
• Cervical biopsy
• Blood tests

Treatment depends on the underlying cause. If it is due to infections treatment of infection is required. If it is due to vaginal dryness at menopause, use of lubricants is advised.

Information for women

It is important for you to understand the following points about post-coital bleeding.

• Commonest cause or causes of bleeding
• Whether further investigation is indicated
• Information about investigations, if needed
• The chances of a serious cause like cancer
• Chances of other causes being present
• When to come for follow-up if symptoms persist or recur
• Cervical smear is a screening test that will indicate the cancer in 80 to 90% cases but may miss it in the remaining 10 to 20% of them.