Postcoital bleeding

Postcoital bleeding is non-menstrual vaginal bleeding that occurs during or after sexual intercourse. Though some causes are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.
The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. Postcoital bleeding can be one of the first indications of cervical cancer. There are other reasons why vaginal bleeding may occur after intercourse. Some women will bleed after intercourse for the first time but others will not. The hymen may bleed if it is stretched since it is thin tissue. Other activities may have an effect on the vagina such as sports and tampon use. Postcoital bleeding may stop without treatment. In some instances, postcoital bleeding may resemble menstrual irregularities. Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged. Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.
A diagnosis to determine the cause will include obtaining a medical history and assessing the symptoms. Treatment is not always necessary.

Causes

Vaginal bleeding after sex is a symptom that can indicate:

pelvic inflammatory disease
pelvic organ prolapse
uterine disease
chlamydia or other sexually transmitted infection
atrophic vaginitis
childbirth
inadequate vaginal lubrication
benign polyps
cervical erosion
cervical or vaginal cancer
anatomical abnormality of the uterus, vagina or both.
pregnancy
endometrial polyps
endometrial hyperplasia
endometrial carcinoma
leiomyomata
cervicitis
cervical dysplasia
endometriosis
coagulation defects
trauma

Bleeding from hemorrhoids and vulvar lesions can be mistaken for postcoital bleeding. Post coital bleeding can occur with discharge, itching, or irritation. This may be due to Trichomonas or Candida. A lack of estrogen can make vaginal tissue thinner and more susceptible to bleeding. Some have proposed that birth control pills may cause postcoital bleeding.
Risk factors for developing postcoital bleeding are: low estrogen levels, rape and 'rough sex'.

Diagnosis and treatment

Tests and detailed examination are used to determine the cause of the bleeding:

a pregnancy test
a pelvic examination
obtaining tissue samples
pap smear
colposcopic examination of the vagina and cervix
ultrasound
histogram
cultures for bacteria
biopsy of tissues

A referral may be made to a specialist. Imaging may not be necessary. Cryotherapy has been used but is not recommended.

Epidemiology

Postcoital bleeding rarely is associated with gynecological cancer in young women and its incidence is projected to drop due to the widespread immunizations against HPV. Postcoital bleeding has been most studied in women in the US. In a large Taiwanese study, the overall incidence of postcoital bleeding was found to be 39-59 per 100,000 women. Those with postcoital bleeding had a higher risk of cervical dysplasia and cervical cancer. Benign causes of postcoital bleeding were associated with cervical erosion, ectropion, vaginitis and vulvovaginitis. Other associations were noted such as the presence of leukoplakia of the cervix, an intrauterine contraceptive device, cervical polyps, cervicitis, menopause, dyspareunia, and vulvodynia. In Scotland approximately 1 in 600 women aged 20–24 experience unexplained bleeding. A study of African women found that trauma from consensual sexual intercourse was a cause of postcoital bleeding in young women.

In society and culture

Hymenorrhaphy is a controversial procedure to surgically repair a damaged hymen, thus restoring the appearance of virginity: