Dealing with post-coital bleeding

Many females have experienced vaginal bleeding after sex. Up to 63 per cent of post-menopausal people may experience vaginal dryness and vaginal bleeding or spotting during sex.

Additionally, up to nine per cent of menstruating people experience post-coital (after-sex) bleeding.

Occasional light bleeding is usually not a cause for concern. If you have certain risk factors or have gone through menopause, bleeding after intercourse may be a cause for concern.

CAUSES

Bleeding after sex is medically known as post-coital bleeding. It occurs in people of all ages. In younger people who haven’t reached menopause, the source of the bleeding is usually the cervix.

In those who have gone through menopause, the source of the bleeding is more varied. It can be from the cervix, uterus, labia or urethra.

CONTRACEPTIVES.

Hormonal contraceptives or birth controls can make the linings of the uterus and cervix to become extra sensitive and may result in post-coital bleeding.

PREGNANCY

Having sex during pregnancy may occasionally cause bleeding, this should checked out immediately to ascertain if there are other more serious cause of bleeding in pregnancy.

VAGINAL DRYNESS

Vaginal dryness can lead to bleeding. In addition to the genitourinary syndrome of menopause, other factors can cause vaginal dryness, such as: having intercourse before being fully aroused; friction during intercourse; douching; chemicals in feminine hygiene products, laundry detergents, and pools; breastfeeding; childbirth; certain medications, including cold medication, asthma medications, some antidepressants, and anti-oestrogen drugs; having your ovaries removed; chemotherapy and radiation therapy; and Sjögren’s syndrome (an inflammatory disease of the immune system that reduces moisture generated by glands in the body).

INFECTIONS

Some infections can cause inflammation of the tissues in the vagina, which may lead to bleeding. These can include:

• pelvic inflammatory disease, an infection of the reproductive organs in the lower abdomen, which includes the fallopian tubes, ovaries, cervix, and uterus.

• sexually transmitted infection, such as chlamydia.

• cervicitis, which is inflammation of the cervix that occurs as the result of an infection.

• vulvovaginitis, which is inflammation of the vulva and vagina that often occurs due to an infection.

CERVICAL ECTROPION

Cervical ectropion occurs when the cell type that typically grows on the inside of the cervix grows on the outside instead. Cervical ectropion may result in an inflamed area.

Also known as cervical ectopy or cervical eversion, this condition is caused by high oestrogen levels.

However, it is considered a natural variant and tends to occur in: adolescents, pregnant people, people using hormonal contraception and people who menstruate.

GENITO-URINARY SYNDROME.

Formerly known as vaginal atrophy. It is common in those in perimenopause and menopause and those who have had their ovaries removed.

As women get older, especially when menstrual periods stop, the body produces less oestrogen. This causes the body to produce less vaginal lubrication, so the vagina can become dry and inflamed.

Lower oestrogen levels also reduce the elasticity of your vagina. Vaginal tissues become more fragile, get less blood flow, and are more susceptible to tearing and irritation. This can lead to discomfort, pain, and bleeding during sex.

POLYPS

Polyps are non-cancerous growths, found on the cervix or in the endometrial lining of the uterus. Polyp movement can irritate the surrounding tissue and cause bleeding from small blood vessels.

VAGINAL TEAR

Sex, especially vigorous sex, can cause small cuts or scrapes to the vagina.

This is more likely to happen if you have vaginal dryness due to menopause, breastfeeding, or other factors.

CANCER

Irregular vaginal bleeding, including bleeding after sex, is a common symptom of cervical or vaginal cancer. Up to 3.8 per cent of women with post-coital bleeding have cervical cancer. Post-menopausal bleeding can also be a symptom of uterine cancer.

RISK

The risk of post-coital bleeding is increased if you: have cervical or uterine cancer, are in perimenopause, menopause, or are post menopausal, recently had a baby or are breastfeeding, are not fully aroused before intercourse, and if you douche frequently.

SYMPTOMS

The symptoms you may experience along with post-coital bleeding vary depending on the cause. Post-coital bleeding may be associated with other symptoms such as: vaginal itching or burning, stinging or burning sensation when urinating, painful intercourse, heavy bleeding, severe abdominal pain, lower back pain, nausea or vomiting, unusual vaginal discharge.

DIAGNOSIS

The following investigations can be helpful:

• Examination of your vagina and cervix, either visually or through a magnifying device called a colposcope

• Possible biopsy if cancer is suspected

• Transvaginal ultrasound

• Urine test

• Blood tests

• Testing of your vaginal discharge

TREATMENT

The cause of your vaginal bleeding will determine your treatment. Treatments may include lubricants.

If your bleeding is due to vaginal dryness, vaginal moisturisers may help. Applied regularly, these products are absorbed by the walls of the vagina. They increase moisture and help restore the natural acidity of the vagina. Vaginal lubricants also reduce uncomfortable friction during intercourse.

Oestrogen therapy

If the vaginal dryness is caused by menopause or the removal of the ovaries, oestrogen therapy is beneficial for treatment. Topical oestrogen products include vaginal oestrogen creams and suppositories. Another option is an oestrogen ring. This is a flexible ring that’s inserted in the vagina. It releases a low dose of oestrogen for 90 days.

Oral hormone therapy, which replaces the hormones oestrogen and progestin, can also be another option for some.

Antibiotics

Vaginitis can be caused by an infection or vaginal dryness. The cause may also be unknown. Depending on the cause, antibiotic may be prescribed. Antibiotics may also be prescribed to treat pelvic inflammatory disease and sexually transmitted infections.

If your cervix is inflamed because of cancer or pre cancer, your doctor may remove affected cells using silver nitrate or cryosurgery. In this process, damaged cells are frozen and killed.

Prevention

Determining how to prevent post-coital bleeding depends on what has caused bleeding for you in the past.

For most people, using water- or silicone-based lubricants will help prevent bleeding caused by vaginal dryness and friction during sex.

It may also help to take sex slowly and to stop if you feel pain. Using vaginal moisturisers regularly can help keep the area moist and make you feel comfortable.

If your symptoms of post-coital bleeding are related to a medical condition, It will be necessary to discuss with your doctor so that appropriate treatment can be instituted.

Contact Dr Maxwell on 3631807 or 7575411.