Bleeding after sex: causes, red flags and when to get it checked

The cervix and vagina have delicate blood vessels. Friction can make them bleed, particularly when they are inflamed, dry or have a growth or ectropion (where the glandular cells that line the canal sit on the outer surface of the cervix). The pattern, including timing in the cycle and pain, helps identify the cause.

• Cervical ectropion (ectopion): common in young women and on the pill or in pregnancy, a harmless cause of light bleeding.

• Infection: chlamydia, gonorrhoea, trichomonas, pelvic inflammatory disease or cervicitis.

• Vaginal dryness and thinning, particularly with menopause or breastfeeding.

• Cervical or endometrial polyps, which are benign growths that bleed easily.

• Hormonal contraception, including breakthrough bleeding on the pill, implant or coil.

• Minor injury or vigorous intercourse.

• Pregnancy-related causes including cervical changes and miscarriage.

• Precancerous cervical changes, cervical cancer and, less often, vaginal or womb cancer.

Bleeding that is persistent or recurs, abnormal or foul-smelling discharge, pelvic or lower back pain, bleeding between periods, bleeding after menopause, unexplained weight loss, missed cervical screening, a history of abnormal smear results, or visible abnormality of the cervix warrant prompt assessment.

• Call 999 or go to A&E: heavy bleeding with dizziness, severe pain or a positive pregnancy test with pain and bleeding.

• Same-day GP or sexual health clinic: bleeding with fever, severe pelvic pain or foul discharge.

• Urgent GP: persistent or recurrent bleeding after sex, or any bleeding after menopause.

• Routine GP or sexual health clinic: a single light episode, if you are up to date with screening.

The doctor asks how often and how much, relation to the cycle, discharge, pain, contraception, partners, previous infections, smear history, menopause, and pregnancy status. They perform an abdominal and speculum examination to look at the cervix, take swabs and may do a smear if due.

• Swabs for chlamydia, gonorrhoea and other infections.

• Cervical screening (smear) if due or overdue.

• Pregnancy test where relevant.

• Colposcopy: a magnified examination of the cervix if the cervix looks abnormal or screening is abnormal.

• Pelvic ultrasound, hysteroscopy or biopsy for persistent bleeding.

Use water-based lubricant, avoid intercourse until assessed if bleeding is heavy or painful, and attend cervical screening when invited. Complete treatment for infections and ensure partners are treated. Condoms reduce infection risk. Keep a note of bleeding episodes, timing and any associated symptoms.

The NHS route is a GP or sexual health clinic, with colposcopy under the gynaecology pathway if needed. Private gynaecology offers direct access to examination, swabs and colposcopy.