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What can cause bleeding during sex?

Asked by Katressa, Birmingham, Alabama

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I have been bleeding during sex. An ER doctor I saw said it could be precancer cells. I am just wondering what causes these cells. Why does it happen, and what are the symptoms? I don't have a gynecologist because I lost my insurance.

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Living Well Expert Dr. Jennifer Shu Pediatrician,
Children's Medical Group

Expert answer

Thank you for your question, and I'm sorry to hear about your situation. To best help you, I consulted with Dr. Jennifer Gunter, an ob/gyn at Kaiser Permanente in San Francisco, California, and author of "The Preemie Primer: A Complete Guide for Parents of Premature Babies -- from Birth through the Toddler Years and Beyond." She shared the following information:

Bleeding after sex, also called post-coital bleeding, is a symptom that should not be ignored because it can be a warning sign of several serious conditions. Conditions that can cause bleeding after sex include the following:

1) Precancer (dysplasia) or cancer of the cervix. Most precancers and early cancers do not bleed, but it is very important to rule this out. A Pap smear is recommended, and for women over 30, an HPV test should be done. HPV (the human papillomavirus) is the virus that causes cervical cancer. Most Planned Parenthood clinics or county health departments can perform a Pap smear and HPV testing at a lower cost than a doctor's office. In some cases, the doctor may also want to take a scraping from the inside of the cervix (called an endocervical curettage) to rule out any abnormalities that are out of reach of the Pap smear. For students, many student health clinics also do Pap smears.

2) Women over 35 should also be evaluated for precancer and cancer of the uterus. For most women, this will include an endometrial biopsy. This type of biopsy takes a sample of cells from the lining of the uterus and is a simple office procedure. This test may also be available at a reasonable price at a local Planned Parenthood clinic. Obesity can be a risk factor for cancer of the uterus because fatty tissue makes the hormone estrogen, which has an important role in the development of endometrial cancer. Some doctors might recommend an endometrial biopsy for women who are younger than 35 if they are overweight.

3) Chlamydia and gonorrhea, two sexually transmitted diseases that cause infection of the cervix, can also cause bleeding after sex. It is wise to get tested for these infections. This can be done with a swab from the cervix (during a pelvic exam) or even with a urine test. Testing for these diseases at Planned Parenthood, but most counties have low-cost or no-cost testing for sexually transmitted diseases. The U.S. Centers for Disease Control and Prevention can help you find the closest clinics.

4) Finally, a common and harmless cause of bleeding after sex is a condition called a cervical ectropion. What this means is that the cells normally found on the inside of the cervix are growing on the outside of the cervix. When these cells are on the outside, they can become irritated and inflamed by the higher acid content of vaginal secretions and can bleed when touched (such as during intercourse or with a Pap smear). A cervical ectropion is easily seen during an exam with a speculum (as during a Pap smear). Sometimes this condition can be aggravated by high estrogen levels, so women who are on the birth control pill may benefit from switching to a pill with lower estrogen levels, or switching to a non-estrogen form of birth control, like an intrauterine device, can help.

I hope this information is helpful and wish you the best of luck.

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