Almost any bleeding during pregnancy should be evaluated, even if it isn’t accompanied by pelvic pain, abdominal pain or contractions. This can help prevent complications like ectopic pregnancy and placental abruption.
The most common reason for spotting after sex is due to hormonal changes, such as increased levels of progesterone, which cause blood vessels in the cervix to grow larger and more fragile. Light spotting also can be caused by implantation, which occurs when a fertilized egg attaches to the uterine lining.
Light Bleeding
During the first trimester, light bleeding after sex is normal and nothing to worry about. It’s referred to as spotting and typically resembles the colour of your period. It can occur when the fertilised embryo burrows into the lining of the uterus (implantation bleeding). The lining usually sheds, or ruptures and vaginal mucus and semen carry some of the blood away. It can also happen if the cervix is irritated by an infection, an inflammation or growths on the cervix. Using lubricants can reduce the frequency of this type of bleeding.
The cervix can become sensitive as the pregnancy progresses, so it’s more likely to bleed if you have intercourse or bump your uterus with your hand or when getting up or sitting down. It’s also more likely to bleed if you have a condition called placenta previa, where the placenta covers the cervix. This is more serious than spotting and can cause heavier, bright red bleeding.
If you have this type of bleeding, tell your doctor or midwife about it. They will want to know when it started, how long it lasted, if you had any pain and what the colour of the blood was. This helps them decide whether the bleed is caused by sex or something else. They may suggest a pelvic examination or a pap smear to find out what’s happening.
Medium Bleeding
Spotting or light bleeding after sex when pregnant can happen for a number of reasons. During the first trimester, it is often due to implantation bleeding – which occurs when a fertilized egg attaches itself to the lining of your uterus – and can occur around the same time as or shortly after having sex. This spotting may be pink, very light red or brown. It is usually not painful and there is no reason to panic. It is important to use pads instead of tampons and to keep track of how much you are bleeding and when you bleed so that your doctor can be aware and check for anything that needs to be treated.
Bleeding that is bright red and heavy can be a sign of placenta previa, which happens when the placenta covers part or all of your cervix. This condition is not related to sex but can cause pain and require medical attention.
It is also possible that the cervix has gone through a remodelling process in preparation for your baby’s arrival, which can cause light bleeding and spotting. It is important to use pads to keep track of how much you are bleeding, when and how often, and to save any clots or tissue that you pass so that your doctor can examine them.
Heavy Bleeding
Bleeding can occur after sex while pregnant, but it is not always a sign of trouble. Light bleeding usually results from the fertilized egg attaching to the uterus lining, and occurs in about 25% of pregnancies in the first trimester. It may also be a sign of cervical ectropion, which is when the cervix inverts and can cause a bleed if bumped during intercourse. Light bleeding can also result from a pelvic exam or ultrasound because the cervix becomes more tender during pregnancy, as well as sexually transmitted infections like chlamydia, gonorrhea and genital warts.
Medium bleeding is more worrisome because it can mean a missed period or miscarriage. Heavy bleeding is an emergency and requires a trip to the hospital right away. If you have bleeding, make sure to save any clots or tissue for examination. Your doctor will likely order an ultrasound of your cervix to see what’s going on, and probably recommend bed rest until it passes.
Very rarely, your bleeding could be a sign of a low-lying placenta (placenta praevia), which can also cause severe vaginal pain and is an emergency that requires immediate care. Bleeding in the second trimester can also be a sign of a uterine polyp, or cervical cancer, which can require treatment with antibiotics. Depending on what you find, your doctor will advise you about further treatment and if it is necessary to abstain from penetrative sex for the rest of your pregnancy.
Miscarriage
In rare cases, bleeding after sex could be an early sign of a miscarriage. This is more likely to occur during the second trimester, and the cause would usually be a problem with your placenta or uterine wall. If you have heavy bleeding that fills a pad every hour, and it’s accompanied by cramping and pain, then this is a medical emergency and you should seek immediate treatment.
Other serious causes of bleeding include a low-lying placenta (placenta praevia), or ectopic pregnancy (when the fertilised egg implants outside the womb, usually in one of the fallopian tubes). These can be life-threatening for both you and your baby.
Bleeding can also occur due to cervical polyps, which are small benign growths on the cervix. They are often triggered by increased levels of the hormone progesterone during pregnancy and can affect women of any age.
Having penetrative sex can increase your risk of having an abnormally shortened cervix, which is called cervical incompetence. This can also lead to miscarriage, and so your doctor may ask you to avoid sex until they see a normal ultrasound of the cervix. They may also suggest a procedure called cerclage, which involves stitching the cervix closed. This can help prevent a miscarriage or early delivery. They may also want to wait and monitor your cervix for further signs of problems.
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