If you’re not on your period, bleeding after sex can be scary. But research suggests many women experience it in their lifetimes. Up to 9 percent of premenopausal women report postcoital vaginal bleeding, and that number shoots up to 63 percent for menopausal women. In premenopausal women, bleeding usually comes from the cervix; however, it can come from the uterus, labia, or urethra, too.

Even though it’s relatively common, any abnormal bleeding is something to discuss with a doctor.

“Anytime someone starts to experience bleeding after sex for the first time and hasn’t been evaluated before, they should definitely get it evaluated, because there are some concerning things that can cause bleeding after sex,” says Dr. Kelly Culwell, an OBGYN and former medical officer at the World Health Organization.

So, what are some of those things? Here’s what you need to know:

Infections
Research has linked certain infections to postcoital vaginal bleeding. Pelvic inflammatory disease, which is an infection of the reproductive organs, can cause bleeding. Sexually transmitted diseases, like chlamydia, can also cause bleeding. “It could either be an infection of the cervix that’s causing the bleeding,” Dr. Culwell says, “or it could just be completely normal.” But any abnormal bleeding can be the sign of a serious illness and should be checked by a physician.

Vaginal tearing
Bleeding can also be caused by friction during sex, tears caused by childbirth, or vaginal dryness, the latter of which increases as women age. “In older women, the lining of the vagina gets thinner, and it would be more likely to cause some little microscopic tears or bleeding in the vagina.”

Cervical or endometrial polyps
Polyps, or non-cancerous growths in the womb or cervical lining, can become irritated from sex and cause bleeding as well. “A polyp inside the uterus is usually completely benign and not a big deal. There can also be polyps of the cervix, which are also completely benign, but they can cause spotting,” Dr. Culwell says.

Cancer
Serious conditions like cervical, vaginal, or uterine cancer can also cause irregular vaginal bleeding. “It could also be a sign of precancerous changes of the cervix, or even in very extreme situations, cervical cancer, although that would be very, very rare. But those are definitely reasons that you should be evaluated,” Dr. Culwell says. “Other extremely rare causes would be cancer of the lining of the uterus or endometrial cancer, but that would really be in older women.”

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