I have a cervix and I bleed after sex

Hello. Hello. Welcome. You’re listening to Dr. Martha Reid at Doctors Choice Integrative Medicine in downtown Vancouver. A space where I bring passion, inspiration and nourishment to the conversation of your health.

Today, I would like to talk about a really fascinating topic to me: why we bleed after sex.

This is going out to all those human beings that happen to have a cervix, a uterus, and a vagina. And this topic came up yesterday, actually, when I was working with one of my patients who identifies as a woman and uses the pronouns, “she” and “her”.

We were doing a pelvic exam, which for many of you, you may know of it as the pap test. And it’s just a standard medical procedure to assess the health of the cervix and to ensure that we’re preventing deleterious conditions like cervical cancer. So this particular patient of mine had the question: why do I bleed after vaginal intercourse? This has always happened and I don’t understand why. Can you tell me if it’s normal? Is there anything you can see while doing my pelvic exam that might give hints if this is OK or not? 

And I said: absolutely! Let’s talk about that. So, first off, (and this is before we began the pelvic exam), I said, first off, there are a number of different reasons why you might bleed with vaginal intercourse:

One of those reasons could be an STI or a sexually transmitted illness. And that would be a wise thing to rule out. So that led to the questions: is this a new partner for you? Have you and or your partner had STI testing when it comes to bleeding post vaginal intercourse? The cervix is often involved in this, and if we’re talking about STIs, it could be a concern around chlamydia or gonorrhea because that creates inflammation of the cervix.

So, we talked about whether that could be a possibility and why don’t we get that tested and roll that out. In this particular case, that had already been rolled out. OK, so then that becomes another question of, well, perhaps there is a growth on your cervix called a polyp.

Well, would you be able to see that when you check my cervix with the pelvic exam?

I said, yeah, absolutely! We can almost always see a polyp. Sometimes they are internal to the cervical opening, but we can often see them on the surface if they’re there, so we can check for that. I said another area that might be an issue of concern would be what is called fibroids or endometriosis, which are concerns that it can occur due to having a uterus and so both of these are different concerns, but they can contribute to vaginal bleeding when you’re not having a menstrual cycle and that can occur after intercourse.

So I said, Do you know if you have a known history of either endometriosis or fibroids? And she said, “no, that’s, that’s been ruled out too”. And I said, OK, so we don’t have STI going on, we don’t have fibroids or endometriosis, we may have a cervical polyp which will hopefully in doing your pelvic exam, get an ability to look for it may be due to a side effect of your birth control.

Are you using a contraceptive method? And this particular patient said, “not at this point, but in the past, yes, I had used oral contraceptives and I’ve also used IUDs” and I said, well, okay, both of those could result in bleeding after vaginal intercourse with the birth control. You might get what’s called a “breakthrough bleed” where you could be having spotting that is outside of your menstrual cycle. That isn’t necessarily always associated with vaginal intercourse, but if you’re getting breakthrough bleeding as a result of the hormones on your pill, (and you happen to be having casual intercourse at the same time), then that could result in the spotting if you had an IUD in, depending on when it was inserted, i.e. how long ago, what type of IUD, whether that insertion is in the right place for you… all of that can contribute to whether you might spot throughout your cycle, and that could be associated with vaginal intercourse.

Well, at this time, this patient isn’t using oral contraceptives nor do they have an IUD, and yet the bleeding is occurring after intercourse. So we’ve ruled that out as a concern. So, then there are three other things to think about.

One would be friction with intercourse: is there enough lubrication vaginally so that the tissues that are quite fragile in that area aren’t being damaged? And, if you’re not getting enough lubrication, that may be that you need to be taking a little bit more time with your partner or with your activities to ensure that your body is is secreting the fluids there to really engage in a comfortable sexual experience. Or potentially using a lubricant to support yourself so that those tissues aren’t becoming damaged. So friction can be a common cause of bleeding with intercourse.

A more scary cause for many of us would be cancer, right? So cervical or uterine cancer could be a cause of bleeding with intercourse. And the pelvic exam known as the PAP is a really great way to assess for cervical issues in particular. And if that were to come back clear and all the other causes are ruled out, then we would look further for any cause of uterine cancer and rule that out.

The last issue could be what’s called an ACC Ectropic Cervical Transition Zone, which most people have never heard of and have no idea whether they have one of these. So that ultimately is going to end up being the main focus of the rest of this little talk. Because with this particular patient, we have ruled out other than the polyp and other than uterine cancer. At this point, we have ruled out whether this patient has fibroids or endometrial cysts or STIs. Friction is not a concern that they feel they have and they are not using any of the birth control methods.

So, do they have this ectropic transition zone or is there a potential for cancer? So we went into doing the pelvic exam and using the speculum. If anybody has had a vaginal exam before, you know that it’s that sort of big like bill-like tool that we use that is inserted vaginally and then it’s turned and then it’s open and click, click and then the practitioner will do a scraping of the cervical surface using different tools to take those cells, put them on a slide that gets sent off to the cancer agency and they determine whether those cells are developing normally. As the practitioner in the position using the speculum, we have a little light that we can see up through the vaginal canal to the cervix at the end and we see the cervical surface and the cervical surface. It’s a really interesting organ, actually. It presents in a couple of different ways.

When you have mature cells on your cervical surface, the surface is smooth, it looks like a dome, and then there’s an opening at the center of the dome that, depending where you are in your reproductive cycle, will determine whether that opening is fully open or totally closed down. If you are approaching an ovulation, (if you are a human being that ovulate and releases an egg monthly), then your cervical opening will be wide, open, round, wide open. There’ll be this lubey, egg-white quality cervical fluid that you’re releasing at the time you’re nearing ovulation. When you are not near ovulation, that opening is totally closed down and there’s not really a lot of cervical fluid on the surface of the cervix.

So this surface, where it’s smooth and it’s kind of a pearly pink color, is when there are mature cells on the surface of your cervix with someone who has what’s called that ectopic cervical transition zone, it means that the surface cells are immature, they’re baby cells that are on the surface. They haven’t matured yet so they’re really vulnerable and they’re a little bit raw.

And it’s really when you look at it through the speculum, it’s quite often really bright red and it looks quite irritated. And that surface type is more common than one might realize.

When I was in medical school, my understanding was that it was relatively rare. Maybe, you know, 20 percent-ish of the population of people with cervixes would have what is called this “ectropic transition zone”, but other than that, it would be internal and you see this pearly surface. In my clinical practice, I see these ectopic transition zones a lot more than just 20%, and I do an incredible amount of pelvic exams in my practice. And so this ectopic transition zone, it’s raw, raw, raw tissue, and if it’s getting bumped with vaginal intercourse, then it will bleed.

It will bleed when I just do the pelvic exam, and the scraping of the cervix or cervical cells. So with this particular patient that was in with these concerns, she had an ectopic transition zone and in just doing the pelvic exam there was bleeding and spotting. So it’s quite likely that that is the underlying cause as to why she bleeds post intercourse. Of course, we’re going to look in and rule out that there is any potential for uterine cancer. No other hints of that with this particular patient, so that’s pretty good, but we’ll rule that out anyway. But for her, as she expressed to me after we had this conversation and we finished her pelvic exam she said it was so relieving to understand that the surface of her cervix had this transition zone of baby immature cells on the surface, not internal.

So it was just more vulnerable; what she’s been experiencing for many, many years in her life is absolutely normal for her. And she expressed that it was just so relieving to know that this isn’t an area of concern. She had been sort of querying this for so long and holding this information inside herself, thinking there was something quite wrong with her cervix or with the way her body functioned during intimacy. And she just was so excited to know that, hey, I am 100% okay in this regard and in very good hands, knowing that if there are any concerns, they’re going to be looked at and ruled out and if they happen to be a concern, they’ll get addressed.

So for all of you out there who happen to be listening to this podcast today, if you have had the experience of vaginal intercourse and you bleed afterwards and you happen to have a cervix and you don’t know if what is going on is okay for your body, see your health care provider of choice, have that really open and honest conversation with them, do a pelvic exam if you haven’t yet and find out whether or not you have polyps, whether or not you’ve got this ectopic transition zone. Discuss whether friction or STIs or endometriosis or fibroids are at all an area of concern for you. And if you would like, in any way, to talk about this further and would like to speak with me, by all means, please just hop over to the website www.doctorschoiceintegrative.com to book a discovery call. I’d be happy to discuss the generalities of this with you.

And by all means, if you’d like to book in as a patient to discuss things further, we’re happy to happy to meet.

Have a really great day and thanks so much for listening!