Most of the time, there’s no reason to panic. “Bleeding after sex during pregnancy is quite common,” says Dustin Costescu, an OB/GYN in Hamilton. “This is a normal variation for most women in most instances. It’s normal for half of my patients to present with spotting or bleeding related to intercourse at some point throughout their pregnancies.”
If you experience bleeding after sex during pregnancy, your healthcare provider will want to know details like when it started, how long it lasted, if it was light or heavy, if there were clots, what colour the blood was and if you experienced pain.
If you experience light bleeding, or spotting, after sex, you’ll see pinkish, reddish or brownish blood on toilet paper when wiping, in your underwear or on your panty liner. It is very light, isn’t painful and doesn’t last long. This is likely because your cervix changes during pregnancy and may become more sensitive and more likely to bleed if it’s bumped during sex or during an examination from your doctor or midwife.
Early on in pregnancy, about a week after conception, you can have implantation bleeding, where the embryo burrows into the lining of the uterus and causes light bleeding. After sex, vaginal mucus and semen can carry some of this implantation blood out of the vagina.
An untreated sexually transmitted infection, such as chlamydia and gonorrhoea, or a yeast infection can cause spotting. Usually, a yeast infection will have additional symptoms, such as itching and irritation. Your healthcare provider can do a simple urine test or vaginal swab to diagnose an infection. It’s important to seek treatment right away to keep you and your baby healthy.
Polyps, or small growths, on the cervix are usually benign and can be related to higher estrogen levels during pregnancy. They can cause bleeding after sex, whether you’re pregnant or not, so it’s a good idea to be up to date on your cervical screening and Pap test.
Dryness, which can lead to tiny tears in the vaginal wall, is another possible source of spotting. “Some people experience hormonal changes in late pregnancy, which can lead to uncomfortable intercourse,” says Costescu, “but there is usually more lubrication in pregnancy, so this is not a common scenario.”
In all of these cases, it’s a good idea to talk to your healthcare provider as soon as possible to figure out what’s going on, but it’s not an emergency.
During weeks 20 to 37, light bleeding, or spotting, accompanied by contractions, cramping, low backache, feelings of pressure in the pelvis or a watery or bloody vaginal discharge (which could mean that you are leaking amniotic fluid), could be a sign of preterm labour, so be sure to contact your healthcare provider right away. Sex doesn’t cause preterm labour in a typical pregnancy, but if you are at risk of preterm labour, your doctor will recommend that you avoid sex.
Less often, bleeding after sex during pregnancy can be a sign of something more serious. “If the bleeding is enough to fill a pad, you should seek medical attention, particularly if it’s associated with abdominal pain,” says Costescu.
The placenta nourishes your baby inside the uterus during pregnancy. If you experience placenta previa, the placenta is partially or completely covering the cervix, which can lead to heavier, bright red bleeding. While sex doesn’t cause placenta previa, it can trigger bleeding. Placenta previa can be diagnosed with an ultrasound scan.
Another serious condition is placental abruption, where the placenta has a small tear and separates from the uterus before birth, causing bright red bleeding and, often but not always, abdominal pain. “Intercourse doesn’t cause placental abruption, but there may be small amounts of blood trapped in the uterus that are dislodged by intercourse,” he says. In both placenta previa and placental abruption, your healthcare provider will recommend avoiding sex for the rest of your pregnancy.
Heavier, bright red bleeding and pain can also be a sign of miscarriage in the first or second trimester. Remember, though, that sex does not cause miscarriage—bleeding could just happen to coincide with intercourse. “Bright red blood is more worrisome than brown or really dark red blood, which signifies older blood,” says Costescu. “This may still need to be looked at, but it’s less of an emergency.” An ectopic pregnancy, where the fertilized egg implants outside of the uterus (usually in a fallopian tube), can cause light or heavy bleeding and pain in the first trimester and needs quick medical attention (and again it’s not associated with intercourse).
“Overall, sex during pregnancy is common and safe,” he says. If you and your partner are comfortable with it and your doctor gives you the green light, go on and get busy (because there will probably be less sex in your future after the baby is born!).