Check-Up: Unpleasant bleeding after sex
Ms Kidd is a 47-year-old woman who writes Check Up from a Kingston address and wishes us a blessed day. She gives a detailed history of her health problem, and she would like us to explain what it means.
Three years ago, she began to notice a small amount of bleeding from her vagina after sexual intercourse. She was seen by a doctor at a Kingston hospital, who did a Pap smear and a pelvic ul trasound. The results came back negative for any disease. However, because they said they saw an inflammatory red spot on her cervix, she was scheduled for minor surgery and her cervix was ‘scraped’. The scraping could have been one of several procedures used to remove a suspicious area seen on the cervix or in the womb, like curettage, colposcopy with biopsy or cryosurgery.
All went well for a while. The problem seemed resolved, and Ms Kidd was very happy.
But, of late, the same bleeding is happening again, and she is seeing a little blood two out of three times that she has sex. Ms Kidd asks Check Up to help her, as this is a very embarrassing problem.
Bleeding after sex (post-coital bleeding) can affect women of all ages and stages, menstruating women, as well as post-menopausal women. Bleeding after sex can come from several sites located near to the female genitalia, including the cervix, uterus (womb), labia (outer genital lips) and urethra (urine tube). When this bleeding occurs, it is important to rule out cervical cancer. This was done years when she did a Pap smear.
However, very often, post-coital bleeding is likely to be caused by a common condition, like womb infections (pelvic inflammatory disease); inflammation or infections of the entrance to the womb (cervicitis); vaginal infections (vaginitis); sexually transmitted infections (STIs); and vaginal atrophy or vaginal dryness.
Vaginal atrophy and dryness occurs eventually in most post-menopausal women, which will include women who have had their ovaries removed.
As women age, their bodies produce less and less oestrogen (female hormone), and it’s this hormone which provides the vagina with lubrication and keeps the vaginal walls plump. Without oestrogen, the vaginal walls tend to become thinner. These conditions can lead to dryness and discomfort with sexual intercourse and even bleeding. At age 47, Ms Kidd could be nearing menopause or is even menopausal, and this condition could be affecting her.
When post-coital bleeding is due to vaginal dryness, using water-based or silicone-based vaginal lubricants can help to solve this problem. Apply this often, and every time before sex. Please don’t use Vaseline, as this can damage latex condoms!
Also, when vaginal dryness is caused by menopause, prescribed oestrogen vaginal inserts can be used for a short time to help the condition settle down by building up the vaginal walls and helping with local lubrication.
In addition, a woman can use supplements to reduce vaginal dryness. Black cohosh, evening primrose, omega-3 and vitamin E are just some of the herbal supplements proven to help some women lessen vaginal dryness.
There are also other situations which can lead to bleeding after sex.
n Some medications, including anti-histamines, asthma medications, steroids, sedatives, anti-depressants and even some anti-hypertensive medications, can cause vaginal bleeding as a side effect of taking them, so check this out.
n Douching is not to be encouraged as it alters the flora (natural bacteria and fungi) in the vagina which can cause infections, resulting in vaginal bleeding.
n Cervical polyps, which are non-cancerous growths.
n Vigorous sex can cause small cuts and tears to the vaginal wall, especially if the vagina is already dry and thin due to approaching menopause.
n Cervical, vaginal or uterine cancer must be considered, as irregular vaginal bleeding is the symptom with which 11 per cent of women with the disease first present with. If Ms Kidd’s last Pap smear was more than one year ago, she should repeat the test now.
Some younger women naturally bleed a small amount after vigorous sex, and this can be normal for them. But when this occurs, it should not be ignored initially. The genitalia should be examined and a Pap smear done. However, when vaginal bleeding occurs after menopause, you should not hesitate to see your doctor immediately.
Too many ladies are overweight, and this puts them at risk of endometrial (uterine) cancer, while being infected with the human papillomavirus is associated with a greater risk for cervical cancer. All women ages 25 to 64 should get regular Pap smear screening tests to help prevent cervical cancer or to diagnose it when it is in the early stages and curable.
Also, for the menopausal and postmenopausal women, it may also be useful to include foods rich in plant phytoestrogens in your diet, as phytoestrogens mimic female oestrogen. Some of these foods include oats, lentils, flax, almonds, walnuts, olive oil, apples, grapes, alfalfa, carrots, sunflower seeds and sesame seeds. Sex may be happier!
Write Check Up: PO Box 1731, Kgn 8