Short answer
Bleeding after sex signals a vulnerable surface, infected, polypoid, ectropic, dry, dysplastic, or pregnant, and the evaluation covers STI testing and cervical assessment together, because the cause list genuinely spans both.
Pregnancy status sets urgency first (any bleeding in pregnancy gets prompt obstetric assessment); then speculum examination, NAAT testing, Pap/HPV status review, and ultrasound for structural sources sort the rest.
Most causes are benign and fixable; a minority are serious and time-sensitive. Evaluation distinguishes them quickly.
Continue with Bleeding After Sex: Potential Causes and STI Testing After Sexual Assault: Supportive Care for the directly connected guidance.
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See Tests & Prices →Causes at a glance (triage view)
- Chlamydia/gonorrhea cervicitis: friable cervix bleeding on contact, often with discharge; exposure history present.
- Trichomoniasis: irritation and discharge alongside.
- Cervical polyps: benign growths bleeding with contact, removed in office procedures.
- Ectropion: glandular cells on the outer cervix (common with pills, pregnancy, youth) bleeding easily but harmlessly.
- Atrophic vaginitis: dryness-related bleeding, mainly postmenopausal.
- Cervical dysplasia/cancer: persistent bleeding, especially with overdue screening. The reason screening history is always reviewed.
- Vaginal lesions, anticoagulant use, trauma: history reveals.
- Pregnancy-related causes: from benign cervical bleeding to miscarriage and placenta issues. Obstetric protocols take over.
What the workup involves
Pregnancy test first (changes everything downstream).
Speculum examination mapping lesions, discharge, and friability.
NAAT testing for STI causes. Pap/HPV status review with colposcopy per findings. Overdue screening magnifies concern and accelerates workup.
Pelvic ultrasound for structural sources (fibroids, polyps, retained products).
Each element rules a category in or out; together they complete the picture in a single visit.
Management matched to cause
Antibiotics with partner care for infectious causes.
Polypectomy for polyps (minor office procedure).
Observation or ablation for ectropion. Moisturizers or vaginal estrogen for atrophy.
Excisional procedures for precancer with fertility counseling.
Obstetric management for pregnancy-associated bleeding.
The breadth of treatments is exactly why accurate diagnosis precedes all of them. And why “probably nothing” is never the endpoint without evaluation.
When to seek care
Promptly for any new persistent postcoital bleeding (days, not months).
Urgently for heavy bleeding (soaking protection hourly), any bleeding in pregnancy, faintness, severe pain, or known precancer/cancer history.