TRIGGER WARNING: This post discusses pregnancy loss and miscarriage.
The sight of blood can freak people out at the best of times, particularly if they're pregnant. However, if you find yourself bleeding during or after sex while pregnant, try not to panic.
As difficult as it might be, there are multiple reasons why this could be happening and some of them are extremely normal.
Here we look at the ins and outs of having sex while pregnant, including whether bleeding is normal or cause for concern.
Can having sex while pregnant cause bleeding?
The short answer to this is both yes and no. If care is taken, penetrative vaginal intercourse does not necessarily cause bleeding by itself.
However, a large number of women experience bleeding after sex while pregnant for a number of very normal reasons. These can include:
- Injury (e.g. vaginal lacerations, such as those caused by rough sex or vaginal dryness);
- Hormonal changes;
- Aggravation of the cervix (e.g. via deep penetration), and/or
- Cervical polyps.
Any normal bleeding caused by sex should be a light spotting as opposed to heavy or prolonged bleeding.
Spotting is not always considered cause for concern, although it's always safest to see your doctor if any vaginal bleeding occurs during your pregnancy.
Is bleeding after sex while pregnant normal?
Bleeding after sex while pregnant is considered common and may not be cause for concern. The Royal Australian College of General Practitioners reports that as many as 20-40% of women experience vaginal bleeding during their first trimester [1].
The reason bleeding is so common during pregnancy is largely due to hormonal and bodily changes. Due to these changes, any penetrative act — from a pap smear to sexual intercourse — can potentially result in light bleeding.
Bleeding after sex during pregnancy
Bleeding after sex may signal different things at different stages of a pregnancy.
Many of these are unrelated to the act of sex itself. Nevertheless, we've included a few common causes of bleeding to be aware of if you are concerned about bleeding after sex.
Note: bleeding after sex while pregnant can occur for any number of reasons. Those discussed below are only a handful of examples, and any bleeding should still be discussed with your doctor.
Bleeding after sex: The first trimester
Bleeding is common during the first trimester (the first 12 weeks of pregnancy). In fact, 1 in 4 women may experience bleeding in early pregnancy [2].
Here are some other, common reasons you may be bleeding during weeks one to 12.
Implantation bleeding
Implantation bleeding describes the spotting that can occur when a fertilised egg attaches to the lining of the uterus. This happens approximately 8 or 9 days after conception or 6-12 days after you ovulate, depending on when you've conceived during your cycle.
Implantation bleeding is not likely to happen immediately after having sex, unless by coincidence. It is also not a cause for concern.
Hormonal changes
Hormonal changes during the first trimester are a key reason you're likely to experience bleeding. Around the 7-week mark, pregnant women experience a 'luteal-placental shift' as the placenta develops to support the pregnancy [3].
This luteal-placental shift results in your body making less progesterone, which is what would usually trigger a regular period [4]. Even when pregnant, this can similarly result in breakthrough bleeding.
While some experience this as spotting, others may notice heavy bleeding akin to a regular period. This type of bleeding is not considered a cause for concern.
Ectopic pregnancy
Ectopic pregnancy describes when a fertilised egg implants itself outside of the uterus, typically in the fallopian tubes. While treatable in some cases, it can also be extremely risky for both parent and child.
Diagnosis is likely to occur in an early ultrasound, but if bleeding occurs, it could be an early warning sign to get a check-up. Bleeding due to ectopic pregnancy is not related to sexual intercourse.
Pregnancy loss
While miscarriage can occur at any point in a pregnancy, it is most likely to occur in the first trimester. Pregnancy loss is fairly common and thought to occur in as many as 1 in 5 confirmed pregnancies [5].
The Royal Womens Hospital of Victoria suggests the actual figure is much higher, as most miscarriages occur within the first 12 weeks and many women may have been unaware they were pregnant [5].
A miscarriage is often defined as pregnancy loss occurring before 20 weeks gestation. There are different types of miscarriages and symptoms vary.
Bleeding can range between light to heavy, and the blood can differ in colour from red to brown or pink. You may also experience some cramping. It's important to note that miscarriage and related bleeding is not caused by sex.
Bleeding after sex: The second trimester
Light bleeding after sex during the second trimester (weeks 13-28 of your pregnancy) is most likely related to increased blood cell activity around your cervix.
Cervical changes and irritation
Bleeding during pregnancy is common largely due to increased blood cells around the cervix. As deep penetration can irritate the cervix, it may result in an increased chance of vaginal bleeding while pregnant.
Any contact with the outer cervical opening, such as during a pap smear or other vaginal swab, can cause bleeding for the same reason.
It can also be common for cervical polyps to develop during pregnancy which, if aggravated, will result in bleeding. Cervical polyps are not commonly cause for concern. It is important to note that any bleeding caused by contact with your cervix is likely to be light spotting, unless a serious injury has occurred.
Heavy bleeding may be a a sign something else is wrong.
Placenta previa
A key sign of placenta previa [6] — when the placenta grows to cover the pregnant person's cervix — is painless, spontaneous vaginal bleeding after 20 weeks gestation.
It is likely to involve heavy, bright red bleeding. However, some people do not experience symptoms at all. Diagnosis of placenta previa is likely to happen during a routine ultrasound.
Depending on your personal history and the severity of the issue, complications can arise and you may be advised to abstain [7]. Having said that, bleeding due to placenta previa is sporadic and not related to sexual intercourse.
However, bleeding may worsen or be triggered by vaginal intercourse, especially if deep penetration occurs.
Bleeding after sex: The third trimester
During the third trimester, the cervix continues to soften and will eventually dilate in the lead-up to labour. Be mindful of these causes for bleeding:
Placental abruption
Placental abruption can be the cause of bleeding but is not caused by having sex. Therefore any bleeding due to placental abruption may occur spontaneously (at any time) as well as after sex.
A placental abruption is when the placenta becomes detached from the uterine wall. It is a serious complication and can occur at any time after 20 weeks but is most typical during the third trimester.
Vaginal bleeding is the most common symptom but can be accompanied by abdominal pain and other symptoms [8]. Mild placental abruptions can be managed and monitored, often resulting in a healthy birth for mother and child.
However, moderate to severe cases can be much higher risk and may require medication or immediate delivery, depending on the gestational term.
Your doctor may advise you to abstain from sex during pregnancy if you have suffered a placental abruption.
Dislodging the mucus plug, AKA 'the bloody show'
The 'bloody show' describes when the mucus plug is released from your cervical opening. This usually occurs after 37 weeks and can be aggravated by penetrative sex during this time.
During pregnancy your cervical opening is plugged with mucus, acting as a barrier to prevent infections or bacteria reaching the foetus. Towards the end of your pregnancy, the cervix will start dilating and the mucus plug will fall away.
This can happen all at once or gradually and results in a mucous discharge, tinged brown or pink due to blood. It should be noted that losing your mucus plug does not automatically mean you're in labour.
Your cervix can start dilating weeks before the baby's arrival. However, if too much is dislodged too early, it can present issues. While sex is not a 'cause' of the bloody show, it can work to further dislodge the mucus plug.
Regardless of whether or not the bloody show has begun, penetrative acts at this time of pregnancy should be done with care. If you believe you are losing your mucus plug prior to 37 weeks, see a doctor.
Is sexual activity safe during pregnancy?
Sexual activity is considered safe during pregnancy [7]. There are, however, some instances where sex during pregnancy is not be recommended.
These may include:
- If there is a history of preterm labour;
- In some instances of multiple births (carrying twins, triplets etc);
- The presence of other complications (such as placental abruptions, placenta previa and more).
Having said that, a lot of people are fearful of sex during pregnancy and many of those fears are unfounded. For example, one major concern is that it will induce preterm labour. While there is some evidence of sexual arousal having this effect, it is rare.
In fact, studies investigating the relationship between sexual activity and preterm labour found that sex does not cause preterm labour and does not result in an increased risk [7].
However, complications related to sexual activity, such as STIs or bacterial infections, may have this effect. To protect against STIs and other infections, condoms are still recommended during pregnancy.
You can also practice the many forms of sex that do not require vaginal penetration. As every person is different, always seek medical advice to discern whether sex is safe during your pregnancy.
Can you prevent bleeding after sex during pregnancy?
You can help prevent bleeding after sex during pregnancy by not engaging in rough penetrative sex. Be mindful that sex does not exclusively mean penetrative, vaginal intercourse.
There are many forms of sexual activity that are equally or more pleasurable for the participating parties. Couples engaging in penetrative vaginal sex are encouraged to be slow and gentle, and review sex positions or acts that are less likely to cause harm or pain.
The takeaway here is to go easy when having sex when you're pregnant and consult with your doctor if you're not sure about anything at all. They are the expert and will be able to guide you on what is best.
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