Did you notice some bleeding or spotting after pregnancy sex? Find out the possible causes, and learn when to see a doctor.

Pregnancy sex has a host of benefits, ranging from lowered blood pressure to increased intimacy in your relationship. But what if you have a romantic night with your partner and notice some blood on the toilet paper afterwards? The panic will probably set in immediately: What happened? Did I hurt the baby? Could I be miscarrying? 

Before you make a beeline for the hospital, it’s important to realize that bleeding after sex while pregnant could be normal, says Mary Jane Minkin, M.D., a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine. In fact, 15–25% of women experience vaginal bleeding in the first trimester, according to the American College of Obstetrics and Gynecology (ACOG)—and those brown or red specks of blood are usually harmless. 

The most common cause of bleeding is related to your pregnancy hormones. Levels of progesterone rise throughout gestation, and this tends to make blood vessels enlarge and become more friable (easily traumatized). Intercourse might cause a vessel on the cervix to be injured and start bleeding, especially if the cervix comes in contact with your partner’s penis. This will not affect or endanger your pregnancy, but switching up sex positions may resolve the issue. Try spooning, rear-entry positions, or sitting on top of your partner. 

Other non-worrisome causes of bleeding during pregnancy sex include vaginal dryness or cervical polyps. What’s more, implantation bleeding sometimes happens when the fertilized egg attaches to the lining of the uterus—usually 10 to 14 days after conception. Implantation bleeding appears inconsistently for hours or days, and it’s usually tinged pink or brown.

In some cases, however, bleeding after sex could signal trouble, especially if it happens during the second or third trimester. Placenta previa (a condition in which the placenta fully or partially covers the cervix) and placental abruption (when the placenta separates from the uterus) sometimes lead to bleeding. Other concerning causes include miscarriage, ectopic pregnancy, or early labor. 

It’s important to note that pregnancy sex doesn’t cause miscarriage, placenta previa, or other dangerous conditions. To be on the safe side, though, Dr. Minkin says to notify your practitioner about any bleeding during your pregnancy and let him/her decide where it’s coming from. Don’t have sex again until you get the all-clear, and wear pads instead of tampons to track the blood flow. Call 911 if you have extremely heavy bleeding, painful cramps, high fever, dizziness, or contractions. 

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