Uterine fibroids are non-cancerous growths that develop in the muscular wall of the uterus, known as the myometrium. Up to 80% of women may develop them by age 50. While many women experience no symptoms, others face significant issues, including heavy menstrual bleeding, pelvic pressure, and discomfort during intercourse. Fibroids can directly cause bleeding during or immediately following sexual intercourse, a symptom known as postcoital bleeding.
The Direct Link: How Fibroids Cause Bleeding During Intercourse
The physical mechanism for fibroid-related bleeding after sex depends on the location and vascular nature of the growth. Fibroids that grow into the uterine cavity (submucosal fibroids) or those located near the cervix are the most common culprits. These locations place the fibroid where it is easily irritated by mechanical forces.
Fibroids often possess an irregular network of blood vessels to support their growth, making them prone to bleeding when disturbed. The physical pressure and friction of penetration can cause small abrasions or irritation to the tissue surface overlying the fibroid. This mechanical trauma can rupture fragile capillaries, leading to spotting or light to moderate bleeding.
Submucosal fibroids specifically distort the uterine lining (endometrium), which is already prone to bleeding. This distortion increases the risk of the endometrial tissue becoming easily eroded upon contact or pressure. In rare instances, the pressure from intercourse can lead to a disruption of the blood supply or a small tear, resulting in sudden bleeding. About 30% of women with symptomatic fibroids report experiencing postcoital bleeding.
Other Potential Causes of Postcoital Bleeding
While fibroids are a possible cause, bleeding after intercourse can arise from several other gynecological conditions. Inflammation of the cervix, known as cervicitis, is a common non-fibroid cause that makes the cervical tissue sensitive and likely to bleed upon contact. This inflammation can be due to infections, including sexually transmitted infections, or non-infectious causes like allergies.
Cervical polyps, which are benign growths on the cervix, are also a frequent source of postcoital bleeding. The friction from intercourse can easily disturb them and cause spotting. For post-menopausal women, vaginal dryness and thinning of the vaginal walls (genitourinary syndrome of menopause or vaginal atrophy) can cause tissue tears and bleeding due to lack of lubrication and elasticity.
When to Seek Medical Attention and Diagnostic Steps
Any unexplained bleeding during or after intercourse requires immediate consultation with a healthcare provider. This symptom requires professional investigation to rule out more serious conditions, such as precancerous changes or cancer of the cervix or uterus. Persistent or increasingly severe bleeding, or bleeding accompanied by significant pain, warrants urgent medical evaluation.
A physician will typically begin with a thorough medical history and a physical pelvic examination. A Pap smear and testing for infections may be performed to exclude cervical or infectious causes. If fibroids are suspected, imaging tests are the next step to confirm their presence, size, and exact location.
The primary diagnostic tool is often a transvaginal ultrasound, which uses sound waves to create detailed images of the uterus and ovaries. For precise mapping of the fibroids, especially before treatment planning, a magnetic resonance imaging (MRI) scan may be utilized. These methods help the doctor determine if the fibroid’s position, such as being submucosal or low-lying, is the probable cause of the postcoital bleeding.
Treatment Strategies for Reducing Fibroid-Related Bleeding
Treatment focuses on eliminating the fibroids to stop the abnormal bleeding. Initial management often involves medical strategies aimed at shrinking the fibroids. Hormonal treatments, such as birth control pills or progestin-releasing intrauterine devices (IUDs), can help regulate the menstrual cycle and reduce blood flow, lessening the chances of breakthrough bleeding during intercourse.
Gonadotropin-releasing hormone (GnRH) agonists are another medical option that temporarily induce a menopausal state, which can significantly shrink fibroids and reduce bleeding. For women seeking a non-surgical option, Uterine Fibroid Embolization (UFE) is a minimally invasive procedure. During UFE, an interventional radiologist blocks the blood vessels supplying the fibroids, causing them to shrink and die, which effectively reduces bleeding symptoms.
Surgical interventions offer definitive removal of the growths. Hysteroscopic myomectomy is often used for submucosal fibroids, removing them through the vagina and cervix without an abdominal incision. For larger or more numerous fibroids, a traditional myomectomy removes the fibroids while preserving the uterus. In cases of severe, persistent symptoms where other treatments have failed and family planning is complete, a hysterectomy remains the definitive solution, removing the entire uterus.