Can an IUD cause bleeding after sex?

An IUD is a type of birth control. It is a small device placed in your uterus, or womb, to prevent pregnancy. There are two types of IUDs:

• Copper IUDs: These are plastic devices wrapped in copper, which can last as long as 12 years.
• Hormonal IUDs: These contain the hormone progestin and are usually changed every 3–8 years, depending on the brand.

IUDs may cause changes to your menstrual cycle and bleeding patterns but don’t usually cause bleeding after sex. Bleeding after sex — also called post-coital bleeding — can affect all women whether they have an IUD fitted or not.

We use the term “women” in this article to reflect the term assigned at birth. However, gender is solely about how you identify yourself, independent of your physical body. 

Here are some potential causes of bleeding after sex:

Changes in bleeding patterns

An IUD doesn’t usually stop your period. But 2016 research suggests that an IUD can cause changes in your menstrual cycle and bleeding patterns. Changes may include:

• irregular or heavy bleeding straight after inserting either type of IUD
• irregular or light periods or a stop to your periods altogether when using a long-term hormonal IUD
• heavy bleeding during periods when using a long-term copper IUD
• spotting or breakthrough bleeding (bleeding in between periods) during the first 3–6 months of IUD use

If you notice bleeding after sex and have an IUD, this may be usual spotting or breakthrough bleeding. But it is worth speaking with a healthcare professional to rule out any other causes of the bleeding.

Your IUD has moved

Research from 2015 suggests you may notice pain and bleeding — including after sex — if your IUD has moved or a healthcare professional didn’t insert it in the correct position.

Some other signs that your IUD isn’t in the right position can include:

• not being able to feel the strings of the IUD with your fingers
• feeling the plastic of the device
• your partner being able to feel the device during sex
• bleeding in between your periods or very heavy bleeding
• cramps
• pain in your abdomen
• unusual vaginal discharge

If you’re worried that your IUD has moved, it is important to speak with a healthcare professional such as a gynecologist. They will carry out a range of tests to check the location of your IUD. If your IUD is not in the correct position, it cannot work correctly as a form of birth control.

Infections

Sometimes bleeding after sex is a sign of an infection. For example, pelvic inflammatory disease (PID) and sexually transmitted infections (STIs), such as chlamydia, could cause bleeding after sex. A doctor can help you manage these infections. 

Antibiotics can treat conditions such as chlamydia. Examples include azithromycin (Zithromax) and doxycycline (Adoxa).

Some STIs can also cause lesions on your genitals, which may be another reason for bleeding after sex. A doctor can conduct tests to find out if an infection may be causing your bleeding and help you treat it.

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Not enough lubrication during sex

The United Kingdom’s National Health Service (NHS) suggests that dryness or friction during sex can cause bleeding. Vaginal dryness can naturally happen after menopause when there are fewer vaginal secretions.

If your bleeding is due to friction or dryness, it may be helpful to use lubricants during sex. But it is best to talk with a doctor to rule out any other causes of the bleeding.

A tear in the vagina

Any injury or damage to your vagina may cause bleeding after sex. The NHS suggests that tears resulting from childbirth can be a cause of post-coital bleeding. Other causes of tears or injury in the vagina can include:

• the natural thinning of vaginal tissues that happens with age (also called atrophic vaginitis)
• rough sex
• low estrogen levels — for example, due to menopause or nursing
• improper use of sex toys or other devices designed for intercourse

Minor vaginal tears or injuries will often heal on their own. More serious tears may require stitching.

Polyps (tissue growths)

Polyps are tissue growths that look like tiny white bumps. They are most commonly found around the lining of your uterus or colon but can also appear on several other parts of the body. In most instances, polyps are noncancerous.

Older research from 2014 suggests that bleeding after sex can have a range of causes, including cervical or endometrial polyps. This research also estimates that 0.7–9% of those who menstruate experience bleeding after sex.

A doctor can perform a scan to find out if you have any polyps. If they are small, you may not require any treatment. If your polyps are large, surgery may be necessary to remove them.

Cervical ectropion

Cervical ectropion is a condition that causes the delicate cells that usually sit on the inside of your cervix to spread to the outside of your cervix. These delicate cells can bleed very easily and cause bleeding after sex.

This condition doesn’t usually require treatment unless your symptoms get in the way of your day-to-day life. If you do have treatment, a doctor will usually recommend cauterization (removing the misplaced tissue with chemicals or electricity).

Cervical cancer

In rare cases, bleeding after sex may be a sign of cervical cancer. A 2019 study screened 635 women with bleeding after sex for cervical cancer. Of those, 2% were diagnosed with cervical precancer or cancer. 

Contact a doctor if you have noticed bleeding after sex. Even though it is rare and unlikely, it is important that a doctor carries out testing to rule out cervical cancer.

When should you be worried?

You should speak with a doctor if you have noticed any bleeding after sex. It is especially important to contact a doctor if you are also experiencing pain during sex.

There can be many different causes of this bleeding, many of which can be easy to resolve. A doctor can help you determine what is causing the bleeding and build a treatment plan if needed.

Summary

IUDs do not usually cause bleeding after sex. However, many different factors may result in bleeding after sex, such as vaginal dryness, your IUD moving, or infections.

Some of these issues are simple to fix, like vaginal dryness. Others may require treatment from a doctor. It is important to speak with a doctor if you have noticed any bleeding after sex.

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