Aunt Vadge: unusual bleeding after sex play – what’s wrong with me?

Dear Aunt Vadge

I am a 19-year-old college student in Texas. On July tenth my boyfriend fingered me, and the day after I started bleeding, red spotting with some clots, and did not stop spotting for a month. I did not get my “normal flow” period for July or August.

Just a couple of days ago my boyfriend fingered me and I am once again in the same boat. I started bleeding the next day and had some bigger clots. I do have to wear some type of panty liner for the blood and the blood is sometimes visible in the toilet and always visible on the toilet paper.

I last had actual vaginal sex around the first of May, I got my actual period a couple of days after and also had a normal period the next month and therefore don’t think I am pregnant. I had two normal periods then after being fingered (kinda rough) everything went out of whack. What is wrong with me?

We are always extremely careful when we have sex. The last time was as mentioned in May, we used a condom and he pulled out. We checked the condom for holes afterward and found none. I am almost completely positive I am not pregnant.

There was some pain and discomfort during the fingering, but not the entire time just for brief moments, it felt like maybe he was going too fast and too hard. I was wet and enjoying it and did finally orgasm. My periods are not super regular, they are very irregular and I always have clotting. The last couple of days my bleeding (or spotting) has gotten heavier  and still has clots but it is no where near my normal flow. 

– Concerned

Dear Concerned,

Thanks for your email. Your bleeding does indeed sound unusual for the circumstances, so let’s review what it might be.

The problem you describe is medically known as metrorrhagia, which simply describes bleeding between menstrual periods, which can be spotting, or heavier bleeding, depending on the cause. There are a large range of causes of metrorrhagia. You must see a physician as soon as possible to get a full examination, however below are some thoughts to help explain things.

Normally pregnancy would definitely be on the list of possibilities (including ectopic pregnancy), however you seem sure this is not the case.

Cuts and tears vs. hormonal or other problem

You are getting clots, which would indicate the blood is coming from your uterus, not your actual vaginal tissue. If it was a tear in your tissues, the blood would just dribble out eventually and not have time to clot. This means your problem is quite possibly hormonal or have other causes, however it might also be more than one issue that appears as one.

Rule out infections, PID, HPV, cancer

You must be able to rule out an infection, pelvic inflammatory disease, a sexually transmitted infection, or worse, certain cancers. Yes, cancers.

Spotting after bleeding is one of the key indicators for cancer of the cervix, ovary or endometrium, and while cancer is usually reserved for those in their older years, HPV can cause cervical cancer in women your age – one per cent of all cervical cancers are detected in women under the age of 20.

This means it is not impossible, so shouldn’t be ruled out. Immediately. You need a full STI check and pelvic examination, as while it may be a benign condition, there is no such thing as no-big-deal mid-cycle bleeding (though it doesn’t have to be earth-shattering).

Cervical ectropion

The other issue that can cause bleeding after sexual activity is cervical ectropion/eversion. This is where specific mucous-producing cells that usually only grow in the neck of the cervix grow on the vagina side of the cervix.

They are easily busted open by sex (or fingering), and bleed easily. This problem is reasonably common, and is detected by a cervical examination since these cells are slightly differently coloured than the usual cells.

This does not explain the clotting, however, and the variability of the bleeding, since these cells don’t bleed if they are not disturbed, and the amount of blood they produce (unless the ectropion is extensive) won’t be significant. The cervix does not tend to bleed excessively.

Not ovulating

Irregular periods mean you are probably not always ovulating, and when you don’t ovulate, the hormonal cascade that makes your period come on time isn’t fulfilled – this is usually a hormonal problem that needs correcting.

This results in the endometrial cells (your period-forming cells) being partially formed, and as a result, they can and do break away from the uterine wall easily and at random throughout the rest of your interrupted cycle, which can result in very random spotting or mid-cycle bleeding (due to a lack of progesterone).

The DUB article clarifies the reasons for this, and teenage girls are the perfect candidates for this type of bleeding.

In your case, having an orgasm where the cervix contracts may assist this blood – which may be clotty – to be expelled from the uterus, resulting in the bleeding only after sex play, but which may or may not be specifically related to the fingering, despite appearances.

Being underweight (lack of oestrogen)

A common reason for not ovulating and therefore having irregular and skipped periods in women your age is being underweight, and having a lack of fat. Your fat cells convert testosterone to oestrogen, and therefore the less fat you have, the less oestrogen you have.

The less oestrogen you have, the harder it is for your body to ovulate – your cycle is set off by certain hormonal triggers, and if one isn’t set off, the rest remain untriggered. This is why skinny teenagers get their periods later than everyone else.

There are other reasons you may not be ovulating, but it’s important to rule out all the nasty ones, and if it isn’t any of them (thankfully) then you would be well placed to visit a naturopath, who can help you with your diet and other elements of your existence – teenage girls are famous for having problems with food, which needs to be solved, since it results in bad skin, bad hair, irregular cycles, and feeling like crap. It’s a poor start to your grown-up life!

While you may have a great diet and be a healthy weight, knowing teenage girls, there is a good chance that this isn’t true, and therefore your problem may be solved by putting on a little weight, but it could be any number of things, so you must get help to do this.

There are a number of other options here, so check out the metrorrhagia article and the DUB article and see your doctor to get a diagnosis. Once diagnosed, treatment can be decided, and you can solve this problem once and for all.

Warmest regards,
Aunt Vadge  

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