Are you bleeding after intercourse? You need to see a doctor sooner

Joel and Tracy came to the Sexology Clinic last December. They had not had sex for three months before the clinic visit and this was causing them distress. 

"My husband here just wouldn't touch me; he says I am unclean," Tracy lamented. Joel fixed his gaze on the floor and fumbled with car keys in his hand. He avoided eye contact. He was visibly uneasy with the discussion. 

"I feel rejected, he is uncaring and does not bother what I feel," Tracy continued.

The couple was in their early forties. They had been happily married for 11 years and had four children. Trouble started when they had sex one night and it turned out to be bloody. Joel was stained with blood and decided to shower immediately. The beddings too were soiled.

"I thought she was on her periods and gave her but a week later it was the same bloody affair," Joel explained. He made a unilateral decision to keep off sex. Three months passed. Tracy was getting troubled and irritated. The relationship was beginning to suffer frequent conflicts. Tracy felt rejected. She felt Joel was selfish and did not care about her sexual needs.

"I do not experience any pain," she explained, "I have even told Joel to use a condom if the blood worries him."

On further inquiry, I noted that Tracy's menstrual cycle was regular and that the bleeding during sex was not connected to the menses. This worried me. I especially wanted to know if Tracy had ever had a pap smear, a test that is done to screen for cancer of the cervix.

"I didn't know a pap smear is important, I will start doing it every year," she said, "but for now what are the possible causes of the bloody sex?"

Well, bleeding during or after sex can be caused by several diseases. At the very least the bleeding can be the result of hormone problems causing changes in the cervix, a condition generally called cervical erosion. Hormones could be deranged due to the use of contraceptives, during pregnancy, or just due to natural changes in the body. Most women with cervical erosion will also have excessive discharge. Correcting the hormone problems resolves the condition. 

Secondly, bleeding during sex can be the result of infection, especially if the infection involves the cervix, a condition called cervicitis. Other than bleeding, excessive and smelly discharge can happen too. 

The most sinister of all causes of bleeding during sex is however cancer or pre-cancerous conditions of the cervix. This is the reason routine Pap smear is recommended because it detects cancerous changes early enough before full-blown cancer happens. If early intervention is not undertaken, the pre-cancerous lesions develop into cancer. The affected cervix bleeds easily during sex. There may be no other symptom beyond the bleeding until cancer has become big and invaded other organs.

"Now that is scary!" Tracy exclaimed, "So I could be ill!"

"You see! When I said I was uncomfortable you got offended, I wish you had listened," Joel says. 

I examined Tracy. I checked her cervix and found it to be harder than normal, deformed, and with a growth. I booked her for examination in theatre to determine the extent of the growth and take a biopsy for checking in the lab. 

My fears were confirmed when the lab results came out. Tracy had cancer of the cervix. A plan of treatment was developed for her including surgery to remove the cervix and the entire uterus, radiotherapy, and chemotherapy. The experience was a difficult one given the side effects of the treatments. 

"I feel like I have been to hell and back but I am lucky to be alive," Tracy said when I met her last week. She had lost quite some weight and was weak. It was time to discuss how to resume sex after cancer care. 

"But one thing is clear in my mind, nobody should go through what I have gone through if they can avoid it," Tracy quipped, "let all women go for routine pap smears." I nodded in affirmation

Prof. Osur is a Kenya-based reproductive and sexual health expert and a reproductive rights advocate

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