Q: I’ve been with my partner for eight months and the sex is great. The best I’ve had. Unfortunately, my vagina does not seem to think so. I have been noticing bleeding during sex. It doesn’t happen every time, but often enough to present a problem. My boyfriend is super understanding, but the issue bothers me and makes me feel unsexy. I’ve had all the STD tests, a pap and a pelvic ultrasound to rule out any medical issues. I thought my IUD could be the culprit, but I’ve had it for four years and never bled with others. My doctor says that some women experience this regularly, even if they do not have an IUD. Is this something I just need to live with?


A: Probably not. Hormonal intrauterine devices are often the culprit when women have spotting between periods and bleeding during or after sex. Hormonal IUDs work by thinning the lining of the uterus so fertilized eggs aren’t welcome. This makes the uterus more susceptible to shedding. If you’re currently enjoying the best sex you’ve ever had — high five! — then I’ll assume you’re also having orgasms (and hopefully massive ones). Because your uterus contracts during orgasm, it’s that much more likely to shed some blood after sex if you’re using a hormonal IUD. A little inconvenient bleeding is actually a fairly common side effect for women using hormonal birth control. It’s when a little becomes a lot that you should be concerned and talk to your doctor again. Occasional spotting that can be managed by a panty liner is normal; using multiple pads or tampons a day or having a period that never stops are signs that something is wrong.

If you’re using the Mirena IUD, ask your doctor about the relatively new Skyla IUD. Skyla is made by the same company (Bayer) but releases a lower dose of the hormone levonorgestrel. That could make a big difference as far as the compromising of your uterine lining is concerned. It’s also smaller, which makes insertion and removal more comfortable.

Interestingly, Skyla was specifically tested on and is marketed to women who have not had children. The reason? The FDA won’t allow Bayer to market Mirena to women who have not had children because they approved that IUD based on testing done only on women who have given birth. The FDA’s little technicality might make some doctors and patients skittish about IUDs. However, most doctors know that IUDs are safe regardless of whether a woman has had children, and will happily prescribe them to mothers and non-mothers alike.

If you’re already using the Skyla and still having this issue, then the hormone is the culprit. Your other IUD option is the ParaGuard copper IUD, which is hormone-free. Pure copper is safe for you but creates an inhospitable environment for sperm, so they die once they’re in. It has its pros (more than 99 percent effective, can be used for up to 12 years) and its cons (side effects include heavier periods and cramping), but it’s a go-to for many women.

You could also try another type of birth control. The NuvaRing releases different hormones than do IUDs, so it might not cause post-coital bleeding. Oral contraceptives are another alternative and there are as many options there as there are M&Ms under the driver’s seat of my car.

Finding the perfect birth control is like trying on swimsuits except worse, because it can take months to years to do. Communicate regularly with your doctor about your side effects and don’t resign to feeling defeated by safe sex. You can always forgo the hormones and go the barrier-method route. And don’t forget there are dozens of other ways to get off that could never possibly get you pregnant.