bubble_chart Concept

Intercourse bleeding refers to the occurrence of vaginal bleeding in women during sexual intercourse.

As early as the Tang Dynasty, Beiji Qianjin Yaofang recorded "women bleeding during intercourse," and by the Song Dynasty, Furen Liangfang Daquan named it "intercourse bleeding." Gynaecology Essentials referred to it as "intercourse bleeding"; Fuqingzhu Gynecology also called it "sympathetic bleeding."

Occasional intercourse bleeding in newly married women is not pathological. Intercourse bleeding during pregnancy is a different matter and is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Liver-kidney Yin Deficiency︰The blood is bright red, with soreness in the waist and tinnitus, flushed cheeks, insomnia and dreamfulness, vexing heat in the chest, palms, and soles, red lips, and a dry mouth. The tongue texture is tender red, and the pulse is thin and rapid. Jingyue Quanshu states: "For women who experience bleeding after intercourse, it is mostly due to weak yin qi, unconsolidated kidney essence, or fire in the yin aspect." This syndrome is commonly seen in older women whose yin essence is already depleted. If sexual activity further exhausts their essence, it will inevitably lead to frenetic stirring of ministerial fire, causing the blood to lose its containment and resulting in bleeding after intercourse. The clinical characteristics include: besides bleeding after intercourse, symptoms such as dizziness, tinnitus, dry eyes, insomnia and dreamfulness, vexing heat in the chest, palms, and soles, a tender red tongue, and a thin, rapid pulse are also present. The appropriate treatment is nourishing yin and reducing fire, with the formula Zhi Bai Rehmannia Decoction as the base, modified as needed.
2. Chong Ren Dampness-heat︰The discharge is purplish-red in color, often mixed with yellow or red and white hues, sometimes accompanied by a small amount of reddish leukorrhea, or accompanied by lumbosacral aching pain, loose stools, and dark urine. The tongue coating is usually yellow and greasy, with a slippery and rapid pulse or a soft and rapid pulse. This is commonly seen in women suffering from yellowish leukorrhea. It is mostly caused by poor hygiene during menstruation or postpartum, or engaging in sexual activity during these periods, allowing dampness-toxin to invade the uterus and appendages when the body is vulnerable. Alternatively, it may result from spleen qi failing to transport fluids, causing water-dampness to sink into the kidneys, with dampness-heat scorching the collateral vessels. The disease mechanism primarily involves the accumulation of dampness and heat. When dampness-heat pours down into the thoroughfare and conception vessels, and the belt vessel fails to regulate the meridians, it leads to yellow or red leukorrhea that is foul and turbid—a distinguishing feature from other conditions. The main treatment is to clear and drain damp-heat, using formulas that clear heat and stop bleeding.
3. Spleen Qi Deficiency︰The blood color is pale red, accompanied by limb fatigue and lack of strength, shortness of breath and reluctance to speak, abdominal distension and fullness after eating, occasional loose stools, or accompanied by edema, increased leucorrhea, a pale tongue, and a deep weak pulse. The main cause is dietary overstrain injury to spleen qi, and the key mechanism of disease is spleen deficiency with qi sinking, leading to failure of control. Clinically, in addition to bleeding during intercourse with pale red blood, symptoms also include mental fatigue, limb fatigue, reduced appetite, abdominal distension and fullness, shortness of breath, reluctance to move, a pale tongue, and a weak pulse. The primary treatment is tonifying the spleen and replenishing qi, using Returning to Spleen Decoction with the addition of Sanqi powder.

The symptom of postcoital bleeding is commonly seen in women suffering from leukorrheal disease. Beiji Qianjin Yaofang and GynaecologyZhengzhi Zhunsheng have documented cases of postcoital bleeding caused by contact with other objects, which are indeed observed in clinical practice. Therefore, it is particularly important to inquire about the cause during clinical diagnosis and to pay attention to checking for local injuries and other pathological changes.

bubble_chart Documentation

1. 《Annotations on Furen Liangfang．Chapter on Various Diseases: "Women experiencing bleeding and pain during intercourse, fever, thirst, and a desire to vomit, or those who use cold and cooling medicines, find their symptoms worsening, with frequent vomiting, reduced appetite, and daily emaciation. I said: The condition is due to liver fire, and the medicines further injure the spleen. First, use Six Gentlemen Decoction with Gardenia and Bupleurum, to strengthen the spleen and stomach and cure all symptoms. Then use Supplemented Peripatetic Powder to restore physical strength and vitality."