Post-Intercourse Bleeding During Pregnancy: What to Know

Question
I am 11 weeks and 3 days pregnant. After intercourse a few nights ago, I had two tiny little pinkish dots of blood on my toilet paper right after sex (after I urinated). Nothing was found after that, and I had no cramping. I attributed it to perhaps aggrevating my cervix. I called my OB, and was given a rhogam injection the next day (I'm rh negative). I was not instructed to abstain, and last night my husband and I had sex again. Once again, I had four tiny little red dots of blood on my toilet paper immediately after intercourse. I called my OB so she could mark it in her charts, and she then told me to abstain, and instead of coming in for my next prenatal appt in 2 weeks, she wanted me to come in for an ultrasound and check-up next week. Now I'm concerned that something might be wrong. I've had no spotting since, and no cramping either time. I'm sure it was from the act of intercourse itself, and likely rupturing a blood vessel during the act. However, now I'm starting to panic thinking something is wrong and they aren't telling me. Am I just being paranoid? Is it normal for pregnant women to bleed sometimes after intercourse? Would sex harm the baby at all?

Answer
It is very normal and common to have occasional spotting during pregnancy, especially just after intercourse. During pregnancy, the mucosa of the vagina is very "hyperemic", which means that blood is at the surface and any friction or rubbing against the vaginal wall (as with a penis) will cause a small amount of spotting. This spotting usually stops very quickly and causes no harm to the pregnancy or to the fetus. You do not need RhoGam after this type of bleeding.  However, at 11-13 weeks, there is also a possibility of having a "subchorionic hematoma" that can cause bleeding. This is a sequestration of blood in the folds of the developing placenta. This also does not interfere with the pregnancy and is not dangerous, but you may have heavy bleeding with it. A sonogram will show if there is a subchorionic bleed. It dissipates on its own within a few weeks. I think, like you do, that the spotting was merely due to sex. You can ignore it as long as it does not continue heavily on its own.