Hi! At 48 years of age you could be going through premenopause, and this can miss periods once in a while
until they stop completely. Also vigorous workouts can affect the hormonal balance in the body, and this can
cause missed periods. However, all missed periods should be investigated for pregnancy and you should take a
pregnancy test. If it is positive, then bleeding after intercourse can be due to local causes or due to
threatened abortion and needs to be investigated immediately. The various other causes for vaginal bleeding
after sex are injury and friction, STDs like Chlamydia, gonorrhea, and trichomoniasis, cervical polyps, yeast
infections, non specific vaginitis, endometriosis, cervical dysplasia which is a precancerous condition,
uterine polyps, uterine fibroids and cervicitis (inflammation of cervix). None of them are conditions that
should be ignored. At your age non specific cervicitis can be the leading cause. Since there is pain at the
end of urination, UTI or urinary tract infection can co-exist but will not cause spotting as you are having.
Since a confirmed diagnosis cannot be given on net please discuss these possibilities with your gynecologist
once and get the required tests like internal examination, PAP smear, vaginal swab test for STD, and
ultrasound. Please feel free to ask anything else you may want to know. Take care!