Does Oral Sex Cause Palatal Petechiae?

Palatal petechiae are small, pinpoint spots of hemorrhage that can be caused by negative pressure, the activation of the gag reflex, and/or physical force from the fellatio. The petechiae typically affect the soft palate or the junction of the hard and soft palate, often dispersed bilaterally. 

Typically, fellatio-related palatal petechiae resolve in 1-2 weeks without causing more damage.

Palatal lesions associated with fellatio have mostly been documented in women.

However, these lesions can develop in men or children who have experienced sexual abuse. In the U.S., more than 80% of people ages 15-44 have engaged in oral intercourse with a partner of the opposite sex.  Only 5% of men in this age group have engaged in oral intercourse with other men. 

Despite the prevalence of oral sex, there are not many reports of fellatio-related palatal petechiae in scientific literature. Along with petechiae, palatal lesions, such as ecchymosis, nonhemorrhagic erythema (with or without candidiasis), ulcers, vesicles, and papules have been linked to fellatio.

Palatal petechiae and purpura associated with fellatio are likely the results of multiple factors. Direct and vigorous contact between the penis and the palate may cause mucosal damage, submucosal vascular rupture, and bleeding. 

One case report highlighted that petechial hemorrhages were secondary to an acute reflex palatopharyngeal spasm brought on during fellatio. However, the report asserted that the simultaneous “negative pressure induced during irrumation” plays a part in the mechanism of injury, leading to soft palate mucosal petechiae. 

Additional clinical data are consistent with the hypothesis that negative pressure is a substantial factor in the etiology of palatal petechiae. Researchers had previously observed petechiae and erythema on the lips and palates of children who frequently sucked drinking glasses. 

Infectious disorders may be linked to fellatio. A person who experiences irrumation-induced submucosal bleeding could be dealing with a sexually transmitted disease at the same time.

A biopsy is not required to confirm a diagnosis of palatal petechiae unless there is a suspicion of other causes. Other conditions that can cause palatal petechiae may include:

• Blood disorders
• Antithrombotic drug therapy
• Viral or streptococcal infections
• Severe vomiting and coughing

If the diagnosis of fellatio-associated trauma cannot be made, more testing may be required:

• Complete blood counts with platelets and other coagulation studies to look for blood dyscrasias
• Serologic studies and cultures for Epstein-Barr virus and beta-hemolytic streptococcus infection
• Radiologic studies (such as roentgenograms, computerized axial tomography, and/or MRI) to look for nasopharyngeal carcinoma

Submucosal bleeding caused by irrumation of the palate heals in less than 7-14 days. Therefore, there is no need to treat the palatal lesion. The lesions could come back after new instances of receptive oral sex. 

To avoid the future development of petechiae and purpura associated with fellatio, the person must understand the cause of the oral lesions.