Brief overview
- Causes: In women, for example, inflammation, inadequate lubrication, infections, cysts, fibroids, endometriosis, vaginismus, psychological causes; in men, foreskin tightening, penile curvature, prostatitis, urethritis, penile fracture, among others.
- Treatment: change of position, prevention of infections, lubricants, relaxation techniques, medications, surgical interventions, psychotherapy
- When to see a doctor? Always discuss pain during sex with the doctor
What is pain during sex?
Pain that occurs immediately before, during or after penetration of the penis during sexual intercourse (GV) is called dyspareunia (algopareunia). They are triggered by organic and/or psychological causes.
What are the possible causes?
Pain during sex is experienced by both men and women. There are many possible causes.
Causes in women
The main causes when women experience pain during sex are:
Inflammation in the genital area: inflammation of the vagina and/or labia is often accompanied by pain during sex. Sometimes the discomfort even makes sex impossible. Chronic inflammation of the fallopian tubes and ovaries also causes pain during sex.
Fungal infection of the vagina (vaginal mycosis): A vaginal infection with Candida fungi triggers itching, burning, pain during sex and, if the urethra is involved, discomfort during urination.
Narrow vaginal opening: In girls and young women, a very narrow vaginal opening is sometimes responsible for pain during the sexual act.
Uterine fibroid (uterine myoma): Myomas are growths in the muscular layer of the uterus and are the most common benign tumors in the female genital tract. Depending on their location, they cause, for example, menstrual irregularities, increased urination, constipation, abdominal and back pain, and pain during sex. However, many uterine fibroids do not cause any symptoms at all.
Endometriosis: In this disease, for unknown reasons, benign, usually painful growths of uterine mucosa occur outside the uterus in neighboring organs (lower abdominal or pelvic cavity, fallopian tubes et cetera). The possible consequences, in addition to infertility, menstrual disorders and abdominal pain, are pain during sex.
Adhesions and scars: Tissue damage, adhesions, or scars after childbirth, surgery, or STDs sometimes cause pain during sex.
Vaginismus: In vaginismus, there is an involuntary and sometimes painful tightening of the muscles in the lower part of the vagina (vagina) and the perineal muscles as soon as an attempt is made to insert a finger, tampon or penis. The woman becomes completely tense and sometimes clamps her legs together protectively. Neither sexual intercourse nor a gynecological examination are possible with vaginismus.
Uterine prolapse and uterine prolapse: Pain during sex may be caused by uterine prolapse. In this case, the uterus slowly lowers due to a weakness of its holding apparatus and the pelvic floor. Usually, the vagina also lowers at the same time, as well as the bladder and/or rectum. In very rare cases, there is a complete uterine prolapse in which the vagina bulges outward.
In some cases, it is not possible to identify a clear cause for pain during sex. If there is nevertheless chronic, often burning pain with local hypersensitivity of the vulva, this is referred to as vulvodynia.
In some women, ovulation also causes localized pain in the lower abdomen (central pain), which is sometimes unpleasant during sex but completely harmless.
Causes in men
Pain during sex in men has the following main causes:
The so-called paraphimosis (“Spanish collar”) is an emergency that must be treated immediately by a doctor, because otherwise there is a possibility that the glans dies. Inform the emergency doctor in case of suspicion!
Chronic inflammation of the prostate gland (prostatitis): Chronic inflammation of the prostate gland sometimes triggers very variable complaints, including severe pain during sex (more precisely: during ejaculation), pain “deep in the pelvis”, in the perineal area, penis, testicles, groin or pubic region, and disturbances in bladder emptying.
Penile fracture (penile fracture): A cracking sound and severe penile pain during vigorous sexual intercourse indicate a penile fracture. The strong connective tissue covering the erectile tissue, which is filled with blood, tears. The erection immediately subsides, the penis swells and becomes discolored.
A penile fracture is an emergency and requires prompt medical attention. In case of suspicion, inform the emergency doctor!
Permanent erection (priapism): Priapism is a very painful prolonged erection lasting at least two hours. The cause usually remains unclear; in rare cases, for example, leukemia, tumors or blood clots (thromboses) in the pelvic region are the reason for priapism. Medications (such as sexual enhancers) also sometimes trigger permanent erection. Because of the threat of tissue damage, rapid medical treatment is advisable!
What to do about pain during sex?
How to help yourself
The following tips often help with pain during sex:
- Organically caused pain during sex sometimes only occurs in certain sex positions, such as with endometriosis, uterine prolapse or large fibroids. A change of position during sex often prevents the discomfort or at least reduces it. So it is often better for the woman to take the active part (woman on top, man on bottom).
- Lubricating creams are useful if a lack of vaginal lubrication is causing the pain during sex.
- For endometriosis, relaxation techniques such as tai chi, qigong, and yoga are recommended to relieve discomfort such as cramping and pain during sex.
Home remedies have their limitations. If the discomfort persists for a long period of time, does not get better or even gets worse, you should always consult a doctor.
How the doctor treats pain during sex
For women who are not allowed to use preparations containing hormones for medical reasons or who wish to do without them, there are hormone-free alternatives: Gels, creams or suppositories that are used to treat vaginal dryness without the addition of hormones.
Surgical intervention is necessary, for example, in the case of penile hernia as well as in severe cases of uterine prolapse (in milder cases, pelvic floor exercises or the insertion of a pessary are sometimes sufficient).
In the case of vaginal cramps (vaginismus), counseling together with the partner, behavioral therapy measures and exercise programs such as the insertion of increasingly larger “dilators” (dilators) together with lubricant are useful.
When to see a doctor?
In principle, it is important to discuss pain during sex with a doctor – regardless of whether it occurs acutely or has been present for some time.
What does the doctor do?
The doctor will first talk to you in detail about your medical history (anamnesis). Important information for him or her to know includes:
- Where exactly does the pain occur during sex (for example, in the labia area, in the vagina or on the penis, in the lower abdomen)?
- How does the pain feel during sex (burning, stabbing, pulling, etc.)?
- Has the pain during sex been present since the first sexual intercourse? Does it occur every time you have sex or only in certain situations?
