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Pain during sex: causes, frequency, tips

by Josephine Andrews
Published: Last Updated on 168 views

Pain during sex (medically also dyspareunia, algopareunia, cohabitation pain) is a common problem, especially for women. They can make intercourse miserable and put a heavy strain on a relationship. But men also sometimes experience the sexual act as painful. There are many possible causes of pain during sex. Read here what causes them and what you can do about them.

Pain during sex: description

Pain that occurs immediately before, during, or after penetration of the penis during sexual intercourse is referred to as dyspareunia (algopareunia). They are triggered by organic and/or psychological causes.

Pain during sex is not uncommon, especially for women – about ten percent of women feel pain when the penis penetrates and/or during the further course of sexual intercourse; the proportion of women who find sex unpleasant is even greater. In men, on the other hand, pain during sex is much less common.

Pain during sex: causes and possible diseases

causes in women

The main causes when women experience pain during sex are:

  • Inflammation in the genital area: Inflammation of the vagina ( colpitis ) and/or the labia (vulvitis) are often accompanied by pain during sex. Sometimes the symptoms even make sex impossible. Chronic inflammation of the fallopian tubes and ovaries (chronic adnexitis) also causes pain during sex.
  • Insufficient lubrication of the vagina (lubrication disorder): If the pain only occurs during or shortly after sex, insufficient lubrication of the vagina and thus a lack of lubricity is often to blame. Vaginal dryness can be the case, for example, with a lack of arousal, a lack of estrogen after menopause, but also with psychological or relationship problems.
  • 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 – problems with urination.
  • Narrow vaginal opening: In girls and young women, a very narrow vaginal opening can be responsible for pain during sex.
  • Ovarian cysts: Fluid-filled sacs on the ovaries usually form just after puberty and before menopause. Small cysts usually do not cause any symptoms, while larger ones can cause, among other things , menstrual pain , dull lower abdominal pain, back pain and pain during sex and bowel movements.
  • Uterine fibroids (uterine fibroids): Fibroids are growths in the muscular layer of the uterus and are the most common benign tumor in the female genital tract. Depending on the location, they can cause, for example, menstrual disorders, increased urination, constipation , abdominal and back pain and pain during sex. However, many uterine fibroids do not cause any symptoms at all.
  • Other tumors: In addition to cysts and fibroids, other tumors in the genital tract can cause pain during sex, such as tissue growths in the back part of the cervix or in the cul-de-sac (space between the uterus and rectum).
  • Endometriosis : In this disease, for unknown reasons, benign, usually painful growths of endometrium occur outside the uterus in neighboring organs (lower abdominal or pelvic cavity, fallopian tubes, etc.). The possible consequences are infertility , menstrual disorders and abdominal pain as well as pain during sex.
  • Chronic non-bacterial cystitis (interstitial cystitis): A chronic, non – bacterial inflammation of the urinary bladder can cause oppressive pain during sex and possibly the urge to urinate during sex.
  • Adhesions and Scars : Tissue damage, adhesions, or scars after childbirth , surgery, or an STD can be to blame for painful sex.
  • Fixed backward bend of the uterus: Normally, the uterus tilts slightly forward towards the bladder. In some women, on the other hand, it is inclined backwards towards the sacrum – either from birth or as a result of childbirth. If this backward bending is fixed (e.g. due to adhesions with the rectum as a result of inflammation or endometriosis), the uterus can no longer straighten up. This can lead to lower back pain, painful periods, constipation , and painful sex.
  • Vaginal spasm ( vaginismus ): Vaginal spasm (vaginismus) is an involuntary and sometimes painful contraction of the muscles in the lower area of ​​the vagina (vagina) and the perineal muscles as soon as an attempt is made to insert a finger, a tampon or the penis. The woman tenses up completely and sometimes clamps her legs together to protect herself. Neither sexual intercourse nor a gynecological examination is possible with vaginismus.
    Causes of vaginismus

    In most cases, vaginal cramps are a psychological defense reaction triggered by fear(such as before pregnancy or before injury), psychosexual inhibitions, or previous trauma (such as rape). More rarely, vaginismus is the result of prolonged pain during sex (dyspareunia).

  • Uterine prolapse and uterine prolapse: Pain during sex can also be caused by a uterine prolapse. The uterus slowly descends due to a weakness in its supporting apparatus and the pelvic floor. The vagina, bladder and/or rectum usually descend at the same time. In the worst case, there is a complete prolapse of the uterus, in which the vagina turns outwards.
  • Lichen sclerosus (LS): This is a chronic inflammatory skin disease of unclear origin that occurs primarily in women. It can develop at any age in the area of ​​the labia. A skin that is often parchment-like, thin and discolored to a porcelain-white color is typical. The decrease in tissue elasticity leads to shrinkage effects that can cause pain during sex. Other possible symptoms include itching around the labia, burning, soreness, painful urination and constipation.
  • Psychological causes: Pain during sex is sometimes based on negative sexual experiences (such as sexual abuse). On the other hand, it can also happen that an initially organic cause of pain (such as adhesions, cysts) triggers fear of painful sex. This association of thoughts “sex + pain” can become independent over time and continue to exist even after the organic cause of the pain has been eliminated – the pain during sex then only has a psychological cause.

In some cases, no clear cause can be identified for pain during sex. If there is chronic, often burning pain with local hypersensitivity of the vulva , this is referred to as vulvodynia .

Causes and possible diseases in men

The main reasons men experience pain during sex are:

  • Tightening of the foreskin ( phimosis ): Pain during sex can be due to congenital or acquired tightening of the foreskin. The retraction of the foreskin is not possible or only possible with pain. If the foreskin that is too tight is forcibly pulled back, it can become trapped in the glans furrow – this paraphimosis (Spanish collar) is an emergency that must be treated immediately by a doctor, otherwise the glans can die.
  • Pathological curvature of the penis (induratio penis plastica, IPP): IPP causes local fibrous hardening in the wall of the erectile tissue, which often causes painful curvature of the erect penis: there is pain during sex or the erection , sexual intercourse is mechanically impaired . IPP can be congenital or acquired.
  • Chronic inflammation of the prostate ( prostatitis ): Chronic inflammation of the prostate gland can cause very variable symptoms, including severe pain during sex (more precisely: during ejaculation), pain “deep in the pelvis”, in the perineal area, penis, in the testicles , in the groin or Pubic bone area and bladder emptying disorders.
  • Inflammation of the urethra (urethritis): Pain during sex can also be caused by an inflammation of the urethra. This is usually caused by infections such as gonorrhea, chlamydia or other sexually transmitted diseases.
  • Penile fracture (penis fracture): A cracking sound and severe penile pain during vigorous intercourse indicate a penile fracture. The strong connective tissue covering that surrounds the erectile tissue, which is heavily filled with blood , tears. The erection subsides immediately, the penis swells and discolours. A penis fracture is an emergency and requires immediate medical attention!
  • Lichen sclerosus (LS): This condition mainly affects women (see above), but it can also affect men and can cause pain during sex.
  • Permanent erection (priapism): Doctors call priapism a very painful permanent erection lasting at least two hours. The cause usually remains unclear, in the other cases, for example , leukemia , tumors, blood clots (thrombosis) in the pelvic region or certain medications (such as sexual enhancers) are the reason for the permanent erection. Prompt medical treatment is advisable due to the risk of tissue damage!

Pain During Sex: When Should You See a Doctor?

In principle, pain during sex should be clarified by a doctor – regardless of whether it is acute or has existed for a long time.

Pain during sex: what does the doctor do?

The doctor will first talk to you in detail about your medical history ( anamnesis ). Important information for him is for example:

  • When does the pain occur during sex – for example when touching the labia, when inserting the penis, with general coitus movements (coitus = sexual intercourse) or only with particularly deep movements?
  • Where exactly does the pain occur during sex (e.g. in the area of ​​the labia, 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 there since the first intercourse? Do you perform every time you have sex or only in certain situations?

This is followed by a gynecological examination for women and a urological examination for men to clarify possible organic causes of the pain during sex. Further investigations may be necessary:

For example, urine samples are analyzed when infections and inflammations in the genital tract (such as inflammation of the prostate , urethra or bladder) could be causing the pain during sex. In the case of vaginal infections, a swab is taken and examined in the laboratory. Fibroids and cysts as triggers for the pain can often be detected on ultrasound . If endometriosis is suspected, ultrasound examinations and a laparoscopy are also carried out.

This is how the doctor can treat pain during sex

If there is an organic cause behind the pain during sex, the doctor will treat it as best as possible. If the vagina is no longer properly lubricated due to a lack of estrogen (after menopause or after removal of the ovaries) and this causes pain when the penis penetrates, the doctor can prescribe a cream containing estrogen, for example.

There are hormone-free alternatives for women who, for medical reasons, are not allowed to use preparations containing hormones or who do not want to use them: gels, creams or suppositories that can be used to treat vaginal dryness without the addition of hormones.

Medicines are given for inflammation and infections in the genital area that cause pain during sex. Myomas and cysts can also be partially eliminated with medication; if not, the doctor may suggest surgery.

Surgical intervention is necessary, for example, in the case of a penile fracture and in severe cases of uterine prolapse (in milder cases, pelvic floor exercises or the insertion of a pessary is sometimes sufficient).

Vaginismus involves partner counseling, behavioral therapy, and exercise programs (such as inserting progressively larger dilators along with lubricant).

If the pain during sex is (additionally) psychologically caused, psychotherapeutic treatment can be useful.

Pain During Sex: You Can Do It Yourself

The following tips can help against pain during sex:

  • Organically caused pain during sex sometimes only occurs in certain sex positions, such as endometriosis, uterine prolapse or large fibroids. A change of position during sex can therefore prevent or at least reduce the symptoms. It’s often better that way, the woman takes over the active part (woman above, man below).
  • Lubricants are useful if insufficient lubrication of the vagina causes pain during sex.
  • In the case of endometriosis, relaxation techniques such as Tai Ji Quan, Qi Gong and yoga are recommended to relieve symptoms such as cramps and pain during sex .

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