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Pain during sex: causes and therapies

Pain during sex: causes and therapies


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Women suffer from pain during sex as do men, but women are far more often affected by this dysfunction. The technical term is dyspareunia, doctors also speak of coitus pain. Such pain ranges from vaginal itching to stinging, burning and cramps that resemble labor pains during pregnancy.

Sexual pain in women

Some women experience internal pain, others external pain. External pain usually develops at the entrance to the vagina, internal pain in the uterus, urinary bladder or ovaries.

Normal pain

Chronic and disease-related pain are different from normal pain that every woman occasionally has during sex. For example, in the days leading up to menstruation, the vaginal walls are very sensitive; a dry vagina or too tight muscles of the vagina also cause pain during intercourse.

Many women experience pain during their first intercourse. This is due to the hymen on the one hand, but on the other hand to the relationship with the partner, the familiarity in the relationship and the ability to relax.

Even after birth, many women find sex painful, roughly until breastfeeding is over. This is because the hormones changed, the birth leads to injuries that are sensitive even after healing, and some women are more mentally unstable after pregnancy than before. The baby demands attention, and many mothers are too exhausted to enjoy sex. Pain during sex can also be a signal after pregnancy that the woman is not yet ready to have sex again.

Menopause can also make sex painful. Before and after menopause, the hormones change and the estrogens decrease. This causes the vagina to dry out, which can cause pain.

Physical causes

Pain during sex can have psychological as well as physical reasons. Physical causes are:

- Problems in the hormonal balance
- Hygiene and contraceptive methods
- UTIs
- inflammation of the vagina, ovary, fallopian tubes and glands
- Anorexia
- brain tumors
- an underactive thyroid
- STDs such as gonorrhea, syphilis or trichomoniasis
- genital warts
- vaginal fungus
- tuberculosis
- Fibroids
- a lowering of the uterus or vagina
- a vaginal stenosis
- a congenital malformation of the genital organs
- a very tight vagina
- a weakness of the vaginal wall
- Injuries during childbirth and other injuries to the vagina, uterus and ovaries.

Diagnosis and therapy

First, a gynecologist creates an anamnesis, then he looks at the medical history and asks exactly about the pain during sex. Then he makes a suspicious diagnosis. He then examines the patient using colonoscopy, vaginal sonography, swab and biopsy. If there are no physical causes, there are probably psychological reasons: dysharmony in the partnership, stress or deeper sexual fears, for example experiences of abuse or trauma. Then a sex therapist is required.

Treatment depends on the disease. If the pain is caused by another disease, it is treated.

If the patient reacts negatively to certain contraceptives, the doctor and she will go through alternatives. Pain that is caused by bacteria is best relieved by antibiotics. Hormone-related pain can be managed with hormone preparations. A lubricant helps against a dry vagina.

The most common causes of pain during sex that women suffer from are vaginal thrush and inflammation of the vulva. Genital warts are also common for women.

Vaginal fungus

Vaginal thrush is a fungal infection on the female genitals. The mucous membrane of the vagina and vulva become inflamed. Three out of four women suffer from such a fungus at least once in their life.

Yeasts love the vagina, more precisely, they need a temperature of around 37 degrees Celsius and a humid environment. Candida albicans is the "culprit" in nine out of ten such infections. Candida galbrata responsible for the remaining ten percent.

Fungi are part of the normal microorganisms of the vagina, and the Candida species are always in the female genitals. Usually, however, they do not cause inflammation, since the ph value in the vagina is below 4.5 and thus suppresses their growth. But when the balance of the vaginal flora is disturbed, they multiply and infect the vagina.

A weak immune system enables this spread, hormone fluctuations or illnesses are responsible, for example through pregnancy, menopause or the contraceptive pill or diabetes.

Antibiotics for uterine inflammation, cortisone or cytostatics can also weaken the immune system. In industrialized countries, typical behavior also promotes vaginal thrush: extreme personal hygiene such as intimate sprays, special rinses for the vagina, tight-fitting clothing and underwear made of synthetic fibers, as well as too much sugar in food and stress.

Symptoms

Vaginal fungus is characterized by severe itching and a burning pain in the vagina and vulva, as well as a discharge in yellow-white color and crumbly substance, the fluor vaginalis.

There are also swellings, redness, rash, blisters and pustules in and on the vagina and vulva. Sexual intercourse hurts just like going to the toilet.

These symptoms come in very different degrees of severity. Often, women only think that their vagina has itched recently after a check-up with the gynecologist. If no underlying disease is the cause and the immune system stabilizes, the symptoms often go away on their own.

Women who show the symptoms of vaginal thrush can get treatment from a gynecologist. First he examines the genital area and takes a smear from the vaginal mucosa. The doctor usually recognizes the fungus because the infestation changes the mucous membrane. The doctor sends the smear to the laboratory, and that clarifies which fungus it is. This can be seen under the microscope from the fungal threads.

Therapy

Vaginal thrush can be treated effectively with anti-mycotics; these kill the fungus. They contain imidazoles such as clotrimazole, miconazole, flucanzole, fenticonazole, naystatin or providone iodine. Those affected insert them as a suppository in the disc or apply it as an ointment.

Such treatment takes one to six days depending on the severity of the infection. Sometimes the fungus reappears, then it is recommended to take the anti-mycotics as tablets.

So vaginal fungus is easy to fight. Chronic fungal infections occur very rarely, and then the antifungals must be taken for a long time.

Prevention

The fungus can also be found inside the vagina under normal circumstances. Therefore, it is advisable to wash the vagina from the outside in so as not to spread the fungus. Avoid excessive hygiene, especially with perfumed rinses. Instead, water, pH-neutral soaps and lotions with lactic acid are appropriate.

During menstruation, it's all about proper clothing. Panty liners, sanitary napkins and underwear with a plastic coating mean that heat and moisture accumulate, giving the mushroom the best conditions.

Cotton underwear, changed daily, generally protects against infection. Swimwear should not dry on the body, but should be replaced with dry clothes. If the vaginal fungus is already in action, the affected person should change towels and not use them together with others. Anti-mycotic detergents kill the fungus in clothing and laundry.

Suppositories with lactic acid bacteria help both against the infection and to prevent it. Lactic acid lowers the ph value of the mucous membrane in the vagina.

Vaginal thrush and pregnancy

During pregnancy, the hormone level fluctuates, and this helps the vaginal fungus: the protection of the mucous membrane against pathogens becomes weaker.

The fungal infection itself is harmless even for pregnant women; the affected person should nevertheless treat them immediately. The fungus can open the door to serious illnesses; if the fungus weakens the vaginal flora, other bacteria can spread. The vaginal fungus also potentially spreads to the baby during childbirth and then weakens with fungal infection in the mouth and abdomen.

Lactic acid preparations help to acidify the pH during pregnancy if it is above 4.5. Pregnant women can recognize the fungus by regularly measuring the pH in the vagina. There is a special test glove that the woman inserts into the vagina with her index finger. A test strip on the fingertip then shows the pH of the vaginal fluid based on the color.

Vaginal thrush and sex

Vagina is not usually transmitted through “sex” because men and women usually carry the fungus around with them on their genitals. However, this only applies to intercourse with the penis and vagina. Anal intercourse poses a risk, because more of the fungi frolick in the intestine and buttocks than in the vagina, and the change from anal to vaginal intercourse can increasingly bring them into the vagina and thus unbalance the vaginal flora. Here it helps to change the condom.

The fungus infestation intercourse, but women who feel like it do not have to do without it, because medically there is nothing against it. However, the fungus damages some contraceptives: condoms quickly become brittle due to the anti-mycotics and they weaken the contraceptive creams. Birth control pills and contraceptive plasters work without restriction.

Vulvitis

In the case of vulvitis, the woman's external genital organs become inflamed, i.e. the venus mound, the labia, the clitoris, the vaginal vestibule and the Bartholin's glands. All women suffer from this infection at least once in their life.

It is shown by intense itching and burning around the vagina. The pain makes sitting torture as much as the sexual act. Sometimes the lymph nodes in the groin swell, urination hurts when an urinary bladder is infected. Genital warts also cause wetness and bleeding after sex.

Causes

Vulvitis is a collective term for inflammation with very different causes. For example, some women react negatively to synthetic substances in clothing or bandages, or substances in soaps, sprays and detergents.

Gut bacteria, staphylicocci, streptococci and gonococci also trigger inflammation, as well as viruses such as genital herpes or papilloma.

Other causes are: animal pests, for example pubic lice, itch mites or worms, estrogen deficiency or an immune deficiency caused by AIDS such as cancer; Exaggerated as well as nonexistent intimate hygiene, or injuries caused by shaving. Psoriasis is an inflammation of the skin that can also affect the vulva. When there is a bladder infection, the urine irritates the vulva and also provides an ideal, moist and warm microclimate for bacteria and fungi.

The vulva can easily be infected by pathogens from the anus, vagina and urethra, intestinal bacteria enter the area of ​​the vulva if the anus is not cleaned properly or properly, vaginal infections can reach the vulva. Bed linen and towels provide a terrain for itch mites and pubic lice.

A Vulvits is easy to spot. The mucous membrane swells and turns red. The doctor examines the cause using a smear under the microscope.

Therapies

Depending on the cause, there are different healing methods for vulvitis: pubic lice and itch mites are externally controlled with the agent lindane. Antibiotics help against bacteria, the doctor opens a cyst on the Bartholin gland and sutures it to the outer skin; a new gland outlet prevents clogging of the gland.

If there is no infection, chamomile baths work, as does the aftercare. Pain relieving drugs are also useful.

Genital warts

Genital warts are tissue growths on the vagina, anus, rectum and the externally visible parts of the female and male genitals. Young people in their early 20s in particular suffer from it.

The cause of genital warts is an infection with papilloma viruses, which are transmitted through sexual intercourse. As a rule, the partner or partners carries these viruses. If children have genital warts, this is an indication of possible sexual abuse.

Vaccination against the virus protects 90%, condoms also help.

Genital warts are caused by human papilloma viruses (HPV). Some of these viruses are also responsible for uterine, anal, penile and vulvar cancer. These growths can extend over several centimeters, they are white-reddish or gray-brown. Often you can hardly recognize them, then again they form structures that are reminiscent of cauliflower.

Eight out of ten people contract HPV once in their life, only one in every 100 of them can see the warts. Genital warts develop when skin injuries become infected. The warts surface a few weeks to months later. Most of them are transmitted through sex, promiscuous active people take the greatest risk. Condoms help here effectively. Genital warts sometimes also show that the immune system is disturbed, but only with regard to HPV.

Women most commonly suffer from genital warts on the perineum between the anus and vagina, on the labia, at the entrance to the vagina, in the vagina and cervix, on the urethra and on the venous mound.

In men, the warts proliferate on the foreskin, glans, penis furrow, foreskin ligament, urethra and pubic mound, and genital warts occur on the anus in both sexes.

Genital warts itch and sometimes burn. Sexual intercourse then causes burning pain, the friction of the genitals can lead to bleeding and discharge in women.

Diagnosing and treating genital warts sometimes requires several specialists: dermatologists, gynecologists, urologists and proctologists. Reflections of the intestine, urethra or rectum show how the warts spread. The tissue is examined with a colposcope.

A four-fold vaccination against HPV protects against HPV-16 and - 18, which cause cervical cancer, and also against the "more harmless" HPV-6 and HPV-11, which occur all the more frequently.

Vaginal cancer

Vaginal cancer, other names are vaginal cancer, vaginal cancer or vaginal cancer, is a rare cancer that causes pain during sexual intercourse.

Nine out of ten vaginal tumors develop in the uppermost mucosa. In addition to these squamous cell carcinomas, there are adenocarcinomas in the tissue of the glands and melanomas, i.e. skin cancer. Half of the crabs are in the upper third of the vagina and the vaginal posterior wall.

Like others, these cancers are either operated on or irradiated. With an early discovery, vaginal cancer is easy to remove and often heals completely.

The human papilloma viruses types 16 and 18 are involved in vaginal cancer. An artificial estrogen, diethylstilbestrol, was taken by pregnant women. Today it is on the market because it causes adenocarcinoma.

Sexual pain in men

Men experience less pain during sex than women. The pain affects the penis, between the anus, penis and scrotum, on the scrotum itself or on the pubis. Sometimes the pain is there beforehand and intensifies during sex.

Pain, for example, causes a man to lose pleasure in sex and thus endanger the relationship. Often the affected person does not get an erection because of the pain. The resulting suffering can lead to clinical depression. This is also why men who experience pain during sex should see a urologist.

Foreskin narrowing, so-called phimosis, is relatively widespread. The foreskin is so tight that it cannot be pushed over the glans. This is why an erection hurts. A phimosis can be surgically removed.

Inflammation is also common:
- urethritis
- Colon inflammation
- inflammation of the prostate
- Acornitis
- inflammation of the foreskin
- Inflammation of the bladder

There is often an illness behind the pain:
- Tripper
- soft chancre
- trichomoniasis
- Chlamydia infection
- syphillis
- Tripper
- Genital herpes
- Stappylococcal dermatitis

Hardening of the penis causes the erect penis to be crooked. The penile fracture, which arises because a erectile tissue tears in the penis, is more dramatic. An allergy also triggers pain: a man can have an allergic reaction to the woman's contraceptives, but also to hygiene products such as shower gels. Very rarely, prostate cancer is responsible for the pain

In any case, ask a urologist for advice. He examines the nature of the pain. Does the person affected also feel pain when going to the toilet? Is the erection painful itself? Do the pain only come during intercourse?

The urologist examines the external genital organs and, if necessary, takes a smear to identify pathogens; he looks for inflammation and deformation; he examines the blood and urine.

The foreskin narrowing

A normal sized foreskin can easily be pulled over the glans. However, if the foreskin is narrowed, the erection causes pain and the same applies to sex.

A glued foreskin is normal in infants, the foreskin narrows almost always at around 4 years of age. While the foreskin is still too tight in 8% of six-year-olds, only every hundredth seventeen-year-old suffers from it.

A few are innate, some have scarring from inflammation, and others have been injured because someone tried to forcefully pull their foreskin back in childhood. Diabetes mellitus often leads to phimosis.

An adult notices that he suffers from phimosis if he cannot fully retract his foreskin - both erect and non-erect limbs, if he experiences pain on the foreskin during masturbation, sexual intercourse, and generally with an erection. This stretching pain can be easily distinguished from the burning pain caused by infections of the penile skin or urethra. In particular, the pain does not occur when urinating, and the foreskin does not hurt when someone touches it, as is the case with an external wound.

Adults can get rid of the foreskin narrowing using various methods. Procedures that preserve the foreskin expand the plastic tissue. Circumcision corresponds to circumcision for religious reasons: the entire foreskin over the glans is cut away here. Since no more skin covers the foreskin, phimosis can no longer arise.

Circumcision is not dangerous if it is carried out by a specialist. However, those affected are sometimes unsatisfied with the aesthetic result, for example because the skin obtained is asymmetrical at the edges. Medical problems are rare. The wound bleeds in two out of a hundred patients.

Many men have their foreskin circumcised because they think they have better sex, are more excitable and sexually more potent. Circumcision always affects the sensitivity of the glans. Firstly, care should be taken to ensure that the glans receive the necessary moisture; secondly, the person concerned should ensure that they do not negatively irritate the glans, which is now unprotected by the foreskin, for example through underwear made of rough materials or itchy substances.

Penile cancer

Penile carcinoma is a rare cancer that mainly overgrows the glans and foreskin. The trigger is probably the smegma, the sebum of the foreskin. If this accumulates permanently between the glans and foreskin because the person concerned does not wash, this promotes tumors. Phimosis means that the person affected cannot clean the glans properly. Smoking and papilloma viruses are further risk factors.

Early warning symptoms include: changes in the mucous membranes, discharge and bleeding from the penis (not in the urine). However, these symptoms can also have harmless causes and are therefore rarely taken seriously.

Penile cancer can be operated successfully. Depending on the stage of cancer, this operation ranges from removing the foreskin to amputation of the penis. If the penis has metastasized, chemotherapy and radiation therapy help. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Swell:

  • Oluwatosin Goje: Vulvitis, MSD Manual, (accessed September 11, 2019), MSD
  • David H. Barad: Vaginal itching and discharge, MSD Manual, (accessed September 11, 2019), MSD
  • Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
  • Professional association of gynecologists (BVF): vaginal fungus / Candida infections / vaginal mycosis / vaginal fungus (accessed: 11.09.2019), Frauenaerzte-im-netz
  • Deutsche STI-Gesellschaft e.V. Society for the Promotion of Sexual Health: Candidiasis (fungal disease) (access: 11.09.2019), ststig
  • Janni, Wolfgang / Hancke, Katharina / Fehm, Tanja / u .: Specialist knowledge in gynecology, Urban & Fischer Verlag / Elsevier GmbH, 2nd edition, 2017
  • JoAnn V. Pinkerton: Menopause, MSD Manual, (accessed September 11, 2019), MSD

ICD codes for this disease: F52.6, N94.1ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


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