Dyspareunia - painful intercourse

Technical terms

Dyspareunia, algopareunia, cohabitation pain

introduction

Pain during intercourse can affect both men and women. In general, however, it is believed that women are significantly more likely to experience pain during intercourse than men.

The complaints that occur during traffic can be less pronounced or even so severe that the affected person experiences a high level of suffering. In addition, persistent pain can increasingly strain the relationship between the affected patients.
Especially in women, the pain that occurs during intercourse can be very different. Some of the women affected only feel a stinging, pulling or burning sensation during or after intercourse. Other women, however, suffer from severe pain, which can be accompanied by pronounced itching.

Because of the pain, both affected men and women usually fail to peak. The reasons for the development of pain during the act can be different. If women experience pain, these complaints can be divided into external and internal pain. External pain usually comes from the external area of ​​the female genital organ. In the case of internal pain, the cause can typically be found in the area of ​​the uterus or small pelvis. Diseases of the rectum, urinary bladder, ovaries or vagina in particular can cause severe pain during the act. In addition, bacterial and viral infections of the genital organs and / or the lower urinary tract are among the most common causes of this pain.

In addition, in the case of pain during intercourse, a distinction must be made whether the symptoms occur during or immediately after the sexual act. The duration of the symptoms perceived can also help to narrow down the possible causes and initiate appropriate treatment. Patients who suffer from persistent pain should consult a specialist immediately.

This is the only way to determine the underlying cause, initiate appropriate treatment and avoid complications.

causes

In women

Pain during intercourse in women can have various causes.
Chronic infections of the lower urinary tract (so-called urinary tract infections) as well as bacterial, viral or fungal infections are among the most common causes of pain during sexual intercourse.
Symptoms that only last for a short period of time are usually caused by inflammation of the female genital organs (technical term: colpitis or vaginitis). This disease occurs when the sensitive environment, which is largely protected from pathogens, is destroyed by antibiotics, excessive hygiene measures or a pronounced lack of estrogen. Patients who suffer from pain during intercourse caused by an inflammation typically notice increased discharge, which can vary depending on the pathogen present.

In addition, the pain can be accompanied by severe itching and / or burning in the genital area. Another cause of pain during intercourse is so-called adnexitis. Adnexitis is a disease that is characterized by the presence of inflammatory processes that are present in the area of ​​the fallopian tubes and / or ovaries, the appendages of the uterus. The affected patients typically suffer from pain on both sides during the act of love if they have adnexitis. In most cases, the symptoms are caused by bacterial pathogens that ascend into the fallopian tubes through the female genitalia and the uterus. An inflammation of the fallopian tubes can be both acute and chronic.

In addition, inflammatory processes in the area of ​​certain glands (Bartholin's glands) of the vestibule of the genital organ can lead to severe pain during intercourse. The so-called bartholinitis is usually caused by a bacterial infection and typically leads to unilateral pain in the affected patients during sexual intercourse. In addition, the labia in a woman suffering from bartholinitis are severely swollen and reddened. In some cases, these swellings are so pronounced that the ducts of the Bartholin's glands are completely closed. As a result, purulent secretions can form and promote the development of an abscess.

Read more on the topic: Bartholinitis Treatment and Bartholinitis Symptoms

In young women, sexual intercourse can be painful if the hymen is very tight and has only a small opening.

Another cause of pain during sexual intercourse is so-called endometriosis. Endometriosis is a widespread, benign disease which, however, goes undetected for a long time in a large number of women affected. Endometriosis is characterized by the growth of uterine lining cells (endometrium) outside the uterine cavity.
In principle, these endometrial foci can occur in any organ. In most cases, however, the scattered uterine lining cells can be found in the pelvis or abdomen area.The tissue displaced in this disease participates in the menstrual cycle, just like the normal lining of the uterus. This phenomenon means that the affected patients suffer from pain during the act, especially during menstruation.

In addition, women with endometriosis typically suffer from menstrual disorders and lower back pain. If there are endometrial foci within the bladder, blood can also be washed out with the urine and problems with urination can occur. Since the symptoms of endometriosis are tied to the hormonal cycle, they typically go away once menopause is reached. Regardless of this, endometriosis should definitely be treated early. The reason for this is the fact that the scattered uterine lining cells can lead to infertility. So-called fibroids, i.e. uterine tumors, can also lead to severe pain during sexual intercourse. A myoma is a benign tumor of the muscle layer (myometrium) of the uterus. The actual tumor consists of a more or less developed connective tissue part and can take on dimensions of several centimeters.

In most cases, a fibroid does not cause any symptoms and therefore remains undetected for a long time. In general, only particularly large tumors or myomas that grow in an unfavorable place cause a pronounced symptom. Affected patients typically notice menstrual disorders and pain during intercourse.

Other causes of pain during intercourse:

• Sexually transmitted diseases (such as trichomoniasis, gonorrhea, or syphilis)

• Genital warts

• Candidiasis

• Scars after childbirth or after a perineal incision (see: perineal incision scar) or perineal tear

• Congenital malformations of the genital organs

• Painful reactions to chemical contraceptives

• Vaginal dryness

• stress

• Pelvic vein syndrome

• Ovulation (painful ovulation)

In men

Pain during intercourse felt by a man can be extremely diverse. Both the intensity and the exact time at which the symptoms appear depends on the underlying cause. Some of these painful situations can even turn into an emergency and make immediate medical treatment essential.

A classic example of such an emergency is what is known as paraphimosis. The narrowing of the foreskin is one of the most common causes of pain in men (technical term: phimosis). In this condition, the foreskin is so tight that it can no longer be pushed back over the glans. As a result, the men affected find an erection of the limb extremely painful. In these cases, phimosis surgery should be considered.

In addition, infections and / or inflammatory processes in the lower urinary tract can also lead to pain during sexual intercourse in men. In this context, the inflammation of the urethra (Urethritis) and the urinary bladder (Cystitis) play a crucial role. In addition, pain during intercourse can be caused by inflammatory diseases of the glans (Balanitis) or the foreskin (Posthitis) caused.
So-called prostatitis (inflammation of the prostate) is one of the most common causes of pain during sexual intercourse. The inflammatory processes in this disease can be of both bacterial and non-bacterial origin. In addition, the inflammation of the prostate must be divided into an acute and a chronic form. In the case of non-bacterial prostatitis, urination disorders or prostatic reflux can often be detected. As a result, urine gets into the ducts of the gland and attacks its sensitive tissue.

Other causes of pain during sexual intercourse:

• Penile fungus - candidiasis in men
• Colon inflammation (diverticulitis)
• Genital herpes
• soft chancre (Ulcus molle)
• Chlamydial infections
• Trichomoniasis
• Thrush / candidiasis (fungal infection)
• syphilis
• gonorrhea
• Induration of the limb in the area of ​​the erectile tissue (Induratio penis plastica)
• Prostate cancer
• torn anus

diagnosis

The most important step in the diagnosis of pain during intercourse is a detailed doctor-patient discussion (anamnesis). The pain is embarrassing for most of the affected patients. For this reason, sensitivity is required in the detailed medical consultation. In order to be able to conclude the diagnosis promptly and initiate appropriate treatment, the doctor's questions should be answered truthfully, even if they are uncomfortable. Above all, the question of when the pain began to appear during sexual intercourse plays a decisive role in this context.
It should also be clarified whether the symptoms occur regularly or only occasionally during sexual intercourse or immediately after intercourse. Possible accompanying symptoms (for example increased discharge, rash, pain when urinating or fever) can provide an initial indication of the underlying disease.

Following this doctor-patient conversation, an orienting physical examination usually takes place. During this examination, the abdomen (abdomen) examined for abnormalities. During the inspection, the doctor pays particular attention to skin manifestations, swellings and scars. In addition, the genital region of the affected patient must be examined for abnormalities.

In women

If a woman suffers from pain during the act of love, a gynecological examination follows. The gynecologist examines both the external and internal genital organs. In addition, swabs of the vaginal secretion are taken during the examination and then examined in a special laboratory.
In addition, an ultrasound examination of the internal genital organs can help rule out an organic cause for the occurrence of the pain. Conspicuous findings in the area of ​​the genital organs should be clarified in more detail with the help of a sample (biopsy). Depending on the suspected cause of the pain, a urine and / or blood test can also be useful.

In men

An examination of the genital region must also be carried out in men who suffer from pain during sexual intercourse. During this examination, the external genital organs and the adjacent body regions (for example the groin area) are examined for skin signs, swelling or deformations.
In addition, a rectal exam should be performed to assess the prostate. In addition, during the examination of the man, smears for pathogen detection should be saved and sent to a special laboratory. An ultrasound examination of the limb and the lower urinary tract can also be useful if the pain persists. In addition, imaging procedures (such as computed tomography) can be effective in some cases.

therapy

Treatment in the event of pain during sexual intercourse depends largely on the underlying disease.

Bacterial infections of the male or female genital organs usually need to be treated with what is known as a broad spectrum antibiotic. These are antibiotics that are directed against a large number of bacterial pathogens that may be responsible for the pain. A special, more effective antibiotic can only be prescribed after the responsible pathogen has been determined.
Inflammation of the external genital organs can be treated in affected women as well as in men by taking non-steroidal anti-inflammatory drugs (e.g. diclofenac). It is imperative that patients note that treatment must be continued even after the symptoms have completely subsided. The attending specialist usually explains how long the medication must be taken for. In addition, bacterial pathogens that cause pain during intercourse can infect both men and women. For this reason, even if one partner shows no symptoms, both should be examined and, if necessary, treated.

In women

Endometriosis does not have to be treated in every case. However, if the affected patients experience pain during sexual intercourse, appropriate therapy should be initiated. In general, endometriosis can be treated surgically or non-surgically (medicinally).
Myomas, which cause pain during intercourse, also usually need to be treated promptly. The benign tumor can be peeled off (so-called enucleation) or surgically removed. Depending on the size of the tumor, it may be necessary to remove the uterus. In young women who suffer from myoma-related pain, however, an attempt is made to preserve the uterus and thus fertility.

In men

If the pain is caused by a narrowing of the foreskin during sexual intercourse, it must either be enlarged or removed. In the case of a slight constriction of the foreskin, cortisone-containing ointments or creams can help relieve the symptoms in the long term. However, pronounced forms of foreskin constriction usually require surgical treatment.
In the case of an inflammation of the glans, which leads to pain during intercourse, the treatment depends largely on the underlying cause. In most cases, disinfecting chamomile baths and antiseptic solutions can help curb the inflammatory processes.