Pain During Sex, pain during Sexual Intercourse, Painful Penis, sharp pain penis,

Best Treatment of Pain During Sex & Sexual Intercourse Painful Penis Treatment

Mens Health

Pain during sex: This also affects men

Best Treatment of Pain During Sex & Sexual Intercourse Painful Penis Treatment: Dyspareunia is more common in women than in men. But some of them are still bothering the problem. Not only the pain itself, but also negative effects on the potency are distressing. The result is fear of failure or even depression, which in turn can dampen the sex life. It is often difficult to talk to the doctor about it. If nothing changes, the partner is disappointed and frustrated. This often disturbs the relationship sustainably. Only professional advice can help now.

Couple in bed

When, where and in what form does the pain occur?

Pain associated with sexual intercourse manifests itself in various forms. There are minor perturbations during or after, which soon fade away. Other complaints in the sensitive zone are more or less constantly present, even without sex. This means that the pain is sometimes just one symptom of several (see section “Varied concomitant symptoms” below).

Some pain situations can even become an emergency, such as when the glans is pinched off the previously recruited narrow foreskin (paraphimosis), or when it comes to the so-called penile fracture.

That the testiclesare highly sensitive, is inadvertently painful touches, abrupt pressure or even a bruise immediately unbearable pain.

Came a man during sex not to orgasm, it may be that he still feels a pressing or pain-like feeling in the testes area for a long time, until a later ejaculation brings relief. Immediately after the orgasm sometimes sensations in the genital area, a pulling or tingling, are felt. Some men feel slight pain in the cross . These are all mostly temporary, harmless disturbances.

Inflammations of the foreskin and foreskin stenosis , for example, are among the major pathological changes that painfully hinder sex and often put a damper on sex life . If the sensitive foreskin is mechanically stressed, pulled, stretched, it causes prompt, violent, pulling pain – all the more natural, of course, when it is constricted or inflamed.

Pain in the perineal area, ie between the testicles and the anal area, often appears as dull, oppressive or boring. Behind this can be, for example, a chronic inflammation of the prostate . For cystitis, in addition to pain during urination, spasmodic pain sensations in front of the abdomen are quite typical. Men who are prone to bladder infections can also be associated with chronic inflammation of the prostate gland. All these complaints often increase in the sexual intercourse.

Of course, problems with joints, hip or back pain can also affect sexuality.

Sometimes the cause of sexual ailments is on the mental level. For example, doctors often recognize a mental background in a clinical picture such as the chronic male pelvic painsyndrome . The symptoms often correspond to symptoms that occur in certain forms of chronic prostatitis (see there).

Some men suffer from a so-called Eichelphobie . This is very feared. More on both issues later in the section “Psyche”.

Study: The question of whether they have more pain during sexual intercourse, affirm 3.4 percent of the interviewed persons. Overall, it is 1.6 percent of men and 5.2 percent of women.

Varied accompanying symptoms 

Pain in sex is not always the only complaint that affects the person concerned. Depending on the cause of the problem, various concomitant symptoms may occur.

Urinary or genital infections, for example, are commonly associated with pain or burning on urination , vaginal discharge , occasionally painful swelling in the testes or in the groin, sometimes with skin lesions. Blood sometimes appears in the urine. Here again different causes come into question, read in the contribution ” blood in the urine “.

consultation
Do not be afraid to go to the doctor for complaints

Pain during sex: When should the person concerned to the doctor?

The rule is: For pain, whatever, complaints urination, vaginal discharge, blood in the urine or semen, fever , chills, skin lesions or other signs of disease always go to the doctor.

You can first contact your family doctor. Take courage: Even a disorder such as pain “only” during sex is not a triviality, but worth a conversation with the doctor. And if you feel that something is wrong with you, your doctor can also give you important advice.

Usually, a urologist is the right person to talk to. He can make a diagnosis and usually treat you. Or he will pass you on to another doctor, such as a dermatologist, possibly also a sexologist. Unfortunately, there are gaps in this regard in Germany. However, some urologists now offer psychosomatic care as an additional qualification.

laboratory medicine

Pain during sex: diagnosis in men

The doctor first gets an accurate picture of the patient’s problem. These are questions like these: In which temporal context are the pains associated with sex? How do you express yourself? What other complaints are there? Are previous illnesses, operations or current illnesses to be considered? Does the partner have complaints in the genital area? Is there a tendency to allergies ?

From the answers, often a first diagnosis is derived, which specifies the further steps.

After a preliminary physical examination of the patient, the doctor examines the external genitalia, the inguinal region and the lower abdomen. As a rule, he also scans the prostate with his finger over the rectum. This is the so-called rectal digital examination. Depending on the suspected diagnosis, laboratory analyzes of the urine, the blood, possibly also of the prostatic retina and sperm, and a genital swab follow. This involves the detection of signs of inflammation and pathogens. Special analyzes in this direction are carried out in the laboratory.

At the next level are certain functional tests and imaging examinations. This is about the excretory function of the urinary organs. On the other hand, there are special examinations to check, for example, the function of erectile tissue. Information about the tissue quality of the penis, prostate and bladder as well as of testes and kidneys provide ultrasound examinations. Computed tomography or magnetic resonance imaging provides detailed insights into the lower pelvic organs, but remains reserved for specific questions. Skin lesions assessed by a dermatologist.

Psychotherapists work with psychological tests and professional conversation techniques.

Overview: Causes of Pain During Sex (Men)

Many disease developments can be painful for men’s sexuality. Here is an overview of the main causes:

External sex organs

penis

  • Foreskin constriction (phimosis)
  • Too short foreskin tape (Frenulum breve)
  • Inflammation of the foreskin (posthitis) / the glans ( balanitis ) or both (balanoposthitis)
  • Penis “break”: tearing of erectile tissue during sex or masturbation
  • penile curvature
  • Hardening of the cavernous body (Induratio penis plastica (Ipp), Peyronie’s disease)
  • Special case: permanent erection (priapism)

Skin diseases on the external sex organs (see also posthitis, balanitis)

  • Intolerance and allergic reactions
  • Lichen disease
  • Genital herpes (infection with herpes simplex virus)

urinary tract

  • Inflammation of the urethra (urethritis)

prostate

  • Chronic inflammation of the prostate (chronic prostatitis, sex can intensify existing pain)
  • Chronic male pelvic pain syndrome (see also “psyche”)

psyche

  • Acorn phobia
  • Chronic pelvic pain and psyche
Phimosis - foreskin narrowing in toddlers

Phimosis: When the foreskin is stuck

If the foreskin can not be pushed back over the glans, there is a phimosis. This is incomplete if withdrawal is only possible with the stiffened penis, and completely if it is impossible even with a limp limb. Infants often have a natural, congenital “phimosis”: a bond between foreskin and glans. Until the age of three to five years, sometimes a little later, it usually dissolves. Otherwise, a real (pathological) phimosis has arisen.

Foreskin constrictions in adults either persist, exceptionally, from childhood, or they are a pathological new development. In this case, the doctor will rule out, among other things, diabetes (diabetes mellitus). The diabetes favors an immune deficiency and thus infections – also in the area of ​​the foreskin and glans (Balanoposthitis, see below). This can lead to a foreskin narrowing over time.

Too tight foreskin hinders genital hygiene. This creates a vicious circle: adhesions and scars caused by inflammation shrink the foreskin. Also, the urethral opening may deform. In the hiding places bacteria are again fixed, which again causes infections and inflammations and intensifies the constriction. The inflammation can also expand: The next target is the urinary tract and prostate. Finally, a chronic inflammation on the penis can also be carcinogenic.

Injuries or rare skin diseases such as lichen sclerosus (see section “Skin disorders in the external genitalia”) favor a similar phimosis.

Symptoms: The symptoms result from the degree of constriction as well as the consequences, namely repeated inflammations as well as disabilities during urination and during sex. Often the erection of the penis is already associated with pain. Sexual intercourse is limited or not possible because the narrowed foreskin can not be stripped back or only in pain .In a complete phimosis, the urethral opening is obscured. The foreskin expands when the bladder is emptied, and the urine stream is thin or dodges sideways. In extreme cases, the urine does not flow in the jet, but can only emerge droplets. A disabled urine drainage often leads to inflammation in the urinary tract and genital area: it can easily cause inflammation of the penis tip and foreskin. The area around the glans is reddened, swollen and hurts. In addition, urinary tract infections occur with burning pain when urinating.

The therapy depends in principle on the cause and severity. If a young boy has a mild phimosis, it may be worth trying the cervical skin with a cortisone ointment. How to do it as a parent doing the best, the treating pediatric urologist will explain in detail. In many cases, this path is a success factor. Only the doctor can decide whether the therapy attempt is justified. With severe constriction and complications a circumcision is necessary. There are different techniques. Also, a plastic surgery may be indicated in individual cases.

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It is not always possible to prevent a phimosis from re-emergence after circumcision (such as enlargement of the pre-hive), for example through scars. 

An emergency called paraphimosis has occurred when the narrowed foreskin is forcibly pushed back and unable to move forward. It constricts the glans, which swells strongly due to the venous congestion and turns bluish red – an extremely painful and serious situation. To avoid serious tissue damage, the person must be treated promptly by a urologist. 

Important: Phimosis increases the risk of penile cancer. In particular, sexually active men with foreskin constriction are advised to have them treated. The cancer can hide for a long time under the foreskin and must initially be painless. Skin lesions that bleed easily and do not heal, small ulcers, nodules or indurations in the area of ​​the glans and foreskin or conspicuous secretions should always be checked by the urologist or dermatologist.

The good news: Careful but not excessive intimate hygiene can prevent certain forms of penile cancer – presumably by reducing the number of infections. The smegma itself probably does not play a direct role. Much more important are infections with Human Papillomavirus (HPV).

Attention: Infections with certain types of HPV are vaccinated for boys and girls aged 9 to 17 years. It helps prevent genital warts and cancers associated with HPV, such as cancers of the penis, intestines, cervix, in the mouth and throat. The vaccine is paid by the statutory health insurance (for some boys still reimbursed as a reimbursement, but in future as normal health insurance).

Short foreskin tape (Frenulum breve)

The foreskin tape is located on the lower front of the penis, between the inner penile foreskin (the inner foreskin) and the glans underside: an important erogenous zone. 

Causes: The ribbon may be too short from birth – possibly together with a foreskin stenosis. In addition, there are even more complex system-related disorders. Also by repeated inflammations, the ribbon may have been shortened, in so far as consequence of the constriction. 

Symptoms: The foreskin can not be withdrawn or only with great difficulty. Possibly the glans buckles down in the state of erection, so the penis bends noticeably. Masturbating or sex often causes pain. Too much stress can cause the ribbon to tear and bleed.

Therapy: The urologist can cut the ribbon in a small procedure, remove it or extend it by means of skin plastic (own skin). With simultaneous phimosis, a circumcision triggers both problems in the same step.

Inflammation of the foreskin and glans: posthitis and balanitis

A foreskinitis affects the inner penis foreskin and usually the glans penis. Then the disease is called balanoposthitis. 

Causes: First, foreskinitis in small boys with natural phimosis is not uncommon, with phimosis – then as a morbid form – can cause problems even in adulthood (see above). On the other hand, sexually active men are affected because foreskinitis is often caused by sexually transmitted infections, such as bacteria such as chlamydia, gonococci and certain herpesviruses (herpes simplex, more in a separate section below). It can also lead to mutual infections of the sexual partners, the so-called ping-pong effect. 

Play a major role insufficient or exaggerated cleaning procedures . A weakened skin resistance or mechanical stress during sex are also risk factors. In all these cases, infection-related inflammation can not occur in the front of the limb (eczema-balanitis). These include seborrheic and allergic reactions on the glans skin. 

A special form of acornitis occurs in the context of the so-called Reiter’s syndrome (balanitis circinata , see also below under “urethritis”). 
Diabetics, usually in the form of a fungal infection (Candida) , are more commonly involved in balanitis . Infections with bacteria also play a role (infection-related balanitis).
Then, various skin diseases favor foreskinitis, including so-called lichen diseases (lichen planus and lichen sclerosus, to the latter for more information below). 
Sometimes there is a drug reaction behind it. 
A special form of balanitis is zoon disease (plasma cell balanitis) in older men. 
There are also inflammations of unknown cause (nonspecific balanitis) and finally inflammatory changes, which are considered precancerous lesions.

Symptoms: Typical signs of foreskin or glans include redness in the area and pain or itching on the front of the penis. The inflamed area may also swell and it may not be possible to retract the foreskin. Some sufferers also feel burning pain in the urethra. The symptoms may increase during sex or prevent it, especially if there is discharge. Depending on the cause of this is very different, sometimes smelly. 

In the Reiter’s disease (the name is now considered outdated, but is still in circulation) can next pathological changes to other parts of the body in the foreskin and glans patchy, slightly ragged, whitish-reddish skin lesions, similar to psoriasis, occur. The psoriasis itself can also show itself as balanitis.

Diagnosis: Medical history and clinical picture are already important information, a pathogen detection in a smear consolidates the diagnosis. Thus, bacteria, fungi or viruses can be identified as the trigger of acute glans and foreskinitis by special laboratory medical methods.

  • Sometimes special skin, blood and urine tests are indicated. 
  • Skin changes, such as spots, shrinkage or poorly healing wounds should always be evaluated by a dermatologist. 
  • If suspected, diabetes should be excluded. 
  • The examination of a small tissue sample from the skin takes place when it comes to the histological diagnosis.

Therapy: Beneficial underlying diseases, such as diabetes or a skin disease, treated by the responsible specialist. An overlying infection, such as with mushrooms, can improve so already. The rest do locally applied ointments with bacteria or fungicidal substances. In case of pronounced findings, the doctor also prescribes them as oral tablets. 

Non-infectious inflammations can often be controlled with cortisone albums of different strengths. Repeated inflammations require closer control; they are also among the possible indications for circumcision and / or corrective surgery on the urethra. 

In cancer precursors, the tissue is usually removed by laser or surgery.

Important: In order to eliminate ping-pong effects (see above) in the case of a genital infection, the sexual partner should also be examined by a specialist and treated if necessary, even if he / she is symptom-free.

Penile Curvature

Candle straight is never an erect penis. Curvatures are especially problematic if they hinder the erection or sexual intercourse mechanically or because of pain. 

Causes: A penile curvature may be congenital or occur in the course of life. In the second case, it sometimes arises after injuries including penile “fracture”, rarely due to a cancer of the penis or scarring after an operation on the urethra. Another important cause is the so-called Induratio penis plastica. More in the next section. 
Congenital curvatures usually show up from puberty. They may be associated with cavernous abnormalities, too short a prepuce ligament, and too short a urethra.

Diagnosis, therapy: Get in case of complaints, or if you feel insecure, expert advice to the urologist – he can best judge whether a morbid condition exists and if so, which therapy is recommended.

Caution: Risk of tearing the penis (penile fracture, penile rupture, penis fracture)

If the erect penis is strained too much, the connective tissue of the erectile tissue may tear. The term break is actually misleading, but quite common. Case histories indicate that this injury to the limb is sometimes the result of attempts to break an erection by manipulations such as severe bending. 

Symptoms: The event is accompanied by a striking noise, almost like a bang, and severe pain. Due to the crack, the penis has a clearly visible kink. Mostly, a strong bruise develops quickly. 
The injury must be operated quickly. Otherwise an erectile dysfunction threatens.

Special case: permanent erection (priapism)

In an erection, the penis gets bigger, harder and straightens up. For this purpose, sufficient blood must temporarily reach the penile erectile tissue. This is a connected to the circuit tissue with fillable small chambers.

Priapism is understood to mean a painful stiffening of the penis that is not caused by sexual arousal and that lasts at least two hours. In the most common form, the blood accumulates in the erectile tissue (so-called low-flow or low-flow priapism, see below, paragraph “diagnosis, therapy”). The technical term priapism comes from the Greek: Priapos, god of fertility.

Attention, emergency: In priapism, a medical diagnosis and treatment must be made quickly because the duration of the erection may damage the erectile tissue and cause erectile dysfunction.

Aid for impotence

Causes: These are very different. Medicines such as some antidepressants, such as serotonin reuptake inhibitors, analgesics, antihypertensive medicines such as alpha-blockers, and certain anti- epileptic drugs . Alcohol and drugs, for example, cocaine, can also be triggering. Sometimes there is a blood disorder such as sickle cell anemia , thalassemia or leukemia (also occurs in childhood). As a result, blood clotting may also change, disrupting blood flow. Also neurological diseases, pelvic fractures, genital injuries or various tumors, such as the prostate, are eligible. Often the cause remains unclear.

Sometimes there is a connection to sex: So a permanent erection can occur in the so-called SKAT. SKAT stands for intracorporal (more precisely, S chwell k örper a utoinjektions t herapie), a method of treatment for impotence. The man injected with a fine needle a drug, usually a so-called prostaglandin, in the penile erectile tissue. After about ten minutes, it comes to an erection that lasts about an hour. Side effects include burning pain and occasionally just an undesirably prolonged erection. SKAT is today a reserve therapy in the event that Potency in tablet form are not effective or should not be taken.

Diagnosis, therapy: In priapism, urologists generally distinguish between forms with increased blood flow or reduced blood flow. Whichever disorder is present, betray an ultrasound underrun and a blood sample from the erectile tissue. Indications for the course of the complaints and the medical history, for the intake of medicines and possible drug use, then the physical examination findings and further analyzes, above all different blood values.

The first, rarer form (high-flow priapism) may disappear with conservative medical attention such as local cooling and anti-inflammatory drugs. Rarely, namely in suspected short circuit between cavernosal vessels and the arterial bloodstream, a catheter measure is indicated. This not only locates the short circuit as a cause, but also fixes it immediately. Since this is an intervention, there are always risks that the patient is naturally aware of.

In the more common low-flow forms with disturbed blood flow, the treatment depends on the cause, as far as detectable. Medications can help to influence the underlying disease and / or to optimize blood circulation. If necessary, the doctor will prescribe suspected drugs. The urologist can also remove blood from the erectile tissue or surgically improve blood flow.

Penis hardening: Induratio penis plastica (Ipp) or Peyronie’s disease

Affected persons describe the changes in the penis that occur in this disease as a plate, swelling, scar or lump under the skin . In fact, the term induration is also more common. The term Induratio penis plastica (short: IPP, another name of the disease: penisfibromatosis) refers to a hardening of the cavernous wall. This is not so rare: about ten to fifteen percent of men are affected. The patients are usually over 50 years old, some of them also have to do with tissue hardening in other parts of the body: on the palm as so-called Dupuytren’s contracture, on the sole of the foot as Ledderhose’s disease, on the shoulder as a chronic shoulder stiffness(frozen shoulder). In each case shortening of connective tissue, and it can cause calcification.

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The causes of Peyronie’s disease are unknown. Among other things, genetic factors and a connective tissue disorder are debated by minor injuries. In about five to 15 percent of those affected, the disease is back, but most of the changes remain on the limb, sometimes with a relapsing course. 

Symptoms of IPP: Elongated, nodular changes occur on the penis, often on the upper side.Affected people sometimes touch them themselves. The skin above is inconspicuous. This is, for example, an important difference to penile cancer, which, of course, can only be assessed by a single doctor. In the further course the tissue possibly shrinks, which causes the penis to curve in the erected state, Especially in acute, months or more than one and a half years early stage of IPP men feel pain during sex. In the chronic phase of curvature, the pain is usually gone. But the form deviation often burdened those affected considerably and partially prevents the erection. If the glans is included, it can lead to a feeling of numbness .This also sometimes causes a weak erection .

The diagnosis results primarily from the clinical findings. In addition, as an imaging method especially ultrasound. Only for specific issues Doctors use magnetic resonance imaging (MRI). Sometimes a tissue sampling (biopsy) is advisable.

For treatment , early-stage physicians use medications such as potassium para-aminobenzoate, as well as a method such as iontophoresis (direct current that better directs drugs through the skin) and shock waves in calcified tissue scarring . Which other drugs are initially considered, which time later is the right one for an operation and which type of intervention ultimately makes sense, is best judged by a well-familiar with the disease urologist.

Decisive are the extent of the changes including possibly accompanying erectile dysfunction and the often considerable suffering. For example, if the disease persists in the second year and has stabilized beyond the last six months (no pain, no further change in the penis, possibly calcifications visible on ultrasound), a plastic surgery may be appropriate. It only corrects the main symptom, not the underlying (unknown) cause.

Intolerance and allergic reactions of the skin

In some cases, skin reactions to changes in the partner’s vaginal milieu may be considered as a cause of pain during intercourse. Ingredients in preparations for intimate hygiene or in lubricants and contraceptives may irritate the skin on the glans penis (see also above: balanitis) or on the penis. Then it is worthwhile first an outlet attempt at these products. Protection also offers a condom. See the doctor if the skin problems do not subside or become worse.

Rare dermatitis: lichen sclerosus

Lichen sclerosus is a rare, inflammatory skin disease that can occur anywhere on the skin. Preferably, it shows in the genital area, especially in women. Lichen actually means small, flat nodule; sclerosus stands for hardening, especially connective tissue. The cause is unknown. Previous damage to the diseased parts of the skin probably plays a role. Also, immune reactions are allegedly involved. Some sufferers also have (other) autoimmune diseases such as hyperthyroidism or white spot disease(Vitiligo). Men are relatively rare. In affected boys, the changes in puberty can improve. Without circumcision, the risk of lichen sclerosus is increased, as it often appears on the foreskin, including ligaments. The disease is not transmitted through sex. 

Symptoms: At the diseased areas of the skin, small, whitish nodules first develop that can coalesce into larger spots. The skin – here the foreskin – thins out, can form fine “wrinkles”, itches, tightens and tears easily. This can lead to scars that narrow the foreskin, and more rarely the urethra opening. This causes pain during sexual intercourse. A narrowed urethra can hinder the excretion of urine. 
The diagnosisAs a rule, the dermatologist. He has her secured by a small tissue sample (skin biopsy). 

Therapy: An ointment treatment of the diseased skin with cortisone or other drugs should be started as early as possible. If that does not help, doctors usually suggest circumcision to men. Occasionally, urethral surgery may be necessary to improve urinary flow. Lichen sclerosus can increase the risk of a certain form of skin cancer . Therefore, affected persons should have their doctor check them once a year.

Grievous Intiminfektion: Genital herpes

Genital herpes is sexually transmitted. The triggers are mainly herpesviruses of the type herpes simplex virus 2 (HSV 2), more rarely type HSV 1, mainly cold sorescaused. The pathogens get into the body after appropriate partner contact or contact of healthy to infected mucous membrane and then settle for a lifetime in nearby nerves. However, the infection does not always cause symptoms: while some have symptoms several times a year, others are less likely, slightly or not at all and know nothing about their infection. Nevertheless, they may be contagious. Immunodeficiency, hormonal fluctuations, severe physical or emotional stress sometimes favor relapses. Then the virus becomes active again and causes the annoying symptoms (see below). In the case of recurrence, this often has a negative effect on the sex life, which in turn can permanently burden the partnership. 

symptoms: 2 weeks after the initial infection, the onset of the disease is initially felt with a tingling sensation on the skin, such as on the penis, on the testicles, thighs and in the anal area. Then the intimate contact is painful. Subsequently, a reddish swelling occurs at the affected areas, which then turns into painful, itchy blisters. They eventually break down and leave little weeping ulcers that crust and heal – a process that can take one to two weeks or more. Women sometimes experience urinary pain (see below: “urethritis”), blisters and ulcers in the internal genital area, and vaginal discharge.
In addition, general symptoms such as feeling sick, body aches, pain-sensitive, slightly swollen lymph nodes in the groin and fever are possible. 
Relapses are often shorter, weaker and usually without general symptoms. 

Tips for prevention:Do not touch the very infectious skin blisters and always wash your hands carefully when suspected contact – also, for example, to avoid infection on the eye. As long as skin symptoms persist, let sexual contacts rest as much as possible. For people who have had a genital herpes infection, it is advisable to protect yourself and your partner with condoms in the first few months after the disease subsides. However, they only shield the covered skin area. This also means: It is important, as an affected person openly with the or the partner on the sex and infection protection exchange. With changing intimate partners, condoms are always recommended. Because: Many people carry the virus in themselves, without knowing or remembering something. Nevertheless, it can spread further through the mucous membranes. If there are suspicious complaints in the genital area, you should go to the doctor. He will also inform those affected about the possibilities of antiviral therapy and the specifics of the infection.

Urethritis (urethritis)

Urethral and bladder infections make some similar complaints. Therefore, they are not always immediately distinguishable from each other. This explains why in the context of a urinary tract infection is often mentioned. Actually, there are differences. They refer, for example, to the causes, and in turn allow certain conclusions about the location of the infection.

Causes: To a urinary tract infection it comes once by pathogens that enter the urethra in unprotected sex. Since women have a significantly shorter urethra, the infection affects them especially the bladder. In men, the events usually take place in the urethra. Involved are then often bacteria of the type chlamydia, gonococci and mycoplasma, viruses such as herpes simpelx (genitalis), also trichomonads and fungi.

On the other hand, an enlarged prostate (benign prostatic hyperplasia, BPH) promotes urinary tract infections in men: BPH is a typical male problem in the second half of life. The enlargement of the gland can cause the bladder to be emptied worse. Remaining urine sometimes provides bacteria with a good breeding ground, so that infection can easily develop.

But other changes in the lower urinary tract can make the emptying of the bladder and thus pave the way for urinary tract infections: such as narrowing by scars (stricture, see above), more rarely a stone at the bladder outlet or malformations, such as an outpouring of the bladder (diverticulum), more rarely Tumor.

Sometimes there are also symptoms of a urinary tract infection (see below) and discomfort during sex, although an infection can not be detected. Doctors then rather assume indefinite, unspecific irritation. This includes, for example, the keyword chronic pelvic pain syndrome. See below under “Chronic Prostate Inflammation, Section: Special Form of Chronic Male Pelvic Pain Syndrome” and in the section “Pain in Sex (Men): Psyche”.

An urethritis can also be caused by mechanical stimuli that irritate the vulnerable mucous membrane, for example in the course of masturbation. Or allergic reactions to chemical contraceptives, lubricants and intimate hygiene products.

Rare is the so-called Reiter syndrome . This is a rheumatic inflammatory joint disease that occurs a few weeks, for example, after a bowel or urinary tract infection. In addition to changing pain in joints, such as knees or hocks, it can cause a variety of discomforts. Here can the urinary and sex tract, the eyes, internal organs and certain areas of the skin such as palms, soles and glans / foreskin on the penis (see above: acorn and foreskinitis).

Occasionally, a urinary tract infection spreads to the prostate (see below), more rarely to the epididymis and testicles.

Important: In order to eliminate the source of infection as much as possible, the partner should always be examined by a doctor if you have urethritis. 
symptoms: Frequently urethral inflammation causes symptoms such as burning pains and problems with urination: those affected have frequent urination, but only excrete small portions of urine. In addition to itching and burning in the urethra, a glassy, ​​slimy or purulent discharge often occurs. The opening of the urethra is often red and painful. The urine also often looks clouded or bloody, and the area above the pubic bone hurts, as well as the sexual intercourse or ejaculation associated with pain. A prostate infection sometimes leads to the fact that the sperm is slightly bloody – all not good sign for lust for sex. 

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Pain during sex: problems with the prostate

Chronic prostatitis (chronic prostatitis)

Chronic inflammation of the prostate plays an important role in connection with sexual pain. However, they usually cause only vague discomfort and affect the condition less strongly than acute inflammation.

Causes: Chronic prostatitis may occur when an acute infection of the gland does not heal properly. It is often caused by intestinal bacteria, sometimes germs transmitted during sex. They first invade the urethra and then spread to the prostate. The pathogens can also become active backwards, trigger inflammation of the urethra again and spread into the prostate.

This explains some of the symptoms: Frequent urinary symptoms such as burning, repeated urination and elimination of only small urine volumes to urinals – typical signs of irritation of the lower urinary tract. In addition, the affected feel an indefinite pressure in the perineal area and pain during sex, or more precisely: during ejaculation. The pain can radiate into the penis, the testicles, groins and the cross . It can also cause problems with the erection . Some sufferers often complain about disorders in the evacuation, muscle pain, fatigue and fatigue .

Complex and common: Special form of chronic male pelvic pain syndrome

Again and again it comes with such symptoms to overlap with the so-called chronic male pelvic pain syndrome . In other words, in the majority of patients with complaints that fit a chronic prostatitis, this syndrome should underlie. It is also called chronic abacterial prostatitis. Abacterially states that no pathogen can be found to a relevant extent in a urine culture. Syndrome means that a symptom is characterized by several symptoms.

Symptoms and Diagnosis: By definition, it is a chronic pain condition with multiple, persistent pains in the abdomen – internally in the pelvic area, in the genitals and perineum.The complaints are often associated with disorders of the bladder and sexual functions. Safe evidence of an organic disease does not arise for the doctor. Only the white blood cells can be increased in the urine (special examination), in the prostate secretion and possibly also in the ejaculate. This fact, a laboratory finding, is considered an inflammatory sign and is then compatible with the variant of the abacterial inflammatory pelvic pain syndromes . For this, however, other conditions must be fulfilled, such as the results of a questionnaire.

In the second form, no signs of inflammation in these body secretions are detectable. This is the abacterial, non-inflammatory form of the syndrome.

In addition to the above criteria, it is important for the diagnosis that any other urological or other cause throughout the lower pelvic area must be excluded. This sometimes leads to extensive investigations. In particular, pathological changes in the urinary tract and the prostate are excluded, as well as a benign enlargement of the gland (see below, “Other causes of prostate inflammation”), then changes in the rectum and anal area, in the groin area and in the back.

This means that the doctor will also examine the patient for a hernia or less common peculiarities such as pubic bone inflammation (more on this in the article ” groin pain “, chapter “Causes: muscles, tendons, joints”). It is clear that the corresponding causes must then be treated. Then it will also indicate which disease has been present or continues to exist.

Occasionally, depression and other mental factors also play a role in pelvic pain syndrome . They can be a consequence, a parallel disorder or a triggering or favorable circumstance. More on this particular aspect later in the section “Chronic pelvic pain and psyche”.

Therapy: For example, doctors use medications that relax the pelvic floor at the bladder outlet . Anti-inflammatory analgesics are also used. As a rule, antibiotics are not or only very cautiously used by physicians in the absence of significant evidence of germs . Also recommended are warm sitz baths and frequent ejaculations. If there is a tendency for constipation , chair-regulating measures make sense. Procedures such as TENS or other nerve stimulation techniques, biofeedback, pelvic floor relaxation exercises are also among the treatment options (more on this later in the section “Chronic pelvic pain and psyche” under “Pain during sex (men): psyche”).

Other causes of prostate inflammation

Other possible causes of chronic inflammation of the prostate are, for example, strictures, so-called strictures, of the urethra. If they lie below the point where the gland ducts of the prostate gland open, the urine can enter the prostate and cause inflammation there. Such constrictions are caused by scars after injuries, such as through a catheter or an endoscopic procedure through the urethra.

Symptoms: The person affected above all sensation of discomfort when urinating, which is considerably more difficult: The beam is attenuated, thin, possibly divided or deviates to the side. Urine can backlog. Possible consequences: Infections that promote acute or chronic smoldering bacterial prostatitis – and pain during intercourse.

Diagnosis and treatment: The urologist can detect, dilate (bougiere) or split (urethrotomy) a stricture by means of procedures such as urinary stream measurement or urethrography. Then the complaints in the urinary and sex tract should improve significantly. However, sometimes urethral strictures tend to rebuild.

Detailed information on inflammatory diseases of the prostate can be found in the guide “Prostate Inflammation“:

Pain during sex: What role does the psyche play?

Mental problems can also cause pain in intimate contact for men. Before the doctor comes to this assessment, he will first have to exclude physical changes to a pronounced hypersensitivity in the genital area, even after ejaculation. Sexual practices that delay ejaculation and overuse the limb may also play a role.

The person concerned makes it easier for the doctor to search for clues by being open to his questions and describing as precisely as possible which problems he has with sexuality. One thing is clear: The psyche affects the sexual experience sensitively. The fact that she can also disturb it is obvious, as well as the reverse case.

Acorn phobia

Acorn phobia means that a man encounters his glans exposed from the foreskin with strong anxiety sensations. Even at the touch of the glans his anxious expectation of pain is so pronounced that he breaks off the sexual intercourse .

Such psychologically induced dyspareunia are now classed by experts as so-called somatoform disorders (see below). For example, it may be based on past conflicts and mental injuries at the sexual level, such as abuse. But also current partnership problems often play a role. Psychological therapy may be the appropriate framework to deal with the disorder.

Chronic pelvic pain and psyche

Persistent pain and dysfunction in the urogenital area without detectable organic cause (see also above in the section “Chronic prostatitis, paragraph: Chronic male pelvic pain syndrome”) are also attributed to the somatoform pain disorders. Thus, the chronic pelvic pain syndrome is therefore the most common somatoform disorder of the genitourinary tract in men. From a psychological point of view, this affects both variants – the abacterial inflammatory as well as the non-inflammatory form, as long as they do not respond to medical therapy.

What does somatoform mean? It says that there is a physical disorder that is not sufficiently explained organically. By definition, this presupposes that the person concerned has been examined carefully and without result by the relevant specialists according to the main complaints: in the pelvic pain syndrome, first by a urologist, possibly also by a rectal specialist (proctologist) or orthopedist. Since the sufferers sometimes suffer from depression or anxiety disorders, should be consulted with appropriate advice a psychiatrist for diagnosis and treatment.

Interactions between conflicting relationships (experts like to use the term “psycho-social factors”) and disturbed processing of these conflicts are assumed to be disease-causing factors. These can be, for example, unresolved mental stress in early childhood, from which develop special partner dependencies.

Some sufferers also suffer from a pronounced negative self-image and disturbed emotionality. At the same time, they sometimes develop a pronounced attention to their own body. If patients see relationships with points of conflict or emotional burdens in their life history and want to find better access to them as well as help in dealing with them, then psychological therapy makes sense.

Specialists in psychosomatic medicine as well as medical and psychological psychotherapists primarily take care of somatoform diseases, provided that the clinical picture has previously been adequately corroborated. Recent recommendations suggest that the physical and psychological diagnostics should be carried out as parallel as possible, especially if mental stress is also recognizable.

Psychosomatic illnesses are not simply “equal to psychic”, but require a holistic view of man, since there are many interactions between body, psyche, nervous, hormonal and immune systems. These are often not yet explored or only hypothetical.

Psychological therapy methods include behavioral, relaxation and conversation techniques, which can also be incorporated into more comprehensive therapy concepts with psychotherapeutic approaches. This also includes pain management techniques, stress management, body awareness methods, respiratory therapy, sports and exercise therapy.

Couple holds hands

Pain during sex: Self Therapy

The treatment of sexual pain is as diverse as the spectrum of causes. There is no one possible treatment. In the description of the triggering clinical pictures, this article partly deals with the therapeutic options. In addition, you will find information under the advisor links in the text. It is important that you confide in a doctor for problems such as dyspareunia, so that the pain does not set. He will also tell you to what extent you may be able to help yourself.

To sexuality are two. An important first step is to talk to your partner about your situation. Only then can he or she understand – regardless of whether your problem is more on the physical or mental level. Sometimes switching to techniques and positions relieves pain and tension. Skin irritation can often be corrected by avoiding certain means of care or prevention . The pain is also often an “SOS of the relationship”. Finding out new ways enlivens being together, promises more fulfillment and opens up new opportunities for the partnership . Also, there is the possibility of partner therapy not only for sexually transmitted infections, but also on the psychological level – as Couples therapy . Here, both partners can actively participate.

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