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Medically reviewed guide · Last updated: 17 November 2026 · Reading time: approx. 12 min
Painful Intercourse: Causes in Women and Men
At a glance
Pain during sex is common and treatable— doctors call it dyspareunia. It affects women considerably more often, but it also occurs in men, and out of embarrassment it often goes unmentioned for years.
Where it hurts is the most important clueburning or soreness at the vaginal entrance points more to dryness, an infection or irritated skin. A deep, dull pain in the pelvis points more to endometriosis, cysts or inflammation of the internal organs.
In men,the cause is often a tight foreskin, a short frenulum, inflammation of the glans, inflammation of the prostate or a curvature of the penis.
Medicines as a causeanti-hormone treatments, antihistamines, bladder medicines with an anticholinergic effect, antidepressants, isotretinoin and some hormonal contraceptives dry out the mucous membranes or dampen arousal.
Get it checked straight awaysudden severe lower abdominal pain with circulatory problems (especially if you could be pregnant), fever with lower abdominal pain, a cracking sound with immediate loss of erection and bruising of the penis, or a painful erection lasting more than four hours — then go to an emergency department or call 112 (emergency number in Germany).
The most common causes compared
Cause
Where and how it hurts
Typical accompanying signs
Typically affected
First step
Dryness (lack of oestrogen, breastfeeding, medicines)
Burning and friction pain at the entrance, especially on penetration
Dryness in everyday life, slight bleeding afterwards
Pain during sex is almost never “all in the mind” — but body and mind reinforce each other. Anyone who has experienced pain once tends to tense up involuntarily the next time, arousal fails to build, the lining stays dry, and it hurts again. That is why it is worth having it checked before this cycle becomes entrenched. If the lack of moisture is the main issue, you will find the details in the article on vaginal dryness; this article is about the pain itself and all its causes — in women and men.
Dryness and a thin lining
Without enough oestrogen, the vaginal lining becomes thinner, drier and more easily injured. This typically happens during and after the menopause, while breastfeeding and during anti-hormone therapy after breast cancer. The pain is felt at the entrance, it burns or chafes, and slight bleeding often follows. First step: a water- or silicone-based lubricant, hormone-free moisturising gels and raising the subject at the gynaecology practice — with a lack of oestrogen, local oestrogen treatment usually works well.
Infections in the genital area
Vaginal thrush makes the lining sore, itchy and sensitive to touch, usually with whitish, crumbly discharge. Bacterial vaginosis tends to show up as thin, grey, fishy-smelling discharge. Genital herpes appears as painful blisters and small sores. Chlamydia and gonorrhoea often cause hardly any symptoms at first, but they can ascend to the womb and fallopian tubes — sex then hurts deep in the pelvis, frequently with bleeding between periods or fever. A urinary tract infection can also make sex painful. First step: an examination with a swab. Sexually transmitted infections are usually treated in your partner as well.
Vulvodynia and vaginismus
With vulvodynia, the skin at the vaginal entrance burns or stings even though there is no infection and no visible change. It is often the provoked form (vestibulodynia): the pain only occurs on touch — during sex, when inserting a tampon, during an examination or on a bicycle saddle. With vaginismus, the pelvic floor muscles tighten involuntarily as soon as something is to be inserted; penetration is then painful or not possible at all. Neither is imagined — both are well-described conditions. First step: a gynaecological examination, often followed by pelvic floor physiotherapy, exercises with dilators (vaginal trainers) and, if needed, sex therapy.
Endometriosis, cysts and fibroids: the deep pain
In endometriosis, tissue similar to the lining of the womb grows outside the womb, for example between the vagina and the rectum. A typical sign is a deep, dull pain in certain positions that often lingers for hours — together with severe period pain, pain when opening the bowels during your period or difficulty getting pregnant. It often takes years to reach a diagnosis. Ovarian cysts, a backward-tilted womb, adhesions or fibroids can also cause deep pain. First step: a gynaecological examination with ultrasound; a pain diary covering two to three cycles helps a great deal.
After childbirth, after operations, with skin conditions
Scars after a perineal tear or an episiotomy, an operation in the pelvis or radiotherapy can harden the tissue. In the period after giving birth, dryness caused by breastfeeding adds to this. Lichen sclerosus, a chronic inflammation of the skin of the vulva, makes the skin whitish, thin as parchment and prone to cracking — sex then easily tears the skin. First step: an examination at a gynaecology or dermatology practice; the condition is readily treatable, but it needs a diagnosis and regular check-ups.
In men: foreskin, frenulum and glans
A foreskin that is too tight (phimosis) pulls painfully during an erection and tears easily. A short frenulum (frenulum breve) pulls the glans downwards during an erection and can tear during sex — this often bleeds heavily but is usually harmless. Inflammation of the glans (balanitis) with redness, burning and a coating is often caused by yeast, more frequently with diabetes or when the female partner has vaginal thrush. First step: a GP or urology practice; a tight foreskin can often be treated with a corticosteroid ointment at first, otherwise the frenulum and foreskin can be corrected with a minor procedure.
In men: prostate, urethra and curvature of the penis
Pain during or after ejaculation, pressure in the perineum and burning when passing urine point to inflammation of the prostate or — much more commonly — chronic pelvic pain syndrome without detectable bacteria. Discharge from the urethra suggests a sexually transmitted infection. In Peyronie’s disease (induratio penis plastica), a palpable, hardened plaque forms in the erectile tissue; in the early phase erections are painful, later the penis becomes curved. Testicular pain after sex also occurs. First step: a urology practice with a urine test and swab.
Allergy, irritation and psychological factors
Latex condoms, spermicides, perfumed lubricants, intimate sprays and soaps can cause burning and redness in both sexes. Very rarely, the body reacts allergically to components of seminal fluid. Stress, relationship conflicts, fear of pain, low libido, depression or distressing sexual experiences hold back arousal and lubrication and increase muscle tension. This is not an excuse but part of the explanation — and it can be addressed well, for example in sexual counselling.
Self-tests: first clues at home
These observations do not replace an examination or a diagnosis. But they help you narrow down the cause and prepare for the conversation at the practice — many people find that easier with a few notes.
The where test: does it hurt at the entrance on penetration (superficial) or deep inside with certain movements (deep)? Superficial pain points more to dryness, the skin, an infection or the pelvic floor; deep pain points more to the organs in the pelvis.
The since-when test: has it always been like this, or did it start after giving birth, with a new partner, with a new medicine or with the menopause? The onset often reveals more than the intensity.
The tampon and everyday test: does it also hurt when inserting a tampon, when cycling or in tight clothing? That points more to vulvodynia or the skin than to an internal organ.
The cycle check: is the pain worse around your period, together with period pain or pain when opening the bowels? Then think of endometriosis and note down the days.
The accompanying signs check: discharge, itching, blisters, bleeding after sex, burning when passing urine? In men: a tight foreskin, tears, a coating, a palpable hardening or a curvature during an erection?
Warning signs: when not to wait
Sudden, severe lower abdominal pain after sex, especially with dizziness, circulatory problems or if a pregnancy is possible
Fever with lower abdominal pain and unusual discharge
An audible cracking sound from the penis with immediate loss of erection, swelling and bruising
A painful erection lasting longer than four hours
Sudden, severe testicular pain, even without any connection to sex
Painful blisters, ulcers or new lumps in the genital area
Acute pain with circulatory problems: emergency department or 112 straight away Sudden, intense lower abdominal pain with dizziness or a feeling of fainting can point to a ruptured ovarian cyst, a twisted ovary or an ectopic pregnancy. A penile fracture (cracking sound, immediate loss of erection, bruising) and an erection lasting more than four hours are urological emergencies, as is sudden severe testicular pain. In all these cases: go to an emergency department straight away, and with circulatory problems call 112 (emergency number in Germany).
Bleeding after sex: get it checked, do not wait Usually a sensitive spot on the cervix, a polyp or inflammation is behind it. But because changes to the cervix can also show up this way, repeated bleeding after sex should be checked promptly at a gynaecology practice — even if your last screening was normal.
If sex happens against your will Pain during sex can also be linked to pressure, coercion or violence. You do not have to carry this alone: the German helpline Hilfetelefon “Gewalt gegen Frauen” (Violence Against Women helpline) can be reached around the clock on 116 016, free of charge and anonymously. After an assault, a medical examination can secure evidence and prevent infections or a pregnancy.
The treatment pathway: step by step
Leave out irritants. No soap, intimate sprays or douches, lubricants without fragrances and, if a latex allergy is suspected, latex-free condoms. Oil-based lubricants can damage latex condoms.
More time, more lubricant, different positions. Plenty of foreplay and positions in which the person feeling the pain controls depth and pace relieve many symptoms — but they do not replace a medical check if the pain persists.
Examination at the practice. Women go to a gynaecology practice, men to a GP or urology practice. There you will be asked questions and examined, a swab or urine test will be taken and, with deep pain, an ultrasound carried out. Feel free to say beforehand that the examination might hurt — it can be done gently.
Treat the cause. Infections are treated specifically with antibiotics, antifungal or antiviral medicines, a lack of oestrogen with local oestrogen, foreskin problems with an ointment or a minor procedure, endometriosis with hormone therapy or surgery. Which treatment suits you is always decided by the practice treating you, together with you.
Pelvic floor and pain memory. With vulvodynia, vaginismus or chronic pelvic pain, current evidence suggests that a combination of several approaches helps most: pelvic floor physiotherapy, dilators, sex therapy and, if needed, local anaesthetic gels or low-dose pain-modulating medicines. The evidence for individual medicines is limited.
Specialist services. Endometriosis centres, dysplasia or vulva clinics, specialist urology outpatient clinics and sexual medicine are the next step if the symptoms persist despite treatment.
The medication angle: when tablets make sex painful
Medicines contribute in three ways: they dry out the mucous membranes, they lower oestrogen, or they dampen desire and arousal — and without arousal, lubrication is lacking.
Anti-hormone treatments and hormone withdrawal
Aromatase inhibitors, tamoxifen and GnRH analogues, used for example for breast cancer or endometriosis, frequently cause dryness and pain during sex. With these in particular, taking them regularly over years is crucial. Talk about the symptoms openly instead of quietly leaving out the tablets — hormone-free moisturisers, pelvic floor physiotherapy and, in consultation with the oncology team, local treatments can help.
Drying medicines
Antihistamines for allergies such as cetirizine, bladder medicines with an anticholinergic effect such as oxybutynin, tricyclic antidepressants and the acne medicine isotretinoin can also dry out the mucous membranes in the genital area. In some women, hormonal contraception, especially progestogen-only methods, encourages dryness — switching to a different product is an option; more on this in the guide Medications and contraception.
Antidepressants and other “desire dampeners”
SSRIs and SNRIs dampen desire, arousal and orgasm in many people. In men this includes ejaculation problems, in women a lack of lubrication. Beta blockers, antipsychotics and opioids can also slow down sexual function. For finasteride, the summary of product characteristics lists testicular pain alongside libido and ejaculation disorders. Anyone who wants to switch or stop an antidepressant should do so under medical supervision — background in the guide Stopping SSRIs.
Erectile dysfunction medicines: watch out for prolonged erections
PDE5 inhibitors such as sildenafil rarely cause pain themselves. According to the summary of product characteristics, however: if an erection lasts longer than four hours, medical help is needed immediately. The combination with nitrates for angina is dangerous — according to the summary of product characteristics, it is contraindicated.
Antifungals and painkillers
Repeated self-treatment with clotrimazole or other antifungals without a confirmed fungal infection irritates the lining further. Painkillers such as ibuprofen before sex at most dull the pain, but they do not resolve the cause. Over-the-counter painkillers should not be taken for longer than three to four days in a row or on more than ten days a month without medical advice.
Discuss first, then change For almost every drying or desire-dampening medicine there are alternatives or supportive measures. But do not stop anti-hormone therapy, antidepressants, blood pressure medicines or contraception on your own initiative — stopping abruptly can do more harm than the side effect.
Anti-hormone therapy, antidepressant, the pill — what is behind it?
The digital medication plan shows all active substances at a glance — the best basis for the conversation at the practice.
Use lubricant as a matter of course — not only once it hurts. Water- or silicone-based, without fragrances, and no oil with latex condoms.
Condoms protect twice over — against sexually transmitted infections that can cause deep pain and inflammation in the pelvis.
Gentle intimate care — lukewarm water is enough; soaps, sprays and douches disturb the protective environment. Men should clean the glans under the foreskin with water every day.
Talk early — with your partner and at the practice. The sooner the pain is treated, the less often the cycle of fear and tension becomes entrenched.
Keep new medicines in mind — if the symptoms start after a new medicine, note down the product and the date and mention it at your next appointment.
Cycle, pain, medicines — all in one place
With your health history, you can see whether symptoms are linked to your period or your medicines.
Occasional mild discomfort, for example with little arousal or an awkward position, does happen. Recurring or persistent pain during sex, however, is not normal and should be checked by a doctor. The most common causes, such as dryness, infections or tension in the pelvic floor, are readily treatable.
A deep, dull pain in the pelvis that occurs in certain positions can point to endometriosis, ovarian cysts, fibroids, adhesions or inflammation of the womb and fallopian tubes. It should be assessed at a gynaecology practice, usually with an ultrasound. If fever or sudden severe pain occurs as well, you should seek medical help the same day.
Above all, medicines that dry out the mucous membranes or lower oestrogen: aromatase inhibitors, tamoxifen, GnRH analogues, antihistamines, anticholinergic bladder medicines, tricyclic antidepressants, isotretinoin and some hormonal contraceptives. SSRIs and SNRIs also often dampen desire and arousal. Do not stop anything on your own initiative; instead, discuss alternatives with your practice.
Common reasons are a tight foreskin, a short frenulum, inflammation of the glans, inflammation of the prostate or chronic pelvic pain syndrome, and sexually transmitted infections. If erections are painful and the penis becomes curved, Peyronie’s disease may be behind it. The first point of contact is a GP or urology practice.
The first step is to clarify whether dryness, an infection or a skin condition is behind it, because the treatment depends on that. Lubricants, gentle care and, with a lack of oestrogen, local oestrogen help many women. With vulvodynia or vaginismus, pelvic floor physiotherapy, dilators and sex therapy are the most important elements.
Women should go to a gynaecology practice, men to a GP or urology practice. With persistent symptoms, pelvic floor physiotherapy, sexual medicine, endometriosis centres or specialist clinics for vulval conditions can be added. With sudden severe pain, fever or circulatory problems, the emergency department is the right place.
Gesundheitsinformation.de (IQWiG) and gesund.bund.de (German national health portal): Endometriosis, vaginal thrush, chlamydia infection — German source. Accessed 2026.
S2k guideline on the diagnosis and treatment of endometriosis (DGGG, SGGG and OEGGG, 2020) — German source. Accessed 2026.
S3 guideline on peri- and postmenopause — diagnosis and interventions (DGGG, SGGG and OEGGG, 2020) — German source. Accessed 2026.
Hilfetelefon “Gewalt gegen Frauen” (Violence Against Women helpline; Bundesamt für Familie und zivilgesellschaftliche Aufgaben, German Federal Office of Family Affairs and Civil Society Functions): counselling service 116 016. Accessed 2026.
Summaries of product characteristics for the active substances mentioned (including sildenafil, finasteride, tamoxifen, aromatase inhibitors, isotretinoin, oxybutynin, clotrimazole, ibuprofen). Accessed 2026.
This article is for general information and does not replace medical advice, diagnosis or treatment. The self-observations described are a guide and not a diagnosis. If you have sudden severe lower abdominal pain, fever with lower abdominal pain, an injury to the penis, an erection lasting more than four hours or sudden testicular pain, please contact a doctor, the emergency department or the emergency services straight away.
