The church was built between 1880 and 1882 to a design by the Gothenburg architect Adrian C. Peterson, and was consecrated on 15 January 1882. It was the only one of Peterson's churches to result from a public competition, and construction was funded entirely through private donations, chiefly the Renström fund. The hill on which it stands, known as Höga Lyckan, was given to Gothenburg's cathedral chapter by a local naval officer. The building was originally to be called Redbergskyrkan, but the city council settled on Sankt Pauli kyrka in 1881.
The church's tower rises 46 metres and is flanked by four smaller turrets, a detail that distinguishes its interpretation of Romanesque style. Built of red brick, the church measures roughly 36 by 23 metres. It could originally seat around 1,200 people; following later renovation the capacity was reduced, with sources differing on the current figure, variously given as about half the original or as low as 600.
Four major renovations have taken place, in 1916-1917, 1941, 1969-1970 and 2009, the last under architect Erika von Geijer, which included the creation of a larger forecourt in front of the church.
Among the church's furnishings is a Christ figure above the altar, a copy of Bertel Thorvaldsen's celebrated Christus in Vor Frue Kirke, Copenhagen. It had previously stood in the Kjellberg Girls' School before being installed here; sources differ as to whether it is a marble copy or a plaster cast, and its date of installation is variously given. The sandstone font is the work of the sculptor Ninnan Santesson, one of several artists who contributed decoration to the interior. Below the church stands a fountain, Elementens kamp (The Struggle of the Elements) by Anders Jönsson, originally sited on nearby Olskrokstorget before being moved and re-erected here in 1971.
The church has had a series of organs, the present mechanical instrument dating from 1969-1970 and later adapted for choral and congregational singing; a smaller organ in the chapel is said to have travelled between several Gothenburg churches before arriving at Sankt Pauli.