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Summary
Definition
Causes & Treatment
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PAIN AFFECTING SEXUAL
FUNCTION IN MEN
CAUSES & TREATMENT
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Causes: [1]
Local Infection:
Phimosis: the foreskin is tight and not able to be pulled back. Pain increases with erection and may not be present at examination in the flaccid state. Following local infection scarring may cause loss of elasticity and predispose to recurrent trauma as small tears may occur in this area during vigorous thrusting or masturbation and become exquisitely painful. Treatment: circumcision may be indicated and bring relief.
Balanitis (infection under the foreskin) may cause pain during intercourse. Treatment: good hygiene, circumcision.
Herpes: painful recurrent blisters on the genitals, burning on contact.
Treatment: Acyclovir ointment and/tablets alleviate symptoms [prescribed by a doctor]. Intercourse should not take place during the active period- once there is itching, burning or blisters, or condoms should be used to protect the partner.
Orchitis: inflammation of the testes due to mumps or gonorrhoea. The testes are swollen and very painful. Intercourse should be avoided until the swelling and pain have settled. Treatment: seek advice from your doctor as soon as possible.
Urethritis and cystitis: inflammation of the bladder and /or the tube leading from the bladder through the penis, causing burning and pain while passing urine, which may contain blood. This may be associated with pain during erection, intercourse and ejaculation. Treatment: antibiotics, fluids, abstain from intercourse in the acute phase.
Urethral stricture: scarring due to previous infection may result in difficulty with passing urine or pain during ejaculation. Treatment: dilataton of the tube [consult a urologist]
Prostatitis: pain at the beginning of, during or after ejaculation which may contain blood, and painful wet dreams. The pain may be felt in the rectum, testes or glans [tip] of the penis. Treatment: antibiotics [consult your doctor].
Local irritation: sensitivity to spermicides or chemicals used by the partner. Discomfort may occur from her poorly fitting diaphragm cap, or the threads of the partner’s intra-uterine contraceptive device, especially if the threads are short, or if the device is extruding. Burning, itching or irritation may result after intercourse with a woman who has a vaginal infection. Treatment: according to the cause.
Tumour: cancer of the penis may cause pain during erection and intercourse. Treatment: surgical removal of the tumour.
Peyronie's disease: there is a thickening [plaque] along the shaft of the penis which causes painful erections and difficulty with penetration due to the penis curving at an angle with an erection. Some men experience pain before the plaque can be felt, and before the angle of the penis is noticed. Occasionally pain persists after the orgasm. Treatment: consult a urologist.
Chordee: the man has a downward bowing of his penis due to scarring following a previous trauma. The angle of the penis results in pain during erection and intercourse. Treatment: consult a urologist.
Priapism: a persistent prolonged erection that is not associated with desire or sexual stimulation. This is uncommon and may follow treatment for erectile dysfunction with medication [extremely rarely], or with injection of medication into the penis. It is extremely urgent to obtain treatment if the erection lasts 3- 4 hours, [if your doctor is not available, go to an emergency unit] as otherwise fibrosis [scarring] may affect future erectile function. As a first aid measure while getting to the hospital: take a cold shower, place an ice pack around the penis, take a pain killer, and gently walk up and down stairs this diverts the blood away from the penis due to pressure of the buttock muscles [2].
Trauma: fracture, or injury for example sustained during masturbation associated with a vacuum cleaner; entrapment of the penile skin in a zipper; foreign bodies inserted into the urethra for sexual stimulation. Treatment: according to the cause- consult your doctor.
General Diseases:
Arthritis and low back pain: may be associated with pain during intercourse.
Treatment: use pain killers, a warm bath prior to intercourse, and positions that do not cause the pain, like the 'woman above' position so that the man is resting on his back and he can have intercourse with limited movements.
Headache: may occur during orgasm or just after, and is usually transient. Treatment: consult your doctor especially if it occurs regularly, is severe or ’explosive’. Preventive treatment with an anti-inflammatory medication taken a few hours prior to anticipated intercourse has been effective [3].
Cardiovascular disease: intercourse may precipitate angina. Treatment: consult your doctor for treatment of the angina, and for assessment to ensure that it is medically safe for you to have intercourse.
Psychological:
If the pain has no anatomical or disease basis, a psychological cause must be suspected. For example, no illness or drug can cause pain in the glans [tip] of the penis during intercourse or ejaculation. Pain during ejaculation that remains undiagnosed after repeated urological examinations may have a psychological cause.
Treatment: a careful history and examination should determine the cause.
The doctor may advise doing laboratory investigations to check urine or semen analysis or of urethral discharge.
In most cases specific treatment should relieve the symptom.
Relationship and sex therapy may be indicated even after the initiating cause has been relieved if the condition has been chronic and affected sexual function leading to avoidance and hostility between the partners.
