Pain in the penis can occur for a number of reasons. In this section we will discuss some causes of penile pain. It is important to realize that pain in the penis is an indication that there is an injury, inflammation, or disorder of the male reproductive system that ought to be treated.
Urethritis is an inflammation of the urethra of the penis. Symptoms often include pain or burning during urination. Many men, may also feel like they need to urinate more frequently or urgently. Urethritis can also cause swelling around the urethral meatus (opening at the tip of the penis) and the area may itch. In some cases, the urethra can be inflamed enough that it bleeds causing blood to mix with urine and semen. When blood mixes with urine it is call hematuria. This often results in orange to red tinged urine. When blood mixes with semen it is called hematospermia and semen can be pink to red in color.
The majority of cases of urethritis are caused by infections. The organisms which cause these infections are usually contracted from a woman’s vagina. This is the reason that men who are sexually active with new sexual partners or who have a sexual partner who has a vaginal infection are at greatest risk for urethritis. In sexually active men who have had a new or multiple sexual partners, there is a high likelihood that the urethritis is caused by a sexually transmitted infection. Two major forms of urethritis are chlamydia and gonorrhea which are sexually transmitted infections. In these cases, there is often a discharge of mucous type fluid from the urethra. This fluid is typically watery or mucous-like and looks whitish or cloudy (not semen that is ejaculated, but a discharge that oozes out of the urethra). For more information on urethritis that occurs after having sex with a new or multiple partners. Multiple types of infection could cause other urethral discharges. Other types of infections such as prostatitis, epididymitis, and cystitis (bladder infections) can also lead to urethritis.
In some men, urethritis may simply be a short term irritation issue caused by injury or exposure to harsh chemicals. Certain medical procedures involving inserting a tube, scope, or catheter can cause scraping and injury to the urethra. In addition, certain medications like alprostadil suppositories are inserted into the urethra using an applicator. Insertion of these foreign devices can cause irritation to the urethra, especially if latex products are used and the man has an allergy to latex.
Other more common causes of urethritis that most men would identify with are chemical irritants. Perhaps the most common is when soap gets into the urethra. The sensitive tissues inside the urethra can burn and sting when exposed to soap. This can occasionally occur during routine washing but is more common when soap is applied to an erect penis (when the penis is erect, the urethra meatus tends to open slightly increasing the chances that soap can enter into the urethra itself). Simply rinsing the urethra meatus (opening) with plain water to flush out any irritants is helpful. Urinating can also flush out the irritant; however, urination can sting and be fairly uncomfortable until the irritant is fully flushed out. This does not require medical attention and the symptoms typically resolve in less than an hour.
The penis can become injured in a number of ways. In this section we will focus on zipper injuries and mutilation. Injuries that occur when the penis is erect such as penile fractures or frunulum tears are discussed in the erection pain/injury section (click HERE to learn more).
Zipper injuries occur typically when a boy (or man) is dressing and zips a portion of the foreskin or shaft of the penis into the zipper. It is more common in boys than in adult men. It typically occurs most often when a boy/man is in a rush or if they don’t wear underwear. Furthermore, elderly men that have shaking hands may also be more prone to have zipper injuries. In some cases, the scrotum may become zipped as well.
So, what exactly is a zipper injury? It often involves the ventral (underside) of the penis skin become zipped into the teeth of the zipper as it is zipped up. It can also involve friction type tears when a zipper is unzipped. It may be more common for males who are uncircumcised to have a zipper injury since the foreskin protrudes further out (and closer to a zipper). In fact, the foreskin is the most common area of the penis to become zipped.
Zipper injuries are typically treated by first unzipping and removing the skin of the penis from the zipper. It may be extremely difficult in some cases to extract the skin from the zipper (think about when fabric gets stuck in a zipper and the zipper becomes stuck and won’t go up or down). For this reason, some men may have to go to an emergency room or urgent care clinic to have the penile skin removed from the zipper.[i][ii]
Bleeding and swelling may occur, but injuries are typically superficial (involving only the skin) and pain and swelling usually subsides. Infections may occur if the area is not kept clean. Cuts can also be difficult to heal in adult men as erections (even nocturnal erections) can reopen cuts. In some cases, a man may have to abstain from sexual activity until the cuts heal sufficiently not to reopen. In severe cases, with deeper tissue injuries, further review by a healthcare professional may be necessary.
Other types of penile injury
Other types of penile injury are rare. These can include self-mutilation and even amputation (cutting the penis off). However, these are usually only seen in patients that have a mental illness or in assault/attack situations. Tissue injuries can also occur in accidents, although the most well-documented tissue injuries (other than zipper injuries) are due to explosive or shotgun type injuries in the battlefield.[iii] In cases of accidental amputation, the penis can be reattached if it is placed on ice and reattached surgically within a few hours.
FORESKIN INDUCED PAIN
Balanitis, BXO, phimosis, and paraphimosis can all cause penile pain – especially pain during an erection (click HERE).
In balanitis, the inflammation of the glans and foreskin can be painful, and this pain can worsen as the skin stretches and moves during an erection. In men with BXO (balantis xerotica obliterans) the hard plaques that form on the penis can be tender and painful. These plaques do not expand during erections causing pain, especially if an erection forces the plaques to crack or split.
Phimosis involves a foreskin that won’t retract. In this case, erections can be painful as the penis tries to expand outwards, only to be constricted by a tight foreskin over the glans. Finally, when the foreskin is stuck and swollen in the retracted position, the swelling itself can be quite painful. However, getting an erection can be even more painful as the foreskin can act as a type of penile strangulation around the neck of the penis rather than the base or shaft of the penis. Circumcision is often a treatment in extreme cases of all four diseases.
PELVIC MUSCLE TENSION
It is possible for muscles to become tense and cause pain. If you think about clenching your hand really tight for a long period of time, you’ll notice that after a few seconds it will become painful. It is possible for the IC muscles that support the penis during an erection, and the BS muscles which surround the root of the penis, to become tense and even lock up – especially during prolonged erections. This can cause significant pain and aching. Typically this type of pain is noticed when a man has an erection or even after ejaculation. After ejaculation, the BS muscle in particular will have contracted strongly to help force semen out of the penis. If this BS muscle has not fully returned to a state of relaxation, it may lock up and cause some pain at the base of the penis which may extend up to the shaft of the penis. This type of disorder is called Pelvic Tension Disorder.
Pain and aching due to muscle tension can also occur in men who prolong sexual activity for hours or engage in vigorous sexual activity. This most often occur in masturbation addiction when prolonged or multiple episodes within the same day lead to extended periods of time with an erection in addition to excessive friction. This type of pain can persist even when the penis is flaccid (limp) but usually resolves a few days after of abstinence.
REFERRED PENILE PAIN
Referred pain describes a type of pain that is felt in one area of the body, but the “problem” is actually in another part of the body. A good example that most people are familiar with is that a person with a heart attack may feel the pain in their left arm. The same holds true with pain in the penis. Pain in the penis may have absolutely nothing to do with a problem or injury to the penis. One common cause of penile pain is actually inflammation of the prostate (prostatitis). The nerves of the prostate and the penis, both eventually connect to the pelvic plexus, so the brain can interpret a pain signal from the prostate as actually coming from the penis. It is not uncommon for men with prostatitis to complain of pain in the penis during or after an erection. However, the penile pain can also occur when the penis is flaccid with the pain either being focused on the shaft or the glans. This can often occur after a bowel movement when the prostate becomes irritated as stool passes by it.
Post-ejaculatory erection pain occurs during the first erection after sexual ejaculation. Since this is so common, it is worth noting some common preventative measures for these men. First, some of the pain can be caused by prostatic fluid or semen being trapped in the ejaculatory duct of the prostate. A man simply urinating after ejaculation can often prevent post-ejaculatory penile pain. This is especially true if ejaculation took place at bedtime (or as a wet dream) and subsequent nocturnal erection pain wakes the man up. If a man has prostatitis, it can also be helpful for him to take an over-the-counter anti-inflammatory medication like ibuprofen or naproxen just after ejaculation to prevent inflammation. During ejaculation, the prostate contracts repeatedly to force sexual fluids out of the ejaculatory duct toward the penis so the semen can be released. These contractions can cause an already inflamed prostate to become more tender (think of running on an already sprained ankle…same principle). Taking an anti-inflammatory can reduce inflammation and thus reduce the transmission of nerves signals that could be interpreted by the brain as pain in the penis.
OTHER CAUSES OF PENILE PAIN
Some sexually transmitted infections like genital herpes or genital warts can appear on the glans or shaft and be a source of pain and discomfort.Pain in the penis can sometimes only occur during erections. In addition, some types of injury only occur when the penis is erect. These types of penis pain are discussed in the section on erection pain/injury (click HERE to learn more about erection pain).
[ii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692577/ (12/16/2016)
[iii] http://emedicine.medscape.com/article/456305-overview#a4 (12/16/2016)
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