Painful Sex in Men

About 1 to 5% of men suffer from dyspareunia, or pain during sex. However, men sometimes feel embarrassed about discussing sexual health, which can mean that some men do not say they have painful sex when they do. When we talk about pain during sex, it can mean a variety of things: an itching or burning sensation, pain during ejaculation, general discomfort during sex and rashes or other forms of skin irritations. Men who suffer from dyspareuina may not be able to feel aroused or achieve orgasm.

Causes

Painful ejaculation, all by itself, can be caused by:

  • Inflammation, or swelling of various parts of the male sex organs, like the urethra (the tube that connects the bladder to the head of the penis) or the prostate (a gland that helps make semen).
  • Cancer
  • Bladder stones
  • Groin hernias
  • Narrowing of the urethra

However, there are some other specific causes of pain during sex. These include:

  • Peyronie's disease, where scar tissue forms in the area of the penis responsible for “staying hard”. Since the scar tissue (plaque) isn't stretchy but the unscarred tissue is, this can make erections painful or hard to achieve, make the penis curve abnormally. 
  • Frenulum breve, which is where the frenulum, a band of tissue that connects to the foreskin and helps it cover the head of the penis, isn't long enough to do its job properly. This makes it harder for the foreskin to retract, which in turn can make sex painful. Furthermore, tearing a healthy frenulum can be very uncomfortable, and take a long time to heal.
  • Phimosis, which is when the foreskin is very tight around the penis, and can't retract properly.
  • Complications after groin hernia surgery.
  • Something blocking the ejaculatory duct. 
  • Squeezing of the pudendal nerve, the key nerve in the area between the anus and penis, which is called the perineum.
  • Sexually transmitted infections (STIs). Not using a condom when having sex, frequently switching partners, or failing to seek treatment can mean that you get infected. If you're sexually active, it's a good idea anyway to get regular STI checkups and to use condoms, unless you're in a monogamous relationship and both people are “clean”. Painful sex can be a symptom of a variety of STIs. 
  • Skin conditions that affect the penis, like itchy rashes or inflammation of the head of the penis or the frenulum.
  • While rare, Mondor's disease, or the inflammation (swelling)related to a blood clot of surface-level veins, can occur in the penis.
  • A yeast infection or thrush.

Finally, there are two other notable types of cause:

  • A side effect of some types of medication, like antidepressants or antipsychotics, can make sex uncomfortable.
  • Issues with mental health: feeling bad about yourself (body image issues, relationship problems and guilt) or trauma from sex abuse.

Separately, there is anodyspareunia, which is discomfort when receiving anal sex. While this can happen due to not properly being prepared (such as not using enough lubrication (lube) or stimulation prior to penetration), or due to the bad feelings mentioned above, conditions such as anal fissures, infections or haemorrhoids can result in painful anal sex. 


Treatments

Treatments are specific to each cause, but can include surgery, medication, and/or therapy. 

Peyronie's disease, frenulum breve, phimosis, and the squeezing of the pudendal nerve can all be treated with surgery. For frenulum breve or phimosis, this could mean circumcision.

However, Peyronie's disease and phimosis can be treated with medication: collagenase cream for the former, and steroid cream for the latter.


Yet further treatment of Peyronie's disease, and, potentially chronic (that is, long-lasting) inflammation of the prostate, can involve Extracorporeal Shockwave Therapy (ESWT). This treatment involves delivering energy pulses. For Peyronie's disease, this can relieve pain and break up the plaque, but won't change the abnormal curvature or improve sexual function. As for prostate inflammation, recent studies have shown that ESWT can lead to short-term improvements, but the long-term effects are unknown. 

For STIs, the usual treatment includes antibiotics or antiviral medications, and, much like vaginal yeast infections, antifungal drugs are suitable for treating thrush in men. 

When doctors aren't quite sure what the underlying cause of the disease is, they may provide drugs that help manage pain, while they look for further solutions. 

Therapy may be offered to someone if it's likely that the pain has a psychological cause.
 

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