Penile pain is a very general symptom that many men experience at some point, however the underlying causes are extensive and can range from simple issues like a poor fitting underwear to an STD infection.
The anatomy of the penis can be considered as a shaft and a head, running through these 2 structures is the urethra which carries urine and semen out of the body. The shaft is made of layers of muscle and connective tissue that are arranged in layers much like an onion over the urethra. The head of the penis is called the glans and is also made of muscle but with a high concentration of nerve endings.
Informing your doctor where the pain is – Shaft or Glans is an important starting point to finding out what the cause of the pain is.
Causes of penis pain
Causes of penile pain can be broken up into
- Mechanical causes
- Infection
- Chronic conditions
Mechanical Issues
Trauma or injury is the most common cause for penile pain in the younger age group 20 – 40. Trauma can come in the form of sports injury, long hours cycling on a poorly fitted bicycle seat, road traffic accidents and even sexual intercourse.
What happens
How much a part of the body can be injured depends on the amount of force impacting it. Certain activities such as cycling or riding a motorbike can put a lot of force onto the penis. A poorly fitted bicycle seat can cause undue pressure on the nerves and arteries running under the pelvis. This can cause significant reduction in blood flow as well as entrapment of the nerves. This can lead to not only pain but also erectile dysfunction.
If the force is sudden and at a high speed, the muscles in the penis can tear. This results in a rapid swelling of the penis and pain. Penis fracture can occur during sex. The most risky sexual position is girl on top. What usually happens is the penis slips out of the vagina and the girl sits down on the penis and fractures it.
What to do
If you have sharp pain in the penis and notice the area swelling. You should seek medical attention early as you may need surgery to correct the injury. Leaving such an injury for too long can have negative long term effects for erections and even urination.
Infection
The most common infections in sexually active men are Chlamydia, Gonorrhea and Syphilis. Exposure to the body fluids of a person with these bacteria can lead to you getting infected. As mentioned in our previous article, these STDs do not go away by themselves. Herpes outbreaks are also a common cause of penis pain. However this is usually obvious as there can be visible blisters and ulcers on the penis. Occasionally, the ulcers are inside the urethra and not obviously visible.
What happens
Early on in the disease, up to 70% of the patients with Chlamydia and Gonorrhea do not experience any symptoms. Over time, the infection progresses and can start to cause pain especially in the urethra in men. This leads to many men reporting pain passing urine, itchy or painful sensation along the length of the penis even at rest. Such situations can worsen to a point where there is discharge or blood coming out of the urethra.
Syphilis can also cause ulcers or Chancres on the outside of the penis. While these can look very bad, they actually tend NOT to be painful. They are however very contagious and the liquid from these ulcers contain Syphilis which can further spread the infection to others.
The ulcers caused by Herpes on the other hand is usually painful or at least very sensitive. The most common complain I hear from patients with Herpes ulcers is that the ulcers really stings during a shower when water comes into contact with it. As previously mentioned, sometimes the herpes ulcers are inside the urethra and not immediately obvious. However this usually causes rather intense pain on the initiation and end of a urine stream.
What to do
Especially because STDs may not show any symptoms, regular testing is the best way to determine if you have an STD. Early identification leads to faster treatment and a lower chance that the infection causes long term damage. Of course if you do have symptoms, see a Doctor for testing and treatment as soon as you can before complications develop.
Chronic Conditions
Chronic conditions such as Peyronie’s Disease and Phimosis that can cause a painful penis while these are not associated with infections, they are equally distressing.
What happens
Peyronie’s Disease is an abnormal curvature of the penis caused by fibrotic plaques within the muscle layers of the penis. These plaques can be the result of previous injury, but in the majority of the cases, there are no clear causes. The plaques act as a tether point within the penis and results in the penis curving towards the plaques especially during an erection. This leads to a painful erection as the penis veers towards an abnormal direction.
Phimosis is a situation where the foreskin covering the head of the penis is too tight. As a result, when the size of the penis increases during erections, men experience pain in penis as the foreskin is forced to stretch with the penis but is unable to move over the glans. Also, because the glans is constantly protected by the foreskin, it can remain extremely sensitive to the point of even being painful.
While some men are born with phimosis, many men also develop phimosis later on in life. The 2 most common causes of phimosis are Diabetes and Lichen Sclerosis. In patients who have poorly controlled Diabetes, or are on certain medicines for Diabetes that makes them urinate out more sugar, they can get serious recurrent fungal infections of the foreskin. This causes the foreskin to crack and can be extremely painful.
What to do
There are several interventions for Peyronie’s each with their pros and cons. These methods include – Surgery, ESWT, PRP or Verapamil injections and are all centered at removing or dissolving the plaque.
Correction of phimosis is more straightforward via a circumcision, which is a surgical removal of the foreskin. Removal of the foreskin leads to the glans being exposed and free to expand during erections without pulling on the rest of the skin.
In summary
There are many causes for pain in the penis. While some may be more urgent than others, it is important that you talk to your doctor about your situation and find the underlying cause for your situation.
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