Why You Might Be Experiencing Pain During Sex (for Husbands)

Four episodes back we addressed the topic of pain during sex for women and that show received a lot of downloads. Today we return to the topic but this time for men. Sexual issues like this can be difficult to figure out and often people just don’t even know who to ask, so they struggle alone. We hope this will be the start of getting help for anyone who is struggling with pain during sex so that you can return to enjoying physical intimacy with your wife. Pain During Sex for Men Often, the cause of pain during sex can by physical, psychological or a mixture of both. Generally, you’ll want to start by addressing this problem with your family doctor to see if there is a medical cause. You may also find help with a referral to a psychiatrist, counselor or sexologist in order to work through the causes and find a solution that works well. If you’re going to talk to your doctor, it helps to go prepared with the information you need. Men can experience pain during erection or ejaculation or post-erection or post-ejaculation.[1] Often, because we feel awkward about the topic, we don’t really think carefully and precisely about the timing of the pain, but do keep this in mind so you can assist your doctor in helping you. Also, sometimes the pain will come with other problems such as erectile dysfunction, though this may be a symptom of another problem rather than the primary cause of the pain. It’s good to note that there are some common lifestyle changes that can help with this issue of pain as well: exercising, eating well, limiting your alcohol consumption and quitting smoking can all help reduce sexual problems for men.[2] Basic Sources of Pain We are going to speak about some more complex causes of pain. But I think it’s worth noting that just the friction of sex can irritate the skin on your penis if your spouse is not sufficiently lubricated. Using a quality lubricant is the solution for this problem.  It’s also helpful to note that there’s a connection between sex drive and pain. Low sex drive does not necessarily cause pain, but pain during sex may cause low sex drive. Finally, we’re not going through an extensive list of sexually transmitted infections or diseases but it should be noted that STIs such as herpes or untreated gonorrhea can cause burning, itching, or sores, bumps, or blisters in the genital area (treatment is similar for men and women).[3] Common Causes of Pain During Sex There are a number of other causes of pain during sex, some of which are not as well-known. Delayed Ejaculation Delayed ejaculation is characterized by taking more than 30 minutes to ejaculate during sex, or in some cases, not ejaculating at all. Depending on what’s happening, this can either be caused by pain or result in pain. It’s hard to distinguish cause and effect: there could be a minor physical issue that results in the delayed ejaculation. Or the delayed ejaculation may be the by-product of a medication and then the pain comes from irritation, for example, from friction due to the extended duration of intercourse. If you’re facing this issue, you should consider causes such as anxiety and stress, or medications such as antidepressants or hair loss treatments. There could also be a prostate or urinary tract infection, a hormone imbalance, possible birth defects, or pelvic or spinal nerve damage.[4] You’ll definitely want to start with your doctor on this one. Your doctor can help you figure out the underlying issues and recommend treatment. In the meantime, use plenty of lubricant and it’s also helpful sometimes to just remind yourself to take the focus off achieving orgasm and, instead, really enjoy being with your spouse.[5] Persistent Pelvic Floor Muscle Spasms Sometimes the muscles in the pelvic floor stop working properly. These are muscles that extend from your pubic bone at the front, back to the base of your spine.[6] One problem that can occur is pelvic floor muscle spasms which involve these muscles over contracting.[7] Pelvic spasms will feel like a sharp pinching and pain in the pelvic area. You may also feel pain in your lower abs and constant pain in the perineum (the area between the anus and scrotum) and groin (note: there are other possible causes of pain in this area).[8] Everything from sitting down to engaging in sex can spark pain[9] and these spasms can also lead to inflammation around the nerves in your genital area which can make erection or ejaculation painful.[10] This problem can occur for a number of reasons. Stress can prompt men to unconsciously tighten and clench their pelvic floor muscles. There may also be a urinary tract infection, prostatitis, or bladder infection that triggers and ongoing dysfunction in these pelvic floor muscles.[11] Physiotherapists can diagnose and treat this issue. Certain activities such as cycling with a hard seat that doesn’t fit is not recommended! Physiotherapists may also recommend things like biofeedback to help relax these muscles or a set of exercises called the Kegel exercises to help gain control or recondition these muscles.[12] Another similar issue is trigger points. When there’s pain in the pelvic floor, it may cause some muscles to form tight bands which can restrict blood flow, leading to inflammation around the nerves. This can lead to pain during sex. Treatment is similar to treatment for pelvic floor pain: you start with a physiotherapist but will also want to incorporate techniques that increase blood flow including quitting smoking if you smoke, exercise, weight loss, and so on. Chronic Prostatitis or Chronic Pelvic Pain Syndrome (CP/CPPS) Prostatitis is an inflammation of the prostate gland that causes swelling, pain, or a burning sensation during urination[13] and also during or after intercourse or upon ejaculation.[14] With a prevalence rate of 2-16 % in North American males and 3-14% among Asian and European males, CP/CPPS is a urological condition characterized by pain in the pelvic region, and concomitant sexual and voiding dysfunction.[15] A significant percentage of men with this issue also experience erectile dysfunction and reduced sexual interest. It can be caused by the nervous system being chronically activated and tightening of the pelvic muscles. Worry, anxiety and depression can also be factors in contributing to this issue.[16] Working with a urologist is recommended as they can treat the inflamed prostate gland. Things like taking a short walk or a warm bath before engaging in sex can help as well.[17] Hypersensitivity of the Penis Another potential source of pain is that the penis can become sensitive after you orgasm which can make continued intercourse uncomfortable or painful.[18] You may also find that if you are having very frequent intercourse with your wife, your penis becomes oversensitive. This problem may also be occurring on top of the prostate issues discussed earlier.[19] It is also possible that you may have a skin disorder such as Zoon’s balanitis (inflammation of the head of the penis and foreskin), erosive lichen planus (an inflammatory skin condition marked by an itchy, bumpy rash), lichen sclerosis (a chronic inflammatory skin disease), or penile cancer that is causing pain with intercourse.[20] Again, you’ll want to start with your doctor to determine the cause of the issue. If the issue is one of the skin disorders, your doctor will be able to advise the best treatment, but in some cases, you may just be having too much sex on a given day. If that’s the case, you may want to consider finding other ways to be intimate with your spouse. If it’s not just an issue of too much sex or a skin disorder, you may want to follow some of the recommendations for the prostrate issue. It’s also possible to reduce the sensitivity of the penis through the use of condoms or numbing cream. Additionally, you may want to consider changing sex positions to find one that is more comfortable for you.[21] Tight Foreskin or Deformities of the Penis Some causes of pain are related to the foreskin of the penis. There is a condition called phimosis where the foreskin of the penis is too tight to retract over the head of the penis completely. There’s another condition called paraphimosis where the foreskin is tucked behind the penis and cannot be pulled forward.[22] Both of these can make intercourse more painful for men. The best course of action for these issues is to see the doctor. Surgery may be recommended. It’s also possible that the structure of your penis has been damaged by some condition or disease or even has a congenital deformity.[23]This can certainly result in pain in the penis[24] and again there’s a lot of possible root causes here so you’ll want to see a urologist or at least your family doctor to start with. Priapism There’s another condition called priapism which is a prolonged erection of the penis. Before all the men start to guffaw, this is an actual problem and a non-sexual erection can be quite painful. Sometimes it can be stimulated by intercourse but it’s just not going away because blood cannot leave the penis or because the blood flow is regulated improperly in your body.[25] Men can also experience an erection for more than 4 hours, or one that is unrelated to sexual interest or stimulation. In some cases, men may have an erect but not fully rigid penis shaft. In any of these situations, this condition can be quite painful and unpleasant. As far as causes go, it can be related to sickle cell anemia or caused by medications like Viagra, Cialis and Levitra or even by certain antidepressants or antipsychotics. It’s also more common in individuals who abuse drugs or alcohol. It can result from injury to the spinal cord,...