Penile Pain

Pain in the penis can be a result of many underlying conditions. The penis is prone to injuries as well as infections. Majority of men experience some sort of injury to or pain in the penis. Health problems causing penile pain can impact a person’s overall well-being and lead to stress, strained relationship with the partner and also harm a person’s self-confidence. Certain conditions like penile cancer, while highly treatable also cause severe psychological consequences and social stigma along with fear and embarrassment. Hence it is important to identify the problems early to ensure that the underlying condition is managed effectively. In some conditions, the cause is obvious, such as in sports injuries while in others, the penile pain can develop gradually, which may make it difficult to identify the exact cause.

What Is Penis Pain?

Any pain or discomfort felt in the penis is called penis pain or penile pain.

Symptoms of penile pain vary depending on the exact location of pain. The following parts may be involved:

• The root of the penis (a part of the penis that is connected to the abdominal wall).
• Main body or shaft of the penis.
• Head of the penis, also known as the glans penis.
• The urethral tube that runs through the penis and carries semen as well as urine.

The symptoms of penile pain may begin suddenly or may develop over time. The pain may be dull, sharp or even throbbing in nature. Penile pain may disturb a man’s normal activities such as exercise, urination or intercourse. If at any time a man experiences pain in the penis, along with the following symptoms, he should immediately consult a doctor:

• An erection lasting four hours or longer. This condition is known as priapism and is a medical emergency.
• A cracking or a popping sound during sexual intercourse or on erection.
• Inability to pass urine.
• A sports injury or accident in the groin region, testicles or penis.

Other symptoms that accompany penile pain are:

• Presence of blood in semen.
• Bruises on the penis with discolouration.
• Erectile dysfunction which is an inability to achieve an erection enough for sexual penetration, or a painful erection which is not caused by arousal.
• Urethral discharge.
• Inflammation and swelling of the penis.
• Symptoms associated with urination like:
  • Changes in frequency.
  • Dribbling of urine.
  • Difficulty in initiating urination.
  • Painful urination.
  • Burning sensation during urinating.
• Rash on the penis.
• Premature ejaculation
• Pain in the bladder, prostate, testicles or abdomen. (Read more - Stomach pain causes and treatment)
• Sores or lesions on the penis.
• Itching in the penis.
• Lumps in the groin region.
• Accumulation of a thick discharge under the foreskin.
• Significant changes in sexual desire.

Causes

Causes of penile pain include:

• Peyronie’s disease
  Peyronie’s disease is a condition in which a scar tissue or a plaque is formed inside the penis causing it to bend rather than staying erect or straight. The plaque is usually formed on the top or bottom of the penis. As the plaque formation increases, the penis curves which can cause painful erections making sexual intercourse painful or nearly impossible. Peyronie’s disease often begins as a mild inflammation which later becomes a scar. The plaque, however, is a harmless growth and not a cancerous tumour. The condition is not contagious or caused by any infectious disease. The exact cause is not yet known, but it is believed it could be a result of trauma that may lead to bleeding inside the penis. It is also believed that genes are linked to Peyronie’s disease. Some experts believe the condition may be an autoimmune disorder. It is estimated that this disease may affect 1 to 23% of men between 40 and 70 years of age. But the actual numbers could be higher due to lack of reporting because of social stigma and embarrassment.
• Phimosis and Paraphimosis
  In both the conditions, the foreskin of the penis gets stuck. In phimosis, the foreskin is difficult to retract. In paraphimosis, the repositioning of the penis is difficult. These conditions are seen in boys and men who are not circumcised (their foreskin is not removed). It is frequent in small babies as their foreskin is still very tight. But if boys are unable to retract their skin by the time they reach puberty, they may require treatment. Treatment includes the application of steroid creams to loosen the foreskin to circumcision if the former is unsuccessful. In paraphimosis, along with the inability to reposition the foreskin to its normal position, men can often complain of difficult urination, ejaculation and bruising and swelling of the penis. Paraphimosis is always considered as a medical emergency and should be treated right away.
• Priapism
  Priapism is persistent erection lasting beyond four hours and is not relieved by orgasm. Such erections are painful and may not always be associated with sexual activity. Alcohol, drugs, medications, blood disorders and spinal cord problems are some of the causes of priapism. This is a medical emergency and one should seek immediate help from the doctor.
• Prostatitis
  Inflammation of the prostate gland is called prostatitis. The prostate is a small gland which produces almost 50 to 70% of semen and is situated under the bladder in men. There are several types of prostatitis:
  • Acute bacterial prostatitis 
    It is caused by bacteria like E. Coli, Chlamydia etc.
  • Chronic prostatitis 
    It is the most common type of prostatitis. In most cases, the cause is unknown but bacteria may often cause chronic bacterial prostatitis.
  • Asymptomatic inflammatory prostatitis
    It does not produce noticeable symptoms.
  • Chronic pelvic syndrome
    Chronic pelvic syndrome, also called chronic nonbacterial prostatitis is a common condition affecting men. It leads to pain, inflammation of the prostate, pelvis and urinary tract. Unexplained chronic pelvic pain is common in otherwise healthy men and which may lead to disturbance in relationships and also cause sexual dysfunction. Pain associated with sexual disorders have usually been more reported in women than in men. Sexual pain is a very common symptom of the chronic pelvic syndrome.
• Urinary tract infections
  Urinary tract infections (UTI) are commonly caused by bacteria or fungi and are one of the commonest infections seen in humans. UTIs in males are uncommon due to the long length of the urethra, however, they can occur anywhere within the urinary tract. In men, a lower UTI may also be associated with rectal pain.
• Other causes of penis pain include:
  • Bladder stone.
  • Penile cancer.
  • Genital herpes.
  • Sickle cell anaemia.
  • Syphilis
  • Allergy to soaps, detergents or spermicides.
  • Riding a bicycle or a motorbike.
  • Poor hygiene.
  • Reiter’s syndrome (a type of arthritis involving the joints, eyes, and the urethra).
  • Balanitis (infection under the foreskin).

Risk Factors

The factors which are both modifiable as well as unmodifiable include:

• Poor sexual health
  Sexually transmitted diseases can lead to infections during unprotected intercourse.
• Smoking
  Smoking along with other health risks increases the chances of erectile dysfunction.
• Hormones
  Testosterone deficiency, along with other hormonal imbalances have been linked to erectile dysfunction. Obese men have often reported low levels of testosterone. (Read more - Home remedies to boost testosterone)
• Psychological problems
  Anxiety, embarrassment, social stigmas, and apprehensions that erection problems will arise again often lead to depression and panic disorders. These can lead to further problems associated with erectile dysfunction.
• Neurological problems
  Conditions like stroke, injury to the spine and back, multiple sclerosis, dementia can affect the nerve impulses travelling from the brain to penis leading to penile disorders.
• Aggressive intercourse
  If the penis is suddenly bent while it is erect, it may lead to severe trauma and may also lead to fracture of the penis.

It may not be possible to prevent all problems of the penis. Routine examination of the penis provides awareness about one’s penis and can detect changes earlier. Periodic visits to the doctor may also help in early diagnosis and better treatment plans. Sometimes, the mental stigma associated with male sexual health may lead to anxiety, but the embarrassment should not stop one from visiting the doctor.

Prevention of penis pain can be done as follows:

• Maintain good hygiene
  Regular cleaning underneath the foreskin with soap and water is necessary, if not circumcised. Remember to turn the foreskin back to normal position after sexual activity.
• Be active
  Indulging in brisk activity can reduce the chances of erectile dysfunction.
• Avoid smoking and alcohol
  Alcohol and smoking are both associated with low testosterone levels and sexual dysfunction. Take the step to quit them for optimum hormonal levels and sexual activity. Experts advise no more than 2 drinks a day.
• Make healthy choices
  Maintain a good diet and lifestyle, which can reduce the risk of developing diseases like high blood pressure, diabetes and obesity.

• The diagnosis is established based on the history obtained by the doctor. The doctor will ask a detailed medical history enquiring about the origin, cause, an duration of pain. Also, a sexual history will be obtained to rule out sexually transmitted diseases. A thorough case history will determine the further line of investigation to confirm the diagnosis.
• A complete physical examination including a detailed examination of the penis, testicles, scrotum and groin will be done.
• A rectal examination is also performed to feel the prostate in case of an enlargement.
• Urine tests to screen for UTIs, bacterial growths, syphilis may be advised.
• Blood examinations for sickle cell anaemia may also be recommended.
• Sonological tests like sonography, MRI can be asked to rule out bladder stones, cancers etc.

Treatment usually depends on the cause that has led to penile pain. Some conditions may not need any treatment in the beginning, whereas some require immediate medical attention.

• Medications
  Antibiotics are recommended for infections like UTIs, prostatitis and urethritis. Painkillers are prescribed to reduce the spasms of the urethra which gets affected by prostate inflammations. Other medications to relieve pain like nonsteroidal anti-inflammatory drugs (NSAIDs) are also prescribed.
• Alternative therapies
  Certain procedures like acupuncture, water baths, massage therapy, exercises can help in reducing pain. Speak with your doctor before beginning herbal supplements as they may alter the effectiveness of some medications.
• Surgery
  Circumcision is a procedure performed to remove the foreskin from the penis. This is advised in people with phimosis and paraphimosis.
• Other treatment strategies
  Radiation therapy is advised in people with penile cancer along with chemotherapy.

Lifestyle management

Here are some ways to manage penile pain and keep the penis healthy:

• Be sexually responsible
  Maintain monogamous (single partner) sexual relationships with someone who is free of sexually transmitted illnesses. If the person is under 26 years of age, consider taking the Human Papillomavirus vaccine to prevent the occurrence of genital warts. Turn the foreskin back to its normal position after an intercourse.
• Know your medications
  Discuss the medication related to the concerned illness, its protocol and possible side effects with the doctor.
• Make healthy choices
  Pay attention to your mental health. Poor mental state due to fear, anxiety, depression as a result of penis pain should be addressed by visiting a counsellor or a psychologist. Maintain a healthy lifestyle by exercising daily. Get enough aerobic and cardiovascular activities to reduce the risk of chronic diseases.

Prognosis

The outcome of penis pain will depend on its cause. Conditions such as UTI, prostatitis, and herpes can be effectively treated with medications and hence penile pain in these conditions will have a better outcome. Conditions such as penile cancer, sickle cell anaemia, Peyronie’s and disease are much difficult to treat and as such the overall outcome of these diseases as well as penile pain will depend on the intensity and severity of symptoms.

Complications

Complications of penile pain include:

• Scarring.
• Painful retraction of the foreskin.
• Insufficient blood supply to the penis.
• Allergic dermatitis.
• Penile cancer.
• Urinary incontinence.
• Gangrene
• Spread of penile cancer (metastasis).