Pain during sex in men: common causes

Allergy to condom latex, low lubrication and infections are among the causes of pain during sex.

Feeling pain during sex is not normal. Causes are diverse and include friction, irritation, foreskin changes, penile diseases, urethral problems, prostatitis and pelvic pain syndrome.

Understand when the discomfort requires medical evaluation and which treatments may be indicated for each cause.

Is pain during sex normal?

It is not normal, although an occasional episode is not necessarily related to disease. When the pain is intense, persistent or recurrent, especially if accompanied by other symptoms or making further relations difficult, it is important to seek medical evaluation.

The dyspareunia, the medical term for pain during sex, can have different causes. The EAU addresses sex-related pain in the context of male pelvic and sexual pain syndromes.

What can cause pain during sex?

Friction and irritation

Friction occurs from repeated contact and rubbing of the skin or mucosa during sexual intercourse. Irritation involves inflammation or sensitivity caused by physical or chemical agents.

Excessive friction can cause irritation, especially during prolonged or intense intercourse. Low lubrication can worsen the problem.

When frequent, friction and irritation can cause microtrauma, increase sensitivity and cause burning in the penis after intercourse.

Phimosis

The phimosis occurs when the foreskin is tight and makes it difficult to expose the glans.

Difficulty retracting the foreskin can cause pain during erection and sexual intercourse. When the skin is not sufficiently flexible, stretching can cause tension, discomfort, small fissures and pain. Friction during intercourse can intensify these symptoms.

Balanitis and balanoposthitis

The balanitis is inflammation of the glans, while balanoposthitis affects both the glans and the foreskin.

These conditions can cause pain during sex due to inflammation, redness, itching and increased sensitivity. Movement during sex can intensify the irritation, causing pain, burning and, in some cases, small skin fissures.

Urethritis and STIs — pain during sex

Urethritis and some sexually transmitted infections can cause pain during sex because the inflammation of the urethra increases local sensitivity.

Friction and movement can intensify the symptoms, causing pain or burning when urinating. When there is discharge or small lesions, pain during sex may be greater.

The guidelines of the CDC recommend specific investigation for urethritis and testing for agents such as chlamydia and gonorrhea when indicated.

Urinary tract infection and pain during sex

A urinary tract infection can cause pain during sex by increasing the sensitivity of the urethra and other structures of the urinary system.

Pressure, friction and movement during sex can intensify the irritation and burning, causing discomfort.

Peyronie’s disease and pain during sex

The Peyronie’s disease is characterized by the formation of fibrosis in the tunica albuginea, which reduces tissue elasticity.

This change can cause curvature and deformities, as well as pain during erection, making penetration difficult and, in some cases, causing pain after sexual intercourse.

Prostatitis and pelvic pain — pain during sex

The prostatitis and pelvic pain can affect the prostate and nearby structures, causing symptoms such as perineal pain and urinary changes.

Contraction of the pelvic muscles during ejaculation can intensify these symptoms and cause pain during sex or discomfort afterward.

Trauma during intercourse and pain during sex

Intense, sudden pain during sex, accompanied by a cracking sound, immediate loss of erection, swelling or change in the shape of the penis, may indicate a penile fracture or other injury that requires prompt medical evaluation.

Dermatological changes and pain during sex

Dermatitis, eczema, psoriasis and lichen sclerosus can lead to pain during sex by causing inflammation, dryness, itching and increased sensitivity of the genital tissue.

Friction and stretching of the skin during sex can intensify these symptoms and lead to pain during sex, causing burning after intercourse and fissures in the penis.

Pelvic floor changes and pain during sex

The pelvic floor is made up of muscles, tissues and ligaments that help keep the organs of the region in the proper position and participate in erectile function and ejaculation.

Excessive tension or contraction of these muscles can cause pain during sex in the penis, perineum or pelvic region, or after sex.

For men with pelvic floor dysfunctions, the EAU recommends considering individualized approaches and, in selected patients, pelvic floor physiotherapy.

Can pain during sex be an STI?

Yes, it can be related to an STI, especially when accompanied by discharge, sores, blisters or burning when urinating. But these symptoms are not exclusive to STIs and, on their own, do not confirm the diagnosis. Confirmation depends on medical evaluation and specific tests.

Avoid taking antibiotics on your own, as inappropriate use can promote bacterial resistance and make treatment more difficult.

Can pain during sex be related to the prostate?

It can be, especially in cases of prostatitis or syndromes of pelvic pain. However, pain during sex is not specific to prostate problems.

When there are prostate changes associated with pelvic pain, perineal pain, urinary symptoms and pain on ejaculation may occur.

Are pain during sex and pain on ejaculation the same thing?

No. Pain during sex and pain when ejaculating can occur together, but are not necessarily the same symptom.

Pain during penetration, a type of pain during sex, may be related to friction, inflammation, or changes in the genital tissues. Pain during ejaculation, however, may be associated with the prostate, the urethra, or other structures involved in that process.

How does the urologist investigate pain during sex?

Investigation begins at the consultation, with analysis of the clinical history and the physical examination.

Depending on the suspected cause of pain during sex, the doctor may request complementary tests.

Clinical history for pain during sex

The clinical history helps guide the investigation of pain during sex. The doctor may ask:

• When the pain started;
• At what point during intercourse it occurs;
• Where it hurts;
• How intense it is;
• How long it lasts;
• Whether it happens every time;
• Whether it is related to erection;
• Whether it is related to ejaculation;
• Whether there are urinary symptoms;
• Which products are used;
• Sexual history;
• Possibility of STI;
• History of trauma;
• Previous surgeries;
• Medications used;
• Preexisting conditions.

Physical examination for pain during sex

The urologist can assess the penis, the glans, the foreskin, the testicles and the urethral meatus to identify signs of inflammation or injury that may cause pain during sex.

The examination also allows checking for curvature and other anatomical changes that may be related to pain during sex.

Additional tests for pain during sex

Depending on the clinical hypothesis, urine tests, STI tests, microbiological tests, ultrasound, Doppler and other tests necessary to clarify the cause of the symptoms.

How is the treatment for pain during sex?

Treatment depends on the identified cause. The table below gathers approaches that can be used in the main causes of pain during sex.

What to do while the cause of pain during sex is not identified?

While the cause of pain during sex is not clarified, some measures may help prevent worsening of the symptoms:

• Avoid sexual intercourse if the activity is causing pain;
• Avoid potentially irritating products;
• Do not apply ointments without medical guidance;
• Do not use antibiotics on your own;
• Observe other symptoms;
• Seek medical evaluation if pain during sex persists or recurs;
• If an STI is suspected, inform the physician and take measures to reduce the risk of transmission.

If pain during sex persists or recurs, seek medical or urological evaluation.