Painful erections can cause distress and significantly affect a man’s sexual health and quality of life. While it may not be a frequent topic of conversation, the issue is more common than many might think. Understanding the most common causes of painful erections can help men seek appropriate treatment and alleviate discomfort.

1. Priapism

Priapism is a condition characterized by prolonged and often painful erections that last for more than four hours and occur without sexual stimulation. There are two types of priapism: ischemic and non-ischemic. Ischemic priapism, also known as low-flow priapism, occurs when blood becomes trapped in the erectile tissue of the penis and cannot flow out. This form of priapism is often painful and considered a medical emergency because prolonged ischemia (lack of blood flow) can cause permanent damage to the tissue.

Non-ischemic priapism, or high-flow priapism, is less painful and occurs when there is an uncontrolled flow of blood to the penis due to an injury or trauma to the arteries. Conditions that increase the risk of priapism include sickle cell disease, certain medications (especially for erectile dysfunction), and drug or alcohol abuse. Immediate medical attention is necessary to treat the underlying cause and prevent long-term damage.

2. Peyronie’s Disease

One of the leading causes of painful erections is Peyronie’s disease, a condition that affects the tissue of the penis. It occurs when fibrous scar tissue forms in the penis, leading to abnormal curvature during erections. Men with Peyronie’s disease may experience pain, difficulty with erections, and, in severe cases, significant curvature that makes intercourse difficult or impossible. The scar tissue buildup may result from minor injuries to the penis, such as those that happen during sex, sports, or accidents. However, in many cases, the exact cause of Peyronie’s remains unknown.

The pain typically occurs during the early stages of the condition, and it may decrease as the condition stabilizes. Medical treatment can range from injections directly into the scar tissue to surgery in more severe cases.

3. Infections and Inflammation

Infections and inflammation can also cause painful erections. Conditions such as prostatitis, which is the inflammation of the prostate gland, or urethritis, inflammation of the urethra, can lead to discomfort during an erection. Infections of the bladder or urinary tract can also contribute to pain, particularly during ejaculation.

Sexually transmitted infections (STIs) like gonorrhea or chlamydia can cause inflammation in the reproductive organs, leading to painful erections. When an STI is the cause, other symptoms like discharge, burning during urination, or swelling of the genital area may also be present. Treatment typically involves antibiotics or antiviral medications, depending on the nature of the infection.

4. Chronic Pelvic Pain Syndrome (CPPS)

Chronic Pelvic Pain Syndrome (CPPS), also known as Chronic Prostatitis, is a condition that affects men of all ages and can cause pain in the pelvic area, including during erections. The exact cause of CPPS is not fully understood, but it is believed to involve a combination of muscle tension, nerve inflammation, and psychological factors like stress or anxiety.

Men with CPPS may experience persistent pain in the perineum (the area between the anus and the scrotum), lower abdomen, and even the penis. This pain can become more pronounced during erections, ejaculation, or after sexual activity. Management of CPPS often includes pelvic floor physical therapy, medications to reduce inflammation and pain, and addressing stress or anxiety through counseling or stress management techniques.

5. Phimosis and Paraphimosis

Phimosis is a condition where the foreskin is too tight to be pulled back over the head of the penis. This tightness can cause discomfort or pain during an erection, especially in cases where the foreskin has not been stretched enough to allow for full retraction. Phimosis is more common in uncircumcised men and may resolve on its own in younger individuals, but in some cases, medical intervention may be needed.

Paraphimosis, on the other hand, occurs when the foreskin gets stuck in a retracted position and cannot be pulled back over the head of the penis. This can cause swelling and pain, especially during erections, and requires immediate medical attention to avoid complications. Treatments for both conditions include topical steroid creams, manual stretching, or, in more severe cases, circumcision.

6. Trauma or Injury

Physical trauma to the penis or pelvic region can result in painful erections. This can occur due to sports injuries, accidents, or rough sexual activity. A condition called penile fracture, which happens when the tunica albuginea (the protective layer surrounding the erectile tissue) ruptures, can cause immediate, severe pain during erection. Penile fractures typically require surgical intervention to repair the damage and prevent complications like erectile dysfunction or chronic pain.

Conclusion

Painful erections can arise from various causes, ranging from infections and inflammation to more serious conditions like Peyronie’s disease and priapism. While these conditions can be distressing, many are treatable with the right medical intervention. It is essential for men experiencing pain during erections to seek medical advice promptly to address any underlying issues and prevent complications.

References:

• Broderick, G. A., Kadioglu, A., Bivalacqua, T. J., Ghanem, H., Nehra, A., & Shamloul, R. (2010). Priapism: pathogenesis, epidemiology, and management. The journal of sexual medicine, 7(1 Pt 2), 476–500. https://doi.org/10.1111/j.1743-6109.2009.01625.x
  
  
• Flores, J. M., Salter, C. A., Nascimento, B., Terrier, J. E., Taniguchi, H., Bernie, H. L., Miranda, E., Jenkins, L., Schofield, E., & Mulhall, J. P. (2021). The Prevalence and Predictors of Penile Pain in Men with Peyronie’s Disease. Sexual medicine, 9(4), 100398. https://doi.org/10.1016/j.esxm.2021.100398
  
  
• Hayashi, Y., Kojima, Y., Mizuno, K., & Kohri, K. (2011). Prepuce: phimosis, paraphimosis, and circumcision. The Scientific World Journal, 11(1), 289-301. https://doi.org/10.1100/tsw.2011.31
  
  
• Koifman, L., Barros, R., Júnior, R. A., Cavalcanti, A. G., & Favorito, L. A. (2010). Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology, 76(6), 1488-1492. https://doi.org/10.1016/j.urology.2010.05.043
  
  
• Magistro, G., Wagenlehner, F. M., Grabe, M., Weidner, W., Stief, C. G., & Nickel, J. C. (2016). Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. European urology, 69(2), 286–297. https://doi.org/10.1016/j.eururo.2015.08.061
  
  
• Sadeghi-Nejad, H., Wasserman, M., Weidner, W., Richardson, D., & Goldmeier, D. (2010). Sexually transmitted diseases and sexual function. The journal of sexual medicine, 7(1 Pt 2), 389–413. https://doi.org/10.1111/j.1743-6109.2009.01622.x