Penile Pain: Causes and Treatment

Penile pain can occur in the entire penis, in the head or root, or in the foreskin. Penile pain can happen at any age. The degree of pain may vary depending on the cause of the disease. The reasons may vary depending on many factors, from cancer to trauma. Penis pain is actually a common problem in varying degrees. Patients often do not go to the doctor because they are embarrassed or go late.

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What are the causes of penile pain?

Penile pain can occur due to many different reasons. In addition, the causes of pain are also related to age. Factors may be different in adult and child ages. Conditions that cause pain in the penis include:

Priapism: Priapism is a prolonged and involuntary painful erection of the penis. Prolonged prolonged erection causes permanent damage to the penis. Priapism is a urological emergency and in cases exceeding 4-5 hours, the erection must be terminated with an emergency surgical intervention.

Priapism may occur due to various reasons. Various cancer diseases, blood diseases (sickle cell anemia), psychiatric drugs and penile injection treatments are the most common causes of priapism.

Patients with priapism have widespread pain in the penis. Pain is more common in patients with ischemic type priapism.

Penile cancer: Penile cancer is a rare disease. Especially in men who have been circumcised, the incidence of cancer in the penis is very low. Pain varies according to the location and extent of the cancer.
Balanitis: Balanitis is an inflammatory disease of the foreskin and glans penis. It occurs in uncircumcised men. Infectious agents can be fungi, sexually transmitted diseases and other pathogenic bacteria. In addition, some chemical allergens cause balanitis. In severe cases, patients cannot urinate. It is necessary to keep the foreskin clean and circumcision should be performed in cases that recur frequently.
Urinary tract infections: Urinary tract infections also cause pain in the penis. Urinary tract infections are common in uncircumcised men, those with weakened immune systems, diabetics, and those with prostate enlargement (BPH). Depending on the location and severity of the infection, penile pain may be of varying degrees.
Sexually transmitted diseases (urethritis): Sexually transmitted diseases in men can cause penile pain. Factors of sexually transmitted diseases: Factors such as chlamydia, gonorrhea, genital herpes, syphilis. Patients with urethritis experience itching and pain in the urethra.
Phimosis and paraphimosis: Phimosis is a disease that occurs as a result of very narrowing of the tip of the foreskin in uncircumcised men. In phimosis, the foreskin comes back when it is pushed towards the penis, but in paraphimosis, the foreskin that is pushed back does not come back to its place. Paraphimosis is an emergency. If left untreated, it leads to gangrene of the glans penis. Its treatment is emergency surgery. Circumcision is performed with surgery.
Peyronie’s disease: Peyronie’s disease occurs as a result of calcification in the tunica albuginea, which surrounds the corpus cavernosum, which is responsible for erection in the penis. It is thought to be caused by long-term micro-traumas. It is more common in diabetics and rheumatic patients. It is mostly seen in men over the age of 40. In the acute phase of Peyronie’s disease, there is pain in the penis during erection. Bending during erection is seen along with pain. On examination, there is stiffness (plaque, calcification) and pain in the part of the penis with Peyronie’s disease. Some patients may also have erectile dysfunction.
Penile traumas: Penile traumas cause pain depending on the location and degree of trauma. Penile traumas may result from blunt, penetrating or cutting traumas. Traffic accidents and sports activities are causes of trauma.
Mondor’s disease of the penis: Mondor’s disease of the penis occurs as a result of thrombus of the veins (veins) on the back of the penis. The reason is not known exactly. Coagulation occurs in the inner part of the dorsal veins of the penis. Patients come to the urology doctor with the complaint of pain, especially in the back of the penis. On examination, there is stiffness and pain extending along the back of the penis.
Penile injection treatments: Today, patients with erectile dysfunction (impotence) are given penile drugs for treatment purposes. As a side effect of these treatments, there may be pain in tennis. These pains vary according to the drug administered. It usually does not cause a serious problem and goes away on its own.
Cystoscopy-urethroscopy: Depending on the cystoscopic interventions performed for diagnostic purposes, patients may have pain in the penis after the procedure. If the procedure is traumatic, the pain is more. In order not to cause serious penile trauma, cystoscopy should be performed with thin devices.
Urethral catheterization: Inserting a catheter into the urethra for various reasons may cause penile pain. In these patients, the catheter should be kept as short as possible and thin catheters should be preferred.
Penile fracture: Penile fracture or fracture is the rupture of the membrane called tunica albuginea, which surrounds the cavernous bodies during erection. It is a common situation during traumatic intercourse. Serious cases require immediate surgical intervention. Otherwise, serious problems will arise in the future.
Traumatic and long-term sexual intercourse: Long-term and traumatic relationships can cause pain in the penis. In particular, skin rash is common.
Abscess on the penile skin: Abscess of the penile skin for various reasons is an emergency. Abscess must be drained surgically.
Allergic dermatitis on the penile skin: Allergic disorders of the penile skin can cause skin irritation and pain. If there are allergic factors, they should be avoided.
Infected hair follicles: Infections in the hair follicles of the penile skin cause penile pain in advanced cases. It is very important to pay attention to hygiene.
Reiter’s syndrome: It is a disease involving joint pain, eye problems and genital and other skin areas.
Insect bites: Insect or human bites can cause pain in the penis. Insect bites are more common, especially in rural areas.
Penile irritants: Some chemicals that irritate the skin (perfume, spray) also cause irritation and pain on the penile skin.
Bladder stone: Bladder stones cause pain that hits the penis in men.
Ureteral stone: In some of the ureteral stones, pain is felt in the penis depending on the location of the stone. The penis is normal on examination. These pains are called referred pains.
Urethral stone: Sometimes a stone located in the urethra causes inability to urinate and penile pain. The definitive treatment is stone removal.
Painful bladder syndrome: Pain in the muscles and penis is common in male patients with painful bladder syndrome.
Chronic pelvic pain syndrome: There is long-term lower urinary tract pain in the disease called chronic prostatitis or chronic pelvic pain syndrome. However, no micro-organisms could be detected in the studies. The cause of the disease is not fully known.
Infected penile prosthesis: If the prosthesis is infected in penile prosthesis patients, pain, swelling, redness and fever occur in the penis. In this case, a Urologist should be consulted.
Traumatic masturbation: Men who masturbate traumatic may experience irritation and pain on the penile skin.
Lichen sclerosus: It is a chronic disease. There are white, wrinkled and fine spots on the skin of the penis. It is more common in the anus and genital areas. There is bleeding, inflammation and pain in the skin.
The clothes used: The use of tighter and tighter underwear and trousers causes a feeling of tightness and pain in the penis. This can be avoided by wearing comfortable clothes.
Stress, bladder and bowel emptying problems: Conditions such as stress, depression and anxiety, constant sexual arousal, exercise, sexual arousal, constipation, inability to urinate (overfilling the bladder) can cause pain in the penis.
Acute prostatitis: In the inflammation of the prostate, there may be pain in the groin, perineum and penis.
Referred pain: In these cases, there is no problem in the penis, but the pain due to the primary disease may be felt in the penis. Like ureteral stone pain.
Radiotherapy: Radiation therapy given to the penis or neighboring organs for treatment may cause pain in the penis.
Fournier’s gangrene: It is the gangrene of the skin and subcutaneous tissues seen in the scrotum and perineum. It is common in people with weak immune systems and diabetes. Urgent surgical intervention is required.

Is penile pain serious?

One of the issues that our patients wonder is whether the pain in the penis will be a serious condition. The severity of the pain varies depending on the cause. Pain due to serious diseases constitutes a more important health problem and requires urgent treatment. Penile cancer, priapism, paraphimosis and penetrating injuries require urgency.

What are the protective measures against penile pain?

Patients with penile pain should pay attention to some issues. Thanks to these measures, it is possible to be protected against factors such as infectious agents. Also, mild pain can be prevented with lifestyle changes.

Precautions should be taken against sexually transmitted diseases. The use of condoms during intercourse is a very protective measure against the risk of disease. People who are known to be sick and have relationships with multiple partners should be avoided.
Men who have frequent infections and who have not been circumcised should pay great attention to cleanliness, and circumcision should be performed if necessary.
More comfortable clothes should be preferred instead of tight clothes.
Chemicals such as perfumes and sprays that are irritating to the skin should be avoided.
Traumatic sexual intercourse and masturbation should be avoided
Giving importance to hygiene

When to go to the doctor?

In some cases, patients should definitely consult a Urologist. Some penile pain may require immediate medical attention. In the following cases, a Urology specialist should be consulted;

If there is swelling and redness in the penis
If there is long-term itching and pain that does not go away
If there is severe irritation in the penis
If there is severe pain during sexual intercourse
If there is burning, urethral discharge and pain while urinating
If there is blood in the semen
If there is a painful erection that lasts 5-6 hours (priapism)
If there is a penile fracture
Serious injury to the penis, especially if there is an open wound
If the patient with penile prosthesis has pain, redness and high fever in the penis

Patients with penile pain may ask the doctor these questions

From patients who go to a urologist because of pain in the penis, the doctor undergoes a detailed medical questioning. For this purpose, the Urologist may ask the following questions to patients with penile pain;

When did the pain start?
The degree of pain, whether it is continuous or intermittent
Is the pain always the same or has it increased continuously?
Is the pain in the entire penis or in a particular area?
Did the onset of pain occur after a certain event? (trauma, sexual intercourse, etc…)
Whether there is swelling, fever, bruising in the penis
Does the pain occur during erection or is it continuous?
Has there been any recent trauma to the penis?
Have you had unprotected intercourse with a stranger recently?

How is penile pain diagnosed?

A systematic approach is required to diagnose penile pain. For this purpose, we evaluate our patients as follows:

Detailed medical inquiry: Pain in the penis may be due to many factors. The doctor should conduct a thorough questioning to establish the cause of the pain.
Examination: A detailed urological examination is performed. Conditions such as the location of the pain, swelling in the penis, and traces of trauma are evaluated.
Laboratory tests: Urine microscopy, urine culture, discharge culture can be taken for sexually transmitted diseases. If necessary, special tests for sexually transmitted diseases can be ordered.
Blood tests: Some blood tests may be requested to reveal the factor that may be causing the pain.
Radiological diagnostic methods: Ultrasonography for the diagnosis of the disease that may be a factor. Examinations such as CT, MRI, scintigraphy may be required.

How is penile pain treated?

There is no single treatment for penile pain. Since the causes of the pain are different, the treatment questioning: Hi also changes accordingly. The best treatment is to treat the cause of the pain. In other words, penile pain is not a disease, but a symptom of more than one disease. The treatment principles to be applied in the treatment of penile pain are as follows:

Pain due to infections: Antibiotic treatment is absolutely necessary. Pain relievers and anti-inflammatory drugs should also be added.
Priapism: Urgent surgical intervention is absolutely necessary in cases exceeding 5-6 hours.
Traumas and penile fracture: In severe cases, surgical intervention is absolutely necessary.
Penile cancer: Surgical treatment is essential according to its stage.
Phimosis, paraphimosis: Surgical treatment is required
Abscess on the penile skin: Surgical drainage and antibiotic treatment are applied.
Infected penile prosthesis: Although rare, infection may develop in penile prosthesis. In severe cases, the prosthesis must be surgically removed.

In summary; penile pain is not a disease, but a symptom of more than one disease. These diseases can be diseases arising directly from the penis, as well as the reflected pain of other organs. Treatment varies depending on the factor. A wide range of treatment options can be applied, from simple pain relievers to serious surgery. Protective measures should be taken against allergic factors and sexually transmitted diseases.

Prof. Dr. Emin ÖZBEK

Urology Specialist

Istanbul- TURKEY