As a psychosexual therapist, I often encounter men who experience painful erections, a condition that can be both physically and emotionally distressing. These issues are more common than many people realize, but because they aren’t openly discussed, many men may feel isolated when facing them. If this is something you’re dealing with, I want to share my insights into the common causes of painful erections and offer some guidance on how they can be managed.
Warning: There are graphic pictures in this blog!
Priapism: A Medical Emergency
One of the most serious causes of painful erections is priapism, a condition where an erection lasts for more than four hours without sexual stimulation. Priapism is usually very painful and can cause long-term damage to the penis if not treated promptly. There are two types: ischemic and non-ischemic. Ischemic priapism occurs when blood gets trapped in the erection chambers, and it requires immediate medical intervention. Non-ischemic priapism is often caused by trauma or injury. Medications, certain medical conditions (like sickle cell disease), and recreational drugs can all lead to this condition. If you experience an erection lasting more than four hours, seek medical attention immediately to prevent permanent damage.
Peyronie’s Disease: Curvature and Pain
Another cause of painful erections is Peyronie’s disease, a condition that causes the penis to bend or curve due to the development of fibrous scar tissue. This can result in significant discomfort during erections and even difficulties with sexual intercourse. In my practice, I often see how this condition can impact self-esteem and relationships. Fortunately, there are several treatment options available, including medications, injections, and surgery in severe cases. Early intervention can make a big difference in managing this condition effectively.
Sexually Transmitted Infections (STIs)
Infections, particularly sexually transmitted infections (STIs) such as gonorrhea, chlamydia, or syphilis, can cause inflammation and pain during erections. These infections often present with other symptoms like discharge, burning during urination, or general discomfort. If left untre
Chronic Pelvic Pain Syndrome (CPPS)
For some men, Chronic Pelvic Pain Syndrome (CPPS) is the underlying cause of pain during erections. This condition can result from muscle tension, nerve irritation, or even psychological factors such as stress. Men with CPPS often experience ongoing discomfort in the pelvic region, which can interfere with erections and sexual function. From a therapeutic perspective, addressing stress and emotional health, along with physical treatment, can help manage symptoms. CPPS may require a multidisciplinary approach, including therapy, physical therapy, and sometimes medication.
Foreskin Issues: Phimosis and Paraphimosis
Pain during erections can also be caused by conditions related to the foreskin. Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. In contrast, paraphimosis occurs when the foreskin becomes trapped behind the head of the penis and cannot return to its normal position, which can cause swelling and pain. Both conditions can be uncomfortable, but there are treatments available, ranging from topical steroid creams to surgery, depending on the severity of the condition.
Injury or Trauma
Physical trauma, such as a penile fracture, can also lead to painful erections. This injury usually occurs during vigorous sexual activity or an accident and can be incredibly painful. Immediate medical treatment is necessary to repair the damage and prevent further complications. Trauma like this can also lead to psychological concerns, such as anxiety around future sexual activity, which is something I address with many of my clients.
Case Study: James' Journey with Prostatitis and Relationship Challenges
James, a 34-year-old patient from England, came to see me after a particularly painful breakup with his girlfriend. He had been suffering from prostatitis, a condition involving inflammation of the prostate gland, which caused him considerable pain during erections. Despite undergoing numerous medical tests, doctors could not pinpoint a clear cause for his condition. The physical discomfort made sexual intercourse difficult, and over time, this began to strain his relationship. His girlfriend felt increasingly rejected, believing that James was avoiding intimacy, and their frequent arguments eventually led to a breakup.
James was deeply affected by the end of the relationship, as well as by the lack of medical explanation for his symptoms. When he came to see me, his primary concerns were the emotional fallout from the breakup and his ongoing prostatitis, which had no apparent cause.
Through psychodynamic therapy, we began to explore the emotional and psychological layers of his experience. Psychodynamic therapy focuses on uncovering unconscious conflicts and motivations that might be influencing one’s thoughts, emotions, and behaviors. As we worked together, it became clear that James was wrestling with deeper fears and uncertainties about his future, particularly around settling down, marriage, and having children.
Over time, we came to understand that his prostatitis, though physically real, was connected to emotional factors. James’ unconscious resistance to committing to the relationship had manifested through his physical symptoms. His body was, in a sense, sabotaging the relationship because he wasn’t ready for the life changes his girlfriend desired. The pain during erections became a way of avoiding intimacy, which allowed him to maintain distance without directly confronting his fears or having difficult conversations.
As we continued to explore these issues in therapy, James gained a clearer understanding of the emotional roots of his prostatitis and how his body was responding to unresolved internal conflict. He eventually recognized that, on a deeper level, he had not been ready for the long-term commitment his girlfriend was seeking. This awareness allowed him to start processing his emotions, helping him to work through the breakup and understand his own needs and desires more fully.
James’ case highlights how physical symptoms can sometimes be linked to emotional conflicts, even when there is no clear medical explanation. In situations like his, therapy can play a crucial role in uncovering the underlying psychological factors that contribute to both physical and emotional pain.
Final Thoughts
Painful erections can be caused by a variety of factors, ranging from infections and trauma to conditions like Peyronie’s disease. It's essential to address these issues early, as they can not only affect your physical health but also take a toll on your emotional well-being and relationships.
As a psychosexual therapist, I’m here to support you not just in managing the physical aspects of painful erections, but also in navigating the emotional impact they can have on your sexual life and sense of self. If you’re struggling, I encourage you to seek help—there are treatments available, and you don’t have to face this alone.
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References:
Broderick, G. A., et al. (2010). Priapism: pathogenesis, epidemiology, and management. The Journal of Sexual Medicine, 7(1 Pt 2), 476–500.
Flores, J. M., et al. (2021). The Prevalence and Predictors of Penile Pain in Men with Peyronie’s Disease. Sexual Medicine, 9(4), 100398.
Hayashi, Y., et al. (2011). Prepuce: phimosis, paraphimosis, and circumcision. The Scientific World Journal, 11(1), 289-301.
Koifman, L., et al. (2010). Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology, 76(6), 1488-1492.
Magistro, G., et al. (2016). Contemporary Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome. European Urology, 69(2), 286–297.
Sadeghi-Nejad, H., et al. (2010). Sexually transmitted diseases and sexual function. The Journal of Sexual Medicine, 7(1 Pt 2), 389–413.
Milton Sattler Therapy
Psychodynamic Counsellor & Psychotherapist, Gender, Sexuality and Relationship Diversity (GSRD) Therapist, Psychosexual Therapist, CBT Therapist, and Intimate Partner Therapist
Addresses: 6 Bendall Mews, Marylebone, NW1 6SL
78-40 Borough High Street, London Bridge, SE1 1LL
Online Therapy (Zoom)
Mobile: +44 (0)7936898707
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