Many people, for a multitude of reasons, don’t talk about experiencing pain during sex. When the infrequent conversation does come up, it’s usually in the context of women’s health. In men’s health, it comes up even less often.
Do a quick search online, and you’ll find that most articles and studies about dyspareunia focus on women. Very few address men. That knowledge gap reflects just how little attention it gets, even though men can also experience pain during or after intercourse. Pain during sex in men remains under-recognized, under-reported, and under-studied.
That doesn’t mean it’s uncommon. Studies estimate that about 5% of men worldwide experience painful intercourse at some point in their lives – that’s roughly 190 million men across the globe.¹
Intimacy is natural, and a healthy sex life is part of overall well-being. When things in the bedroom become uncomfortable, it’s not something to ignore. In this article, we’ll spotlight common causes, what you can do about them, and when it’s time to speak with a healthcare provider.
What’s Triggering the Pain?
Sex isn’t supposed to hurt. When it does, it’s likely a signal that something deeper could be going on, so don’t just power through it. Do some medical detective work with your urologist and men’s health provider to figure out what’s going on. Although not exhaustive, here are some of the most common causes.
Infections and Inflammation
Pain during sex can be the body’s way of sounding the alarm for an underlying infection. Urinary tract infections (UTIs), sexually transmitted infections (STIs), and prostatitis (inflammation of the prostate) can all cause discomfort or burning during ejaculation, urination, or penetration. Balanitis (inflammation of the head of the penis or foreskin) is another common source of pain. Any inflammation in the genital region can make even mild friction feel unbearable.
We can’t avoid every germ we encounter or the disruption microbes can cause. Still, safer sex practices and good hygiene can create a physiological environment that is inhospitable to them. When the culprit isn’t bacterial, proactive health strategies (like regular checkups, stress management, and an anti-inflammatory lifestyle) can support immune function and lower the risk of chronic inflammation.
Treatment depends on the source: antibiotics for bacterial infections, antivirals for STIs, and pelvic floor therapy or medication for chronic prostatitis. All of the above respond well to additional dietary or lifestyle adjustments in conjunction with medical attention.
Pelvic Floor Dysfunction
When the pelvic floor muscles are overly tense, imbalanced, or irritated, they can compress or entrap nearby nerves like the pudendal nerve, which runs through the pelvis and into the genitals. This can lead to pain that radiates into the groin area, thighs, lower back, and toward the penis or scrotum that’s sharp, burning, tingling, or aching. Some people also describe a pressure or “foreign body” sensation in the rectum or urethra.
The pelvic muscles also support the bladder, bowel, and reproductive organs. Because of the neighboring structures, issues with pelvic floor dysfunction (PFD) can create a cascade of symptoms that feel worse with sitting, sex, bowel movements, or stress.
Referred or radiating pain is one reason PFD can be misdiagnosed or overlooked. It often mimics other issues like prostatitis, sciatica, or hernias, but doesn’t respond to antibiotics or typical treatments for those conditions.
Pelvic floor dysfunction can stem from physical strain, injury, prolonged sitting, poor posture, or stress-related muscle clenching. It’s especially common among cyclists, weightlifters, and people with chronic tension patterns. Unlike infections or injuries, this type of pain often doesn’t show up on imaging or lab work, making it frustrating to diagnose.
Once it can be identified, it’s highly treatable. Pelvic floor physical therapy, biofeedback, breathing exercises, and bodywork can all help retrain muscles to relax and coordinate properly. In some cases, muscle relaxants or targeted injections may be helpful, and many men find lasting relief through conservative, movement-based approaches or a combination of therapies.
Skin Conditions
The skin on the penis is delicate, and like skin anywhere else, it can be affected by dermatological conditions. Eczema, psoriasis, lichen sclerosus, and contact dermatitis can all show up in the genital area, sometimes without warning. These conditions may cause redness, dryness, flaking, or cracking of the skin. Add the friction of sexual activity to already irritated skin, and discomfort is almost inevitable.
Flare-ups can be mitigated by identifying triggers – harsh soaps, fragranced body products, latex, certain fabrics, or even excessive moisture can all contribute to skin irritation. When it comes to our more sensitive parts, switching to gentle, non-irritating products can go a long way.
Treatment often includes topical steroids or barrier creams, but a dermatologist’s insight is warranted, especially if the condition is chronic. Avoiding allergens, keeping the area clean and dry (but not overly so), and using lubricants during sex can help prevent skin irritation.
Phimosis
Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. In some cases, it’s present from birth and resolves naturally. But when it persists or develops later in life, often due to repeated infections or inflammation, it can make erections and intercourse painful. Even minor retraction can cause tearing or micro-injuries, making future encounters more stressful and uncomfortable.
Maintaining good hygiene and avoiding irritants can help prevent inflammation that exacerbates tightness. In recurrent or more severe cases, topical steroid creams can reduce tightness and inflammation, sometimes eliminating the need for surgery. Gentle stretching exercises may also help at times when inflammation isn’t present. When conservative options don’t work, surgical approaches like circumcision or preputioplasty might be considered.
Peyronie’s Disease
Peyronie’s disease occurs when scar tissue develops under the skin of the penis, causing it to bend or curve, sometimes too sharply, making erections quite painful. The curvature can make sex painful or even impossible. The condition can develop gradually or occur after an injury, and some men may not recall a specific event that triggered it.
There’s no surefire way to prevent Peyronie’s disease, but reducing the risk of injury during sex by using adequate lubrication and avoiding rough thrusting can help. Early diagnosis and treatment in the initial inflammatory stage can help prevent progression.
Treatment depends on the severity of the symptoms. For mild cases, watchful waiting may be enough. In more bothersome cases, options include injections into the scar tissue, traction therapy, or surgery for unresponsive cases.
Past Trauma or Surgery
Past injuries to the penis, pelvis, or perineum, usually from accidents, sports, or surgical procedures, can leave behind more than just scar tissue. Nerve damage, altered anatomy, or chronic pelvic floor tension may develop long after the original injury has healed. Even surgeries like hernia repair, prostate procedures, or circumcision can lead to lingering pain or changes in sensation that show up most clearly during sex.
Prevention isn’t always possible, but seeking early treatment for injuries and being proactive with post-surgical care can reduce incidences of long-term pain.
Treatment depends on the nature of the trauma. Pelvic floor therapy, nerve pain medications, scar tissue mobilization, or even reconstructive surgery might be needed. It’s also helpful to work with a provider familiar with post-surgical complications, particularly if pain develops months or even years after the event.
Pain Echoes
Sexual pain is often made worse by the stress it causes – our perception of pain, and the anticipation of it, can intensify how we experience it. Anxiety, fear of pain returning, and a sense of embarrassment can create a feedback loop, where worry tightens muscles, dulls arousal, and heightens the body’s pain response.
Even when the root cause is physical, the nervous system’s pain signals can become amplified, and the body may stay on high alert. Addressing pain with awareness of both the source and the surrounding stress is part of a holistic approach to care and leads to better outcomes.
Therapists who specialize in sexual health can be a real asset in this department. They’re trained to help people reconnect with their bodies through guided support that calms the stress response, reduces discomfort, and rebuilds confidence in intimacy.
Get In Touch
Painful sex doesn’t need to be your norm, and it’s not something to tough out alone. If you’ve been experiencing discomfort that doesn’t go away, seems to be getting worse, or is interfering with your ability to enjoy intercourse, it’s time to talk to someone.
Start with a provider who listens, takes your symptoms seriously, and is willing to explore beyond surface-level explanations. You deserve honest answers and relief.
Dr. Kapadia is a board-certified urologist with fellowship training in male sexual and reproductive health. Schedule a visit to dissolve pain, restore intimacy, and start enjoying your sex life again.
Reference:
- DelCea, C. (2019). Dyspareunia in Men. International Journal of Advanced Studies in Sexology, 1(1), 48–52. https://doi.org/10.46388/ijass.2019.12.11.120.