We are sorry. No matter what you might have been told, sex is not supposed to hurt.
Painful sex for men is not discussed often but isn’t uncommon. In the Marriage Intimacy Project study, 8%[1] of males said they experienced pain with sex at least half (50%) of the time. Of that group, their pain interfered with sexual pleasure at least 70% of the time. While that is less than half the rate experienced by women, that’s still a great concern. Especially if you are one of the couples affected by his sexual pain.
To add insult to injury, male sexual pain (male dyspareunia) has been removed from the diagnostic manual most counselors in the US use (Diagnostic and Statistical Manual of Mental Disorders – DSM-5) though “painful ejaculation” is still in the International Classification of Disease manual (ICD-11).
What’s wrong?
Research into male sexual pain is sparse. It is believed that most men who experience pain with sex either don’t talk about it, or discuss it only with their doctor –and it is rarely explored well.
As with women, technically, painful sex in men is called “dyspareunia”, but that simply means “painful sex”, so it is not very helpful. And, as with women, the root cause is varied and complex. There are often multiple issues involved, including relational, psychological, and biological issues. (The articles, “Help, it hurts when I have sex – for women” and “Sex is not supposed to hurt” explain the complexity involved.)
Areas of pain during sex for men most commonly include the penis, perineum (area between the scrotum and anus), but may also include the testes, lower abdomen, rectum, and any area that hurts during ejaculation[2].
Pain during ejaculation can be caused by many issues, including prostatectomy, inflammation, infection, blockage of the ejaculatory ducts, side effects of other medical treatments, or psychiatric complications. Chronic Prostatitis (inflammation of the prostate) and Chronic Pelvic Pain Syndrome (CPPS) can also cause pain with sex, especially during ejaculation.
Peyronie’s Disease (when fibrous tissue in the penis causes significantly curved erections) is typically painful during erections. Phimosis is an abnormal restriction of the foreskin preventing it from retracting and can cause pain. Rarely, stones in the seminal vesicles (roughly similar to kidney stones) can cause pain. Bladder issues and dermatological issues can also cause pain during sex. Anodyspareunia, or pain during anal sex, is common with this practice and has been shown to have both biological and psychological causes. Finally, as with women, neuromuscular issues like muscle spasms or hyperactive pelvic floor can cause sexual pain in men.
Any of these types of sexual pain (and others not mentioned) can lead to decreased desire, difficulty with erection, delayed orgasm, and eventually depression and marital problems.
Finding help.
Sexual Medicine Specialist
A good place to start would be a sexual medicine specialist. Sexual medicine specialists for men can be located in the “Find a Provider” section of the International Society for Sexual Medicine website (https://ISSM.info). If you can find a local one, be aware that —as with female specialists — they may be private pay (not on your insurance). You also may need to travel a bit to see them.
A second option here would be a local urologist. Many urologists are trained in the basics of diagnosing sexual pain in men. Do your research, however, to find one that has training and experience in working with male sexual pain.
Pelvic Floor Specialist
Pelvic floor therapy has also been shown to be effective with some sexual pain in men. The key is to find a physical therapist specializing in pelvic floor issues. Begin your search at aptapelvichealth.org or pelvicguru.com). Even if the root of your pain isn’t about your pelvic floor, this is still a valuable professional on your team. Besides, getting that part of your body healthier can only be good for you right? It has been shown to increase the pleasure of sex.
Sex Therapist
Finally, don’t rule out a sex therapist trained in working with sexual pain. (Begin your search at ABCST.org.) Some sexual pain is rooted in what is happening to us emotionally and relationally. Good therapy is critical for helping resolve this type of pain. Our thoughts and anticipation of the pain can heavily influence the experience of the pain and related sexual dysfunction. Therapy is also best targeted to decreasing this factor in sexual pain and sexual dysfunction.
Sexual pain can also impact our view of self and sex. It can have a ripple effect through our marriage. A skilled sex therapist can help unravel and address these impacts from the pain.
Stay on the journey
Pursue healing in this area. Unless you have a clear diagnosis and untreatable reason the pain is going to stay, don’t just “play through the pain”. Pursue help and healing.
Finally, a word of caution: Consumer beware. Anyone who provides a simplistic answer to your pain is likely not trained to recognize the complexity and may do more harm than good.
References:
Luzzi, G., Law, L., & , (2006). The male sexual pain syndromes. International Journal of STD & AIDS, 17(11), 720-726.
Raquel Pereira, Cátia M. Oliveira & Pedro J. Nobre (2018) Pain Intensity and Sexual Functioning in Men with Genital Pain: The Mediation Role of Sexually Related Thoughts, Journal of Sex & Marital Therapy, 44:3, 238-248, DOI: 10.1080/0092623X.2017.1405298
Seth N. P. Davis, Yitzchak M. Binik & Serge Carrier (2009) Sexual Dysfunction and Pelvic Pain in Men: A Male Sexual Pain Disorder?, Journal of Sex & Marital Therapy, 35:3, 182-205, DOI: 10.1080/00926230802716310
Tutolo, M., Salonia, A. (2021). How Pain Influences Sexuality in Men. In: Giammò, A., Biroli, A. (eds) Chronic Pelvic Pain and Pelvic Dysfunctions. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-030-56387-5_13