Painful erections

Whether it’s sharp pain, a dull ache, sore to the touch or radiating through your pelvis — feeling pain during an erection can be pretty distressing. Painful erections aren’t normal and you should see a doctor to find out what’s causing it. There are several causes of painful erections. Here are some of the most common reasons why you might experience pain from an erection and what you can do about it. 

How do erections happen?

When you’re aroused your brain sends messages to the blood vessels in your penis, which relax allowing more blood to flow in. This fills up two tubes of spongy tissue in the penis. The veins running through the outer sheath of the penis are then compressed, which stops the blood from leaving the penis, giving you an erection. When the inflow of blood reduces and the veins open, your erection stops.

Causes of painful erections

Priapism

Priapism is when you have a prolonged erection lasting more than four hours, without any kind of sexual stimulation. It’s usually painful and the pain gets progressively worse. Causes of priapism include: use of medications or drugs, traumatic injury and/or medical conditions that affect the way your blood clots. Priapism often affects people with sickle cell disease. If not treated quickly, priapism can damage the penis and lead to problems like erectile dysfunction. Treatment involves draining the blood or surgery. If you ever experience this, it’s important to see a doctor immediately.

Learn more about priapism and painful erections here.

Peyronie’s disease

Peyronie’s disease is when connective tissue under the skin of the penis scars permanently, causing the penis to bend when erect. When Peyronie’s disease first starts, you’ll usually experience pain with and without an erection. The main cause of Peyronie’s disease is likely damage to the penis during sexual activity, even though many men don’t remember any specific injury before noticing symptoms. Surgery is the best way to treat Peyronie’s disease.

Learn more about Peyronie’s disease here. 

Penile fracture

A fractured penis happens when too much pressure is put on an erect penis, causing the tissue inside to rupture. It’s usually caused by vigorous sexual activity. When you fracture your penis, it can make a loud ‘snap’ or ‘pop’ and there is immediate pain and bruising. A fractured penis usually needs to be repaired surgically, and the sooner this happens the better. If you think you have fractured your penis, you should go to the emergency department at your local hospital.

Learn more about penile fracture here.

Penile tumour

Penile cancer can occur on the foreskin, the head or shaft of the penis. It’s uncommon and can be cured if found early. Symptoms of penis cancer include pain or swelling of the head of the penis and pain in the shaft of the penis, so painful erections could be a sign something is wrong. Surgery, radiation therapy and/or chemotherapy may be used to treat penile cancer, depending on the type and stage of the cancer.

Learn more about penile cancer here.

Sleep-related painful erection

A sleep-related painful erection (SRPE) is when you experience a spontaneous, painful erection during sleep. They usually happen during the rapid eye movement (REM) stage of sleep, and can happen without sexual arousal. The exact cause is unknown but it may be due to stress, hormonal imbalances or neurological issues. The pain can be severe, and if it happens often, it’s important to talk to a doctor. Treatment for SRPE varies but includes medication, pelvic floor therapy, sleep repositioning and using a device to support your breathing during sleep. More research is needed to better understand its causes and develop effective treatments for this uncommon condition.

Phimosis

If you have a foreskin and you can’t pull it back over the head of your penis, you might have phimosis. Phimosis can be caused by scarring of the foreskin from injury, infection, inflammation or skin conditions like lichen sclerosis (balanitis xerotica obliterans). If your phimosis is severe, you may have difficulty urinating, or discomfort or pain when you have an erection. Treatment for phimosis include steroid creams and stretching but if this treatment is not effective or if phimosis recurs, circumcision may be necessary.

Learn more about phimosis here. 

Chronic pelvic pain syndrome (CPPS)

Chronic prostatitis or chronic pelvic pain syndrome is a type of inflammation of the prostate gland without an identifiable bacterial infection. Symptoms of CPPS can include genital or abdominal pain or discomfort, lower urinary tract symptoms (such as urinary frequency and urgency, poor flow of urine, and post-urination dribble) and sexual dysfunction (such as erectile dysfunction, premature ejaculation and painful ejaculation). You might also experience painful erections with CPPS. To be diagnosed, you’ll have experienced these for at least a three-month period within the last six months. Treatment for CPPS includes anti-inflammatory medication, pelvic floor therapy and counselling.

Learn more about chronic pelvic pain syndrome here.

Urethritis

Urethritis is the inflammation of the urethra, which is the tube that carries urine from the bladder to the outside of the body. It is often caused by bacterial infections, such as those from Neisseria gonorrhoeae (causing gonorrhea) or Chlamydia trachomatis (causing chlamydia) and can also be caused by viral infections like herpes simplex virus. Non-infectious causes include chemical irritants or physical injury. The inflammation and irritation of the urethra can cause discomfort or pain when the penis becomes erect, as the urethra runs through the length of the penis. Symptoms of urethritis include painful urination and pain during sex or ejaculation, discharge, itching or irritation and blood in urine or semen. Antibiotics are the main treatment for urethritis.

Balanitis

Balanitis is a common infection that occurs at the head of the penis. It’s more likely to develop if you have a foreskin. Symptoms of balanitis include pain in your penis, and swelling and redness of the head of the penis. A fungal infection usually causes balanitis but can also be caused by bacteria and other viruses, chemical irritants and allergies. Usually, washing the penis and the inside of your foreskin with mild soap and warm water will help prevent balanitis. If balanitis is caused by an infection, you can use antibiotics or antifungal ointments/creams to treat it.

Learn more about balanitis here.

Injury

Any kind of injury, damage or trauma to your penis can cause pain and painful erections. If there is any bleeding, a foreign body, a burn or other serious injury to your penis, you should see your doctor.