Why is Sex Painful? The Male Perspective
Learn common causes of pain during sex for men and options to treat it.
According to this BBC article, men think about sex 19 times per day. Not sure if that is more or less than expected, but it’s clear that sexual health is important to men. Poor sexual function is linked to low quality of life in men of all age groups (Agaba et al. 2017). The most common form of sexual dysfunction is erectile dysfunction which occurs in 40-52% of men over the age of 40 and 8-10% in men under the age of 40 (Agaba et al. 2017; Rastrelli & Maggi 2017).
While less common, pelvic pain and pain with sexual activity is an important cause of sexual dysfunction in males. Often, male patients are diagnosed with a form of prostatitis syndrome when experiencing pelvic pain. The NIH 2002 Consensus reported three categories of prostatitis syndrome: acute bacterial, chronic bacterial, and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) (Krieger 2002). CP/CPPS makes up >90% of prostatitis syndrome cases and may or may not be inflammatory in nature (Anderson et al. 2018).
If the presence of inflammation is unclear and there is no bacterial infection, then what is actually going on?
he most common non-bacterial causes of chronic pelvic pain syndrome are:
- Pelvic floor muscle dysfunction (i.e. hypertonic aka “tight” muscles and trouble controlling these muscles)
- Pudendal neuralgia
- Myofascial trigger points in the pelvic region and/or abdominal muscles
- Neurogenic inflammation (due to constant pain signals by the peripheral nerves)
Symptoms associated with CP/CPPS include:
- Pain in the penis, testicles, scrotum, and anus
- Bladder and/or prostate pain
- Difficulty emptying your bladder or starting the stream of urine
- Painful urination
- Pain during or after erections and ejaculation
The first line treatment for CP/CPPS is medication. When a urologist or primary care provider evaluates a patient they may prescribe antibiotics, anti-inflammatories, alpha blockers, or antihistamines. If their symptoms do not resolve with these medications and especially if they persist longer than 3 months, I highly encourage you seek an evaluation with a pelvic floor physical therapist.
Pelvic floor PTs are trained in assessing the muscular and nervous systems in the pelvis to identify neuromuscular causes of your symptoms. With these findings, they provide hands-on manual therapy, retrain the muscles, and prescribe at-home exercises to overcome your pelvic pain. Click here to find a pelvic floor PT near you.
Agaba, P. et al. (2017). Sexual functioning and health related quality of life in men. Niger Med J. 58(3): 96-100.
Anderson, R., Wise, D. Nathanson, B. (2018). Chronic prostatitis and/or chronic pelvic pain as a psychoneuromuscular disorder - a meta-analysis. Urology. 00:1-7.
Krieger, J. et al. (2002). NIH consensus concept of chronic prostatitis/chronic pelvic pain syndrome compared with traditional concepts of nonbacterial prostatitis and prostatodynia. Current Urology Reports. 3: 301-306.
Rastrelli, G., Maggi, M. (2017). Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 6(1): 79-90.