Penile Pain: Causes and When to Get Help

Causes of penile pain by pattern

Infections and inflammation

Balanitis

Balanitis is inflammation of the head of the penis, often with the foreskin too. It causes redness, soreness, itching, a rash and sometimes a smelly discharge. It is common in uncircumcised men and in men with diabetes. Causes include yeast (thrush), bacteria, poor hygiene, and irritation from soaps, lubricants or latex.

Urethritis and STIs

Urethritis is inflammation of the urethra, usually from chlamydia, gonorrhea, Mycoplasma genitalium or trichomonas. It causes burning or stinging when urinating, discharge and sometimes pain at the tip of the penis. Chlamydia often causes few symptoms.

Genital herpes causes painful small blisters that burst into shallow sores, often with tingling beforehand, and flu-like symptoms during the first outbreak.

Urinary tract infection and prostatitis

UTIs are less common in men than women but cause burning, frequency and urgency. Prostatitis causes pain at the base of the penis, in the perineum (between scrotum and anus), during or after ejaculation, and sometimes fever.

Structural and erection-related causes

Peyronie's disease

Peyronie's disease is scar tissue (plaque) that forms in the penis, causing a curve, lump, indentation or shortening during erections. Pain is common in the early, active phase and often settles within 12 to 18 months, though the curve may remain. It can make sex difficult and is linked to erectile dysfunction.

Priapism

Priapism is an erection lasting more than 4 hours that is not related to sexual arousal. The painful type (ischemic priapism) traps blood in the penis and can permanently damage erectile tissue within hours. Causes include erectile dysfunction injections, some antidepressants and antipsychotics, sickle cell disease, cocaine and cannabis.

Phimosis and paraphimosis

Phimosis is a tight foreskin that cannot pull back, which can cause pain during erections and sex, and infections. Paraphimosis is when a retracted foreskin gets stuck behind the head and swells, cutting off blood flow. It is an emergency.

Injury

• Penile fracture: a tear in the tough covering of the erectile tissue during vigorous sex, usually with a pop, immediate pain, loss of erection and dark bruising ("eggplant deformity"). It needs surgery, ideally within a day.
• Zipper injuries, bites and friction injuries.

Other causes

• Kidney stones: pain moves from the back or side to the groin and can be felt in the tip of the penis as the stone moves down.
• Bladder stones: pain at the tip of the penis, especially at the end of urination.
• Skin conditions: lichen sclerosus, lichen planus, psoriasis and eczema.
• Penile cancer: rare. A painless or painful sore, lump or color change on the head or foreskin that does not heal.
• Nerve pain: pudendal neuralgia or pain referred from the lower back.

How doctors find the cause

A doctor will ask when the pain started, whether it is constant or happens with urination, erections or sex, about discharge, sores, sexual partners, injuries, medicines and drug use. They examine the penis, foreskin, testicles and groin, and may check the prostate.

Tests may include a urine test and urine culture, NAAT testing for chlamydia and gonorrhea, swabs from sores or discharge, blood glucose, and ultrasound for Peyronie's disease, fracture or priapism. A CT scan finds kidney stones.

Treatment

• Balanitis: gentle daily washing with warm water, no soap on the head of the penis, and an antifungal or antibiotic cream depending on the cause. A mild steroid cream may be added for irritation.
• STIs: antibiotics or antivirals, with testing and treatment of partners. Avoid sex until treatment is complete.
• UTI and prostatitis: antibiotics, often for several weeks for prostatitis.
• Peyronie's disease: watchful waiting in the early phase, traction devices, injections into the plaque, or surgery once stable.
• Priapism: draining blood from the penis with a needle and injecting medicine to shrink the blood vessels, in the ER.
• Paraphimosis: reducing swelling and manually returning the foreskin, sometimes with a small cut. Circumcision may follow.
• Penile fracture: surgical repair.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose, and cool compresses for swelling.

Frequently asked questions

Why does my penis hurt when I pee?

Pain or burning when urinating is usually caused by urethritis from an STI such as chlamydia or gonorrhea, a urinary tract infection, or prostatitis. Kidney or bladder stones can also cause pain at the tip. See a doctor for testing, because treatment depends on the cause.

What causes pain in the shaft of the penis?

Common causes are Peyronie's disease (with a bend or lump), injury from vigorous sex, urethritis, and, during a prolonged erection, priapism. Sudden pain and swelling after a pop during sex suggests a penile fracture and needs emergency care.

Why does the head of my penis hurt?

Soreness of the head is often balanitis, caused by yeast, bacteria or irritation from soap, especially under a foreskin. Herpes sores and friction can also cause it. Pain at the tip when peeing points to urethritis, a UTI or a stone.

Is penile pain during an erection serious?

It can be. An erection lasting over 4 hours is an emergency. Pain with a new curve or lump suggests Peyronie's disease, which needs a urologist but is not urgent. Pain from a tight foreskin during erections is treatable with creams or circumcision.