Penis Pain: Causes and Emergency Symptoms

Penis pain emergency symptoms

Four causes of penis pain need emergency care because delay can cause permanent damage:

Priapism can be caused by erectile dysfunction medicines or injections, sickle cell disease, some antidepressants and antipsychotics, cocaine and spinal injury.

Common causes of penis pain

Balanitis and foreskin problems

Balanitis is inflammation of the head of the penis, often with the foreskin as well. It causes soreness, redness, itching, a shiny or blotchy rash and sometimes a smelly discharge under the foreskin. Common causes are yeast (candida), especially in men with diabetes, poor hygiene, irritants such as soaps, and bacteria.

Phimosis, a foreskin too tight to pull back, can cause pain on erection and make cleaning hard. In adults it is often caused by scarring from recurrent infection or lichen sclerosus.

Urethritis and sexually transmitted infections

Urethritis is inflammation of the tube that carries urine. It causes burning on urination, pain at the tip of the penis and often a discharge. Chlamydia and gonorrhea are the most common causes, followed by Mycoplasma genitalium and trichomonas.

Painful sores or blisters suggest genital herpes. A painless sore suggests syphilis. All need STI testing.

Urinary tract infection and prostatitis

A urinary tract infection in men causes burning, frequency and urgency, and pain can be felt in the penis. Prostatitis causes pain at the base of the penis, in the perineum, lower back or testicles, often with painful urination and ejaculation. Acute bacterial prostatitis comes with fever and needs prompt antibiotics.

Kidney and bladder stones

A stone in the lower ureter or bladder can cause pain that shoots down into the tip of the penis, often with blood in the urine and urgent, frequent urination.

Injury and friction

Vigorous sex, masturbation, a zipper injury or a sports injury can cause soreness, bruising or small tears. Minor friction injuries heal within days.

Peyronie's disease

Peyronie's disease is scar tissue (a plaque) in the shaft that causes a bend, a lump, narrowing or shortening and pain during erections. Pain usually settles within 12 to 18 months, although the curve may stay.

Other causes

• Skin conditions: lichen sclerosus, lichen planus, psoriasis, contact dermatitis
• Penile cancer (rare): a sore, lump or growth on the head or foreskin that does not heal
• Nerve pain from the pudendal nerve, pelvic floor muscle tension, or chronic pelvic pain syndrome
• Pain after circumcision or other surgery

Penis pain by location

How doctors find the cause

A doctor will ask when the pain started, whether it relates to urination, erections or sex, about discharge, sores or fever, recent sexual partners and condom use, injury, and medicines. The exam includes the penis, foreskin, testicles, groin lymph nodes and sometimes the prostate.

Tests may include a urine dipstick and culture, a urine test or swab for chlamydia and gonorrhea, swabs of sores for herpes, blood tests for syphilis and HIV, blood sugar if balanitis keeps returning, and ultrasound for a fracture, Peyronie's plaque or blood flow problems.

Treatment and home care

• Infections: antibiotics for STIs, UTI or prostatitis; antifungal cream for yeast balanitis. Sexual partners of people with STIs need testing and treatment. Avoid sex until treatment is complete.
• Balanitis self-care: wash daily with warm water, gently retract the foreskin if it moves easily, dry well, and avoid perfumed soaps.
• Phimosis: steroid cream for several weeks loosens many tight foreskins. Circumcision is an option for recurrent problems.
• Paraphimosis: a clinician reduces the swelling and moves the foreskin back, sometimes with a small incision.
• Priapism: draining blood from the penis and injecting medicine to shrink the blood vessels.
• Penile fracture: surgical repair.
• Peyronie's disease: watching while pain settles, then medicines, injections, traction devices or surgery for severe curvature.
• Pain relief: acetaminophen (paracetamol) or ibuprofen; follow the label dose. Loose cotton underwear reduces friction.

Frequently asked questions

What are the emergency symptoms of penis pain?

Seek emergency care for an erection lasting over 4 hours, a snap followed by swelling and bruising during sex, a foreskin stuck behind the head of the penis, rapidly spreading genital redness or darkening with fever, sudden testicle pain, or being unable to pass urine.

Why does the tip of my penis hurt?

Pain at the tip is most often from urethritis (usually chlamydia or gonorrhea), a urinary tract infection, balanitis or a stone passing through the urinary tract. Burning on urination or discharge points to infection. Get a urine test and STI test rather than guessing.

Can a UTI cause penis pain?

Yes. Urinary tract infections in men cause burning during urination and pain that can be felt in the penis, along with frequent urination and cloudy urine. UTIs are less common in men than in women, so a doctor may also check for prostatitis or an STI.

Why does my penis hurt when it is erect?

Pain with erections is commonly due to Peyronie's disease, a tight foreskin (phimosis), or an infection or injury. An erection that lasts too long, more than 4 hours, is priapism and is an emergency.

Will penis pain go away on its own?

Mild soreness from friction or irritation often settles within a few days. Pain from infection, a tight foreskin or Peyronie's disease usually needs treatment. Any pain lasting more than a few days, or with discharge, sores, fever or changes in shape, should be checked.