The erection is a symbol of virility and accompanies pleasure. But what should you do if you feel pain? Whatever the cause, it’s advisable to consult a doctor.
Painful erection: what causes it?
Erectile pain is a symptom, not a disease in itself. The possible causes of erectile pain need to be assessed in order to establish a diagnosis and treat the underlying problem.
If the pain occurs during intercourse, it may be linked to a shock that has caused the corpora cavernosa to fracture. The use of the term « fracture » here is incorrect (and rather distressing), as the penis contains no bone, so it’s not a fracture as such. It’s the erectile bodies (which fill with blood during erection) that are abused (often by impact with the partner’s pubis or pelvis) and tear. This allows blood to diffuse under the skin. A cracking sound can also be heard. The penis then presents a hematoma (very purple, making it look like an eggplant). This is the most common reason.
Another cause of painful intercourse is Lapeyronie’s disease. This is a more or less localized fibrosis of the albuginea (the envelope of the corpora cavernosa). The disease causes an inflammatory reaction, resulting in pain not only during erection, but also at rest. It is fairly easy to diagnose, since the penis (and the fibrous zone) shows a deformity that is perceived by both the patient and the urologist.
There are also 2 types of physical causes:
- Tight phimosis (more common in adolescents or young men). This occurs when the foreskin is too tight. Pain occurs when the foreskin is unhooded (at rest or during erection). Because it’s not tight enough, causing pain. Treatment in this case is surgical.
- The brake that binds the foreskin to the glans may be too short. This will draw the glans downwards. In some cases, this can lead to the brake breaking during intercourse. Since the area is highly irrigated, there may be some heavy bleeding (often impressive). But the injury is not serious.
More rarely, priapism can occur. Priapism is a painful, prolonged erection. This condition can occur after taking an erectile dysfunction treatment (by injection into the corpus cavernosum). Or various medications (antidepressants, neuroleptics, heparin, etc.). It is also seen in blood disorders such as depranocytosis.
How can these pains be treated?
There are 2 cases serious enough to warrant an emergency consultation: trauma (penile fracture) and priapism. In these cases, it’s advisable to see a urologist within a few hours (or go to the emergency room). Surgical treatment will almost certainly be proposed. Lapeyronie’s disease, shortening of the penis or phimosis, on the other hand, require prompt but non-urgent consultation with a specialist.
In the case of fracture of the corpus cavernosum, the sheath of the penis will be incised to suture the tear in the envelope of the corpus cavernosum. This is followed by a minimum 6-week period of abstinence, sometimes accompanied by treatment to reduce or stop erections. If the fracture is very slight (partial and incomplete rupture), painkillers will suffice until the hematoma has subsided.
As for priapism, this too is an emergency that must be treated within 4 to 6 hours. Beware, the after-effects could be irreversible if you wait too long. Medication should be injected into the corpus cavernosum within 3 hours, after which a puncture should be performed.
Phimosis requires surgery. This involves cutting the foreskin to enlarge it and facilitate unhooding, or even circumcision.
In the case of a ruptured frenulum, this will heal on its own in most cases. However, the frenulum will remain fragile and may require surgery to prevent recurrence. This is performed by lengthening the frenulum through sectioning. Sexual intercourse should be avoided for 3 to 4 weeks during the healing process.
Lapeyronie’s disease is a special case. Over time, the pain may disappear, but corticosteroid injections can also provide relief. If the deformity is such as to prevent sexual intercourse, surgery should be considered. By placing sutures opposite the fibrous area, the penis can be straightened. Alternatively, an incision can be made and a graft or replacement tissue inserted. In the United States, a drug treatment is available when the curvature exceeds 30° and has stabilized over time. This involves injecting a collagen-degrading enzyme into the fibrous area under local anaesthetic. This will reduce the collagen that has accumulated in the plaque and is responsible for the deformity.
