Penis pain has many possible causes. Some, like an infection, are easy to treat once diagnosed. A few, like a penile fracture or an erection that won’t go down, are emergencies. When pain keeps coming back and no infection is found, tight or overactive pelvic floor muscles are a common cause, and pelvic floor physical therapy (often called pelvic PT) may help.

This article covers the main causes, the warning signs, and what pelvic PT involves.

When is penis pain an emergency?

Go to A&E straight away if you have:

  • a snap or pop during sex, followed by pain, swelling and bruising. This may be a penile fracture, which usually needs surgery;
  • an erection lasting more than 4 hours (priapism), especially if it’s painful;
  • a foreskin stuck behind the head of the penis that you can’t pull forward, with swelling (paraphimosis);
  • sudden, severe pain in a testicle, which may spread to the groin or lower tummy. This could be testicular torsion;
  • being unable to pass urine.

Common causes of penis pain

Infections

Urinary tract infections can cause burning when you pee, needing to go often, and cloudy or bloody urine. Sexually transmitted infections such as chlamydia, gonorrhoea and herpes can cause pain, discharge, sores or itching. NHS sexual health clinics offer free, confidential testing.

Inflammation of the head of the penis (balanitis) causes soreness, redness and sometimes discharge. It can be due to infection, irritation from soaps, or skin conditions.

Prostate problems

Prostatitis means inflammation of the prostate. Acute bacterial prostatitis comes on suddenly with fever and needs prompt antibiotics. The more common long-term form, called chronic prostatitis or chronic pelvic pain syndrome, often has no infection at all [1].

Peyronie’s disease

Scar tissue in the penis can cause pain during erections, a lump and a curve. Pain usually settles once the condition stabilises. Read more about Peyronie’s disease.

Kidney or bladder stones

A stone moving down the tube from the kidney can cause pain felt at the tip of the penis, often with severe pain in the side or groin.

Injury

A knock, vigorous sex or a cycling injury can bruise the tissues or strain the muscles and ligaments at the base of the penis.

Chronic pelvic pain and the pelvic floor

Some men have pain in the penis, the area behind the scrotum, the lower tummy or the back passage that lasts for months. Tests for infection are clear. This is usually called chronic prostatitis or chronic pelvic pain syndrome (CP/CPPS) [1].

The pelvic floor is a sling of muscles under the pelvis. It supports the bladder and bowel and plays a part in erections and ejaculation. In many men with CP/CPPS, these muscles are tense and tender rather than weak. They may refer pain into the penis, especially after sitting, ejaculation or a bowel movement.

The pudendal nerve, which supplies feeling to the penis and pelvic floor, can also be irritated. This can cause burning or shooting pain that is often worse when sitting.

CP/CPPS varies a lot from man to man. A review describes a system called UPOINT, which sorts symptoms into groups (urinary, psychological, organ-specific, infection, nerve-related and muscle tenderness) so treatment can be matched to each one [1].

How is penis pain diagnosed?

Your GP or a urologist will ask when the pain started, what makes it worse, and about urinary, bowel and sexual symptoms. They’ll usually examine the penis, testicles and groin, and may check the prostate.

Tests may include a urine test, swabs for sexually transmitted infections, blood tests and sometimes an ultrasound scan. The aim is first to rule out infection and other treatable causes.

What is pelvic PT?

Pelvic PT is the American term. In the UK it’s usually called pelvic health physiotherapy. A specially trained physiotherapist assesses the muscles of the pelvic floor, hips, back and tummy, and how you breathe and sit.

For men with tight pelvic floor muscles, treatment usually focuses on learning to relax the muscles, not strengthen them. It may include:

  • hands-on release of tender trigger points, sometimes through the back passage with your consent;
  • relaxation and breathing techniques;
  • biofeedback, which shows on a screen what the muscles are doing;
  • stretches for the hips and pelvis;
  • advice on sitting, bladder and bowel habits, and returning to activity.

Does pelvic PT work?

The evidence is encouraging but limited. In a small randomised trial of men and women with chronic pelvic pain, 57% of those given targeted pelvic floor physical therapy reported improvement. This compared with 21% of those given a general, non-targeted hands-on treatment [2]. The researchers saw this as a reason for a larger trial, not as proof.

In another study of men with chronic pelvic pain, trigger point release combined with relaxation training improved symptoms in many participants. That study had no comparison group, so the results need care [3].

Pelvic PT often works best alongside other treatments, such as medicines for urinary or nerve symptoms, and talking therapies when stress or anxiety are part of the picture [1].

Things you can do now

  • Avoid sitting for long periods, and try a cushion that takes pressure off the area between your legs.
  • Practise slow breathing into your tummy, letting the pelvic floor relax as you breathe in.
  • Don’t strain on the toilet. Eat enough fibre and drink plenty of fluids.
  • Take a break from cycling if it makes things worse.
  • Avoid doing strengthening (Kegel) exercises until you’ve been assessed, as they can make tight muscles worse.

Next steps

Start with your GP or an NHS sexual health clinic, so infection and other causes can be ruled out. If tight pelvic floor muscles are suspected, your GP or urologist can refer you to a pelvic health physiotherapist. Vale Health Clinic doesn’t currently offer pelvic health physiotherapy.

If the pain comes with a curve or lump, or with erection problems, our men’s health team can assess this. The free Peyronie’s consultation includes a diagnostic ultrasound scan when appropriate. Call 01892 543029.

References

  1. Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis 2016;19(2):132–138. doi:10.1038/pcan.2016.8
  2. FitzGerald MP, Anderson RU, Potts J, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 2009;182(2):570–580. doi:10.1016/j.juro.2009.04.022
  3. Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol 2005;174(1):155–160. doi:10.1097/01.ju.0000161609.31185.d5

This article is general information, not personal medical advice. Please speak to a clinician about your own situation.

This article is general information and isn’t a substitute for advice about your own health. If you’re worried about a symptom, speak to your GP or book an assessment.