Dyspareunia: What it is and how it affects men

What is dyspareunia?

It is persistent or recurring genital pain experienced before, during, or after intercourse. This pain is a sign that something is not functioning correctly in the body and can have a physical, psychological, or a combination of both origins. The simple act of penetration or ejaculation can trigger anything from a mild burning sensation to a sharp, debilitating pain.

How is it classified?

According to the time of appearance: Primary vs. Secondary

In primary dyspareunia, pain is present from the beginning of the individual's sexual life; the man has never experienced painless sexual relations.

And in secondary dyspareunia, the pain begins after a period of pain-free sexual intercourse, which points to a specific triggering event or condition, such as an injury, infection, or hormonal change.

According to the location of the pain: Superficial vs. Deep

In superficial dyspareunia, the pain is felt at the beginning of penetration and is localized to the penis, glans, or frenulum. It is usually related to skin problems, local infections, or lack of lubrication.

In deep dyspareunia, pain is felt during or after deep penetration and is often located in the testicular area, perineum, or pelvis. It may be associated with prostate problems, pelvic floor dysfunction, or psychological conditions.

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Causes of male dyspareunia

Physical causes

It can be caused by infections and inflammations such as prostatitis, urethritis or balanitis, and by sexually transmitted infections (STIs) such as gonorrhea, chlamydia or genital herpes, which also cause pain and burning.

Another common cause is phimosis, where the foreskin (the skin covering the glans) is too tight and cannot be retracted, and this tightness causes pain and even small fissures, due to Peyronie's disease in which scar tissue (plaque) forms on the penis, causing it to curve abnormally during erection.

In addition, injuries to the penis, pelvis, or perineum, or surgeries such as vasectomy, inguinal hernia repair, or prostatectomy, can leave scars, nerve damage, or chronic muscle tension that manifests as pain during sex.

Prostatic causes

Chronic prostatitis or chronic pelvic pain syndrome causes pain that can radiate to the penis, testicles, lower back, or perineum, intensifying during or after ejaculation.

Hormonal causes

A hormonal imbalance, particularly low testosterone levels (hypogonadismThis can contribute to sexual pain, as testosterone is essential for healthy tissues and nerve function. Its deficiency can lead to tissue atrophy, decreased libido, or low libido and changes in sensitivity.

Other causes

It can be caused by pelvic floor dysfunction, where the muscles become too tight, weak, or uncoordinated. This chronic tension can compress nerves and cause pain during sexual activity.

Dermatological conditions such as lichen sclerosus, psoriasis, or eczema can affect the skin of the penis, making it fragile, cracked, and painful to friction. Allergic reactions to latex condoms, spermicides, soaps, lubricants, or detergents can cause irritation and burning.

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risk factors

These include having sex without adequate lubrication, having multiple unprotected sexual partners (risk of STIs), participating in high-impact sports or sports with repetitive movements that affect the perineum, chronic stress and anxiety, smoking and excessive alcohol consumption, and certain chronic diseases such as diabetes.

Main symptoms and signs

Pain during penetration

It can be a sharp pain at the time of penetration, associated with problems such as phimosis, infections or irritations on the skin of the penis.

Pain in the penis or glans

A burning, stinging, or dull ache in the shaft or head of the penis. This can be caused by balanitis, infections, or Peyronie's disease.

Pain during or after ejaculation

Known as orgasmalgia or dysorgasmia, it is a sharp pain or cramp felt at the moment of ejaculation or just afterward. It is a classic symptom of prostatitis, but can also be related to problems with the seminal vesicles, the vas deferens, or an obstruction.

Testicular or pelvic pain

Discomfort in one or both testicles, or a feeling of pressure or dull pain in the lower abdomen, perineum, or bladder, which is triggered or worsened by sexual activity.

Other associated symptoms

These include burning during urination, urgent or frequent need to urinate, erectile dysfunction, premature or delayed ejaculation, presence of blood in the semen, anxiety about the possibility of having sexual relations, and decreased sexual desire.

It may interest you: penile diseases.

When to go to the doctor?

• If the pain is intense or worsens over time.
• If the pain is recurring and does not go away on its own.
• If you notice any lumps, deformities, or changes in the shape of the penis.
• If you notice abnormal discharge, sores, blisters, or rashes on the penis.
• If the pain is accompanied by fever, chills, or blood in the urine or semen.
• If dyspareunia affects your self-esteem, your relationship, or causes you anxiety or depression.

Common medical diagnoses and tests

The diagnosis is usually made by a urologist, who will ask about the characteristics of the pain (when it appears, where it is located, what type of pain it is), your medical history, previous surgeries, infections, and lifestyle habits.

The penis, scrotum, testicles, and prostate will also be inspected for abnormalities, tender points, swelling, or masses.

Urine and blood tests are performed to rule out urinary tract infections, diabetes, prostate problems (PSA) and to measure hormone levels (testosteroneIf an STI is suspected, a sample is taken from the urethra to identify the pathogen.

Imaging tests can be performed, such as a penile ultrasound (to assess for Peyronie's disease) or a prostate/renal ultrasound, and in cases of suspected pelvic floor dysfunction, urodynamic studies can be useful to assess bladder and urethral function.

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How to get rid of dyspareunia: Treatment and complementary therapies

Antibiotics for infections

If the pain is caused by a bacterial infection, the first-line treatment is antibiotics specific to the identified pathogen.

Anti-inflammatories

Non-steroidal anti-inflammatory drugs (NSAIDs) can be very useful in reducing inflammation and relieving pain, especially in cases of chronic prostatitis or trauma.

Hormonal treatments

If a low testosterone level is diagnosed, hormone replacement therapy (gels, injections, or patches) can help restore balance and relieve symptoms.

Surgical treatments if necessary

Surgery is used in specific cases that do not respond to conservative treatments. It may include circumcision to treat recurrent phimosis, Peyronie's disease surgery to correct severe curvatures that prevent intercourse, or procedures to correct obstructions.

Psychological therapy

Anxiety, stress, and traumatic experiences are related to dyspareunia, so sex therapy or cognitive-behavioral psychotherapy are fundamental tools to overcome the fear of pain.

Changes in lifestyle

Pelvic floor physiotherapy is recommended, including exercises to relax and strengthen the pelvic muscles, releasing tension and pain; the use of lubricants to reduce friction and make penetration more comfortable; and improved communication with your partner to reduce pressure and explore alternatives.

Prevention and care of sexual health

• Practice safe sexUsing a condom reduces the risk of contracting STIs.
• Maintain good hygieneWash the genital area with water and mild, perfume-free soaps, without irritating products.
• use lube: Helps prevent microtrauma from friction.
• Perform regular self-examsKnow the shape and texture of your genitals so you can detect any changes, lumps, or painful areas in time.
• Strengthen your pelvic floorLearn to identify and exercise these muscles with Kegel exercises to keep them healthy and prevent dysfunctions.
• Manage stressIncorporate relaxation techniques, meditation, or regular physical exercise into your routine to reduce body tension.
• Go to periodic medical check-upsAnnual check-ups are key to the early detection of any abnormality.

Frequently Asked Questions (FAQs)

Is it normal to feel pain during sex?

No, although it can happen occasionally due to poor posture or lack of lubrication, if it is recurrent or persistent, it is a warning sign that should be discussed with a doctor.

Can dyspareunia cause erectile dysfunction?

Yes, anticipatory pain and anxiety about experiencing discomfort again can make it difficult to relax enough to achieve and maintain an erection. In addition, physical conditions such as prostatitis or pelvic floor dysfunction can contribute to both problems.

Can low testosterone cause sexual pain?

Yes, testosterone is crucial for tissue health and trophic state. Low levels can lead to atrophy, decreased natural lubrication, and altered sensitivity, which can make friction more painful.

Can stress cause pain during sex?

Yes, chronic stress causes widespread muscle tension, including in the pelvic floor muscles. This tension can compress nerves and cause pain. Furthermore, stress affects arousal and desire, making it more difficult for the experience to be pleasurable.

Reservation your first medical consultation now

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Doctor T Clinic your ally in men's sexual health

En Doctor T Clinics We do not directly treat this type of pathologies, but if you are noticing chronic fatigue, lack of motivation, problems sleeping, or low libido, it is possible that the origin is a hormonal imbalance, such as a testosterone low.

We offer you tools to detect it early and, if necessary, initiate specialized medical treatment:

•  Online Testosterone Test, where we will evaluate with this quick and free test if you have low testosterone or high testosterone in men with this simple, convenient test without leaving home.
• Comprehensive health assessments focused on male wellness.
• Testosterone Replacement Therapy (TRT), Indicated in cases of primary hypogonadism or secondary hypogonadism, it helps to recover your vitality, sexual energy and general well-being.
• Personalized advice and treatments tailored to individual needs.

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Conclusion

Male dyspareunia is a complex but treatable condition that deserves the same attention as any other health problem. If you experience pain during sex, remember that you shouldn't get used to it; it's essential to seek professional help. A urologist or a sexual health specialist is the one to consult to identify the cause of your pain and find the right solution, restoring your pleasure and confidence in your intimacy.