The Activcore Blog

Let’s Talk About Sex, PART 1: Why Does My Penis Hurt After I Have Sex?

Pelvic health. mens health. pelvic pain

NOTE:  This article contains sexual content intended for a mature audience.

Let’s clear the air and say that first and foremost, men have pelvic floors. There, I said it. Yes, and aside from two distinct muscles, they function similar to a female’s pelvic floor. The muscles of the pelvic floor serve important roles in urinary and bowel control, sexual function, and act as a supportive system for the body.

So, what happens when your pelvic floor muscles act up? A number of symptoms can occur, but for this blog series we’re going to talk specifically about pain during and after sex.

 

The Orgasm

Our focus today is primarily on the finale of sex, the orgasm. Now to be clear, a person can have an orgasm and not ejaculate, and a person can also ejaculate without having an orgasm. Typically these actions occur simultaneously but not always.

Why are we talking about orgasms? Well, because when the muscles of the pelvic floor aren’t working in perfect harmony a lot of things tend to go awry. Things like erectile dysfunction, premature ejaculation, discomfort in the testicles, and pain during or after ejaculation are all potential indicators of pelvic floor dysfunction.

Having a successful sexual encounter requires a beautiful symphony of interactions between your pelvic floor muscles, vascular supply, hormones, sensory input, and brain capacity. When all of these players are playing well together on the same team, it can and should lead to a pleasurable release.

Before we go any further, let's break down the anatomy and physiology of ejaculation. It happens in two parts: emission and expulsion. The emission phase happens when semen is created by combining fluids from the prostate, seminal vesicles, and vas deferens (the tubes that carry semen from the testicles to the penis). Expulsion is the muscular contraction of the pelvic floor muscles which propels the semen into the urethra and out of the penis. This is the part of the climax portion of sex that can cause pain if the pelvic floor muscles aren’t working properly.

Generally speaking, in order for muscles to function appropriately and pain free, they have to be able to move (contract/relax) through their full range of motion. When a muscle is consistently held in a tightly wound position and isn't allowed to relax into a fully lengthened position, this shortened position becomes its new normal.

Clinically speaking, people who have pelvic pain are typically in an overactive, contracted pelvic floor position. They chronically hold tension in their muscles; and when under additional stress during sexual intercourse, their pelvic floor muscles can cause pain by compressing other structures like the urethra, blood vessels, or vas deferens.

 

What else could it be?

Pain during or after ejaculation is often diagnosed (or misdiagnosed) as prostatitis. The most common form of prostatitis is the National Institute of Health’s category III, also known as Chronic abacterial Prostatitis (CP) or Chronic Pelvic Pain Syndrome (CPPS).

Prostatitis is an inflammation of the prostate and those with a CP/CPPS diagnosis have probably seen numerous healthcare providers and been treated with an extensive list of interventions including antibiotics. Prostatitis is a very common diagnosis because it presents with similar symptoms such as painful urination and pain with ejaculation. However, keep in mind that prostatitis is an inflammatory condition. If diagnostic tests don’t reveal an infection in the prostate, it’s probably not prostatitis and those antibiotics that were prescribed likely won’t work.

So if it’s not an infection of my prostate, then what's causing my pain? Well, when held in a chronic stressed or contracted position, your pelvic floor muscles can create similar symptoms to a Urinary Tract Infection (UTI) or an inflamed prostate. For instance, besides pelvic pain, those with a "prostatitis" diagnosis may also experience other pelvic floor dysfunction symptoms such as:

  • Bladder symptoms:  Urinary urgency, urinary frequency, urinary incontinence, poor urine stream (hesitancy), increased peeing at night 
  • Bowel symptoms:  Constipation, hemorrhoids, fissures, or alternating constipation/diarrhea
  • Sexual symptoms:  Erectile dysfunction, premature ejaculation, or reduced ejaculatory strength
  • Numbness/sensory changes along the groin, inner thigh, genitals, lower abdomen, or lower back

There is also a large correlation of emotional distress, anxiety, and fear related to pelvic floor dysfunction which can exacerbate your symptoms. However, if you’ve seen a urologist or primary care physician, and they’ve ruled out other medical diagnoses (UTI, prostatitis, cancer, etc.) to explain your symptoms, your painful climax could be coming from your muscles.

 

Pelvic floor dysfunction is treatable (and preventable)

As an orthopedic physical therapist and pelvic health specialist, I work with many people who have all kinds of sexual problems due to pelvic floor dysfunction. It is much more prevalent than you might think. I perform a thorough medical history, pelvic examination, and movement screen to get to the underlying source of your condition. My treatments are all private and often include skilled internal manual therapy work, neuromuscular retraining, muscle coordination, breathing and other therapeutic strategies, as well as exercise prescription for safe movement and self-care techniques to manage the symptoms at home.

If you feel like you have pain in your penis after sex, or more specifically ejaculation, or any of the above symptoms, it could be possible that you have pelvic floor dysfunction. If this sounds like you, reach out to me or one of our other pelvic floor therapists at Activcore to schedule a consultation. Click here to find an Activcore location near you.

To learn more about this topic, check out my previous blog titled, What is Pelvic Health Physical Therapy? Going Beyond the Pelvic Floor.

 

REFERENCES:

Anderson, R. U., Sawyer, T., Wise, D., Morey, A., & Nathanson, B. H. (2009). Painful myofascial trigger points and pain sites in men with chronic prostatitis/chronic pelvic pain syndrome. The Journal of urology, 182(6), 2753-2758.

Potts, J. M., & O’Dougherty, E. (2000). Pelvic floor physical therapy for patients with prostatitis. Current urology reports, 1(2), 155-158.

Rosenbaum, T. Y. (2007). REVIEWS: Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. The journal of sexual medicine, 4(1), 4-13.

 

ABOUT THE AUTHOR:

Lance Frank. bio photo2

Lance Frank is a Doctor of Physical Therapy (DPT) who specializes in both orthopedic and pelvic health physical therapy for all genders across their lifespan. He works at Activcore in Atlanta, Georgia, located just 2 miles from Emory University.

Lance's clinical background and education make him uniquely qualified to handle more complex conditions like pelvic floor dysfunction, including bowel, bladder and sexual health problems. He holds a Bachelors degree in Health Sciences from the University of Missouri, graduating with honors Magna Cum Laude and as the recipient of the School of Health Professions Student of the Year Award. He holds a Masters degree in Public Health from the University of Missouri, graduating Magna Cum Laude. He also holds a Doctorate degree in Physical Therapy from Emory University, ranked among the top 10 PT schools in the country.

Lance began his clinical orthopedic and pelvic health physical therapy career after graduation from Emory. He has been extensively trained to incorporate the latest clinically supported research into the treatment of his clients. He is also certified in trigger point dry needling, and has a background in strength and conditioning, and mat Pilates as well.

Lance goes beyond the symptoms and looks at the whole body to help you recover from pain and injury, and safely return to a fulfilling life of sport, activity and wellness. He possesses a rare combination of highly developed skill sets in orthopedics and pelvic health that make him exceptionally equipped to treat you from head to toe. Additionally, he is recognized nationally as a leading authority in the application of Redcord, a suspension exercise system designed to help you develop a smarter, balanced body through the power of neuromuscular activation. [READ MORE]

 

 

Related Topics: Pain Relief, Physical Therapy, Pelvic Floor, Incontinence, Pelvic Health, Sexual Problems, Men's Health