Why men experience pain in the penis and scrotum

Pain in the penis or scrotum is something many men experience at some point. It can appear in different ways: pain during ejaculation, pain during intercourse or sudden acute pain. Recurrent or sudden pain in the penis or scrotum should not be ignored. There are many possible causes, so it is important to be aware of both common and less common conditions.

Painful ejaculation

Pain during or after ejaculation can have many causes, including infection of the prostate, testicles or urinary tract. Kidney stones, an enlarged prostate in older men, certain medicines or neurological conditions may also be involved. Psychological factors can sometimes contribute, but medical causes should always be ruled out first.

Tight foreskin—phimosis

When the foreskin cannot be pulled back over the glans, this is called phimosis. It can cause pain during sex, difficulty with hygiene, swelling or problems urinating. Treatment often begins with a corticosteroid ointment that makes the skin thinner and more flexible. If that is not sufficient, surgery may be considered.

A short frenulum

The frenulum is the small band of skin on the underside of the glans where the foreskin is attached. It helps guide the foreskin as it moves. A short frenulum can make the foreskin feel tight and cause pain or small tears, for example during sex. If the frenulum tears, it is usually not dangerous and often becomes more flexible after healing. If you have recurring problems, seek medical care to discuss whether a minor surgical procedure may help.

Peyronie’s disease—a curved penis

If the penis bends during an erection, one possible cause is Peyronie’s disease. Inflammation leads to scar tissue, or plaque, forming in the erectile tissue of the penis. This often causes curvature during erection and may lead to pain or difficulty during sex. The cause is not fully understood, but small injuries during sex—microtrauma—may play a role. Other possible factors include urinary-tract inflammation, autoimmune processes or vitamin deficiencies. If Peyronie’s disease is suspected, a urologist can assess suitable treatment. Options may include injections intended to soften the scar tissue or surgery.

If you think you may have Peyronie’s disease, seek medical care as early as possible. Early treatment can improve the chance of a good outcome.

Testicular torsion—an emergency

If scrotal pain starts suddenly and is severe, it may be testicular torsion. The testicle has rotated and cut off its blood supply, which can rapidly damage the tissue. Pain may be on one side or difficult to locate and can be accompanied by swelling, nausea or pain in the groin or abdomen. If testicular torsion is suspected, seek emergency medical care immediately. Call 112 in Sweden if the situation is acute or you cannot get to an emergency department safely.
Diffuse pain or discomfort can also be an early sign of testicular torsion, so medical care should be sought for these symptoms too.

Epididymitis

If the scrotum becomes swollen, red or warm, this may be caused by inflammation of the epididymis. Other symptoms can include pain or tenderness in the testicle, discharge from the urethra, a heavy feeling in the lower abdomen or fever.

Epididymitis is most often caused by bacteria, but it can also occur following trauma to the scrotum.