Painful Erection

Table of ContentsView AllTable of ContentsSymptomsCausesTreatmentDiagnosisWhen to See a ProviderFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes

Treatment

Diagnosis

When to See a Provider

Frequently Asked Questions

Painful erections are never normal, and there are times when the pain may be a sign of a medical emergency. The pain may be severe and need immediate medical or occur sporadically but resolve once thepenisis soft.

Anerection(“hard on”) occurs when two tube-shaped structures within the penis become engorged with blood due to sexual arousal or stimulation.The pain may be the result of a recent or prior injury, a blood circulation problem, drug use, or a neurological (nerve-related) issue.

This article explores the symptoms and causes of painful erections and explains how the condition is diagnosed and treated. It also describes when a painful erection is a sign of a medical emergency in need of immediate care.

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Painful Erection Symptoms

Pain is the central feature of a painful erection, but the characteristics of the pain can vary based on the underlying cause. For example:

These and other symptoms can point a healthcare provider toward the correct diagnosis and treatment.

Why Do I Have Pain With Sex?

Causes of Painful Erection

There are common and uncommon causes of painful erections, some of which are more treatable than others. Each has tell-tale signs and risk factors that can help differentiate one from the other.

Peyronie’s Disease

When this occurs, scar tissue can develop on the thick membrane surrounding the sponge-like columns of tissues within the penis (called thecorpora cavernosa). This can cause the membranes to suddenly contract at the site of the scar tissue, leading to an abnormal curve.

PD can cause pain during erections due to stretching of the shortened membranes. Depending on the severity of PD, the pain may be felt when getting an erection or only during sexual intercourse. Some people with PD may also feel pain when the penis is flaccid (soft).

Risk factors for PD include:

Pain in Peyronie’s DiseaseA 2021 study published inSexual Medicineconcluded that 65.2% of people with Peyronie’s disease—or roughly 3 of every 5 individuals—experience painful erections.

Pain in Peyronie’s Disease

A 2021 study published inSexual Medicineconcluded that 65.2% of people with Peyronie’s disease—or roughly 3 of every 5 individuals—experience painful erections.

How Peyronie’s Disease Is Treated

Priapism

Priapismis an erection that persists for hours without sexual stimulation. There are three types of priapism a person can experience:

A painful erection is characteristic of ischemic priapism but not non-ischemic priapism. With ischemic priapism, the shaft of the penis will be rigid, but the glans will be soft, and the pain will get progressively worse.

Medical EmergencyProlonged ischemic priapism, including stuttering priapism, is considered a medical emergency.

Medical Emergency

Prolonged ischemic priapism, including stuttering priapism, is considered a medical emergency.

Persistent Genital Arousal Disorder (PGAD): What to Know

Penile Fracture

A penile fracture is considered a medical emergency and can lead to a change in penis shape, loss of the ability to maintain an erection (erectile dysfunction), and difficulties urinating.

While pain is usually felt at the time of the fracture, on rare occasions, a person may only experience pain later when they have an erection or sex.

Sleep-Related Painful Erection

Sleep-related painful erection (SRPE) is a rare condition in which a person experiences painful erections during deeprapid eye movement (REM) sleepbut has normal, painless erections when awake.

SRPE may also result from intermittent (“stuttering”) priapism which tends to occur more at night than during the day.

Can Sleep Apnea Cause Erectile Dysfunction?

Penile Tumors

Another example is a rare, painless tumor called aschwannomathat usually develops on nerves in the head, neck, or limbs. When a schwannoma occurs in the penis, it can cause painful erections during the day but more often during the night.Pain with ejaculationand erectile dysfunction are also common.

Penile Lichen Sclerosus

Penile lichen sclerosusis a rare condition most commonly seen in people with anuncircumcisedpenis that causes the progressive hardening of the tissues of the foreskin and glans. If left untreated, it can cause scarring that affects not only sexual function but urinary function as well.

What Causes Penis Pain During Sex?

How to Treat Painful Erection

The first, best step is to allow the penis to return to its normal flaccid state. This may not be easy if aninjectable erectile dysfunction druglike Caverject (alprostadil) has been used or even possible without medical assistance if priapism is involved.

In non-emergency situations, placing a cold compress on the penis or perineum for 10 to 20 minutes may help reduce the erection while alleviating pain.(But, avoid over-icing the skin as this can cause frostbite and tissue or nerve damage.)

If there is lingering pain, an over-the-counter pain reliever like Tylenol (acetaminophen) or Advil (ibuprofen) can help.

But, treating acute pain is only part of the solution. A healthcare provider will also want to treat the underlying cause to avoid complications and recurrence.

Are There Tests to Diagnose Painful Erection?

The diagnosis of a painful erection involves a physical examination of your penis and a review of your medical history (including any medical conditions you have or any medications you may be taking). You may be referred to a specialist known as aurologistwho is trained in diseases of theurinary systemandmale reproductive tract.

The most common tool used for the diagnosis of penis abnormalities is anultrasound. This is a non-invasive device that uses sound waves to create detailed images of soft tissues. It can check if your penis has any scar tissues, tumors, nodules, bleeding, tears, or circulation problems.

If the cause remains unclear,magnetic resonance imaging (MRI)may be ordered. This technology uses powerful magnetic and radio waves to create highly detailed images of soft tissues. An MRI can sometimes detect what a penile ultrasound may miss.

A penileblood gas testmay be ordered to determine if priapism is ischemic or non-ischemic. For this test, a sample of blood is taken from the penis with a needle and syringe. Dark or black blood is typically a sign of ischemic priapism, while red blood is a sign of non-ischemic priapism.

Other blood tests may be ordered to check for blood diseases associated with priapism, such as sickle cell disease or certain cancers.

If a tumor is found or lichen sclerosis is suspected, abiopsymay be performed to obtain a tissue sample to examine in the lab. This can ensure that the condition is benign and notmalignant(cancerous).

When to See a Healthcare Provider

Ischemic priapism is a medical emergency. If left untreated, the blockage of blood circulation can deprive tissues of oxygen needed to survive. The resulting damage to tissues, nerves, and blood vessels can lead to scarring, changes in penile appearance, and erectile dysfunction.

On rare occasions, priapism can lead to a potentially life-threatening condition calledgangrene, in which the rapid progression of tissue death may require theamputationof the penis.

It has been estimated that priapism lasting 24 hours is associated with a 50% chance of permanent erectile dysfunction.

When to Call 911Call 911 or go to your nearest emergency room if you have an erection lasting more than four hours without sexual stimulation or interest.

When to Call 911

Call 911 or go to your nearest emergency room if you have an erection lasting more than four hours without sexual stimulation or interest.

Summary

Priapism is a medical emergency in which an erection lasts for four hours or more, typically with increasing pain. Priapism can lead to permanent damage and irreversible erectile dysfunction if left untreated.

A Word From Verywell

As embarrassing as it may be to discuss an erection problem with a healthcare provider, don’t let discomfort stand in your way of getting diagnosed and treated.

Delaying treatment for conditions like Peyronie’s disease can make the symptoms far more difficult to treat and increase the risk of complications, such as erectile dysfunction. Moreover, there may be an underlying condition that requires immediate medical care.

Even if the pain is relatively mild, it can still affect your sex life, making it harder to sustain an erection or achieve an orgasm. If you feel awkward discussing erection problems with your primary care provider, ask for a referral to a urologist or speak with a urologist viatelehealth services.

What to Know About Telehealth With a Urologist

Medications don’t cause painful erections but can contribute to a serious medical condition called priapism, in which an erection lasts for four hours or more, causing pain and injury. Rare incidents of priapism have been reported with:Attention deficit hyperactivity disorder (ADHD) drugs like Ritalin (methylphenidate)Alpha blockers like Flomax (tamsulosin)Antidepressants like Prozac (fluoxetine)Antipsychotic drugs like Risperdal (risperidone)Injectable erectile dysfunction drugs like Caverject (alprostadil)Recreational drugs like marijuana and cocaineLearn MoreADHD Medications

Medications don’t cause painful erections but can contribute to a serious medical condition called priapism, in which an erection lasts for four hours or more, causing pain and injury. Rare incidents of priapism have been reported with:Attention deficit hyperactivity disorder (ADHD) drugs like Ritalin (methylphenidate)Alpha blockers like Flomax (tamsulosin)Antidepressants like Prozac (fluoxetine)Antipsychotic drugs like Risperdal (risperidone)Injectable erectile dysfunction drugs like Caverject (alprostadil)Recreational drugs like marijuana and cocaine

Medications don’t cause painful erections but can contribute to a serious medical condition called priapism, in which an erection lasts for four hours or more, causing pain and injury. Rare incidents of priapism have been reported with:

Learn MoreADHD Medications

Erectile dysfunction (ED) drugs don’t cause erection pain, but they can, on rare occasions, lead to a painful condition called priapism, in which an erection won’t go down. Even so, the risk of priapism from ED drugs is low, with just over 400 cases reported to the Food and Drug Administration (FDA) since 1998.Learn MoreErectile Dysfunction Drugs

Erectile dysfunction (ED) drugs don’t cause erection pain, but they can, on rare occasions, lead to a painful condition called priapism, in which an erection won’t go down. Even so, the risk of priapism from ED drugs is low, with just over 400 cases reported to the Food and Drug Administration (FDA) since 1998.

Learn MoreErectile Dysfunction Drugs

Learn MoreWhat Are the Symptoms of Penile Cancer?

24 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Van Driel MF.Physiology of penile erection—a brief history of the scientific understanding up till the eighties of the 20th century.Sex Med.2015;3(4):349-357. doi:10.1002/sm2.89

American Urological Association.Managing patients with penile/glans pain: genito-pelvic dysesthesia.

National Institute of Diabetes and Digestive and Kidney Diseases.Penile curvature (Peyronie’s disease).

Flores JM, Salter CA, Nascimento B, et al.The prevalence and predictors of penile pain in men with Peyronie’s disease.Sex Med.2021;9(4):100398, doi:10.1016/j.esxm.2021.100398

Levey HR, Segal RL, Bivalacqua TJ.Management of priapism: an update for clinicians.Ther Adv Urol.2014;6(6):230–244, doi:10.1177/1756287214542096

Levey HR, Kutlu O, Bivalacqua TJ.Medical management of ischemic stuttering priapism: a contemporary review of the literature.Asian J Androl.2012;14(1):156–163. doi:10.1038/aja.2011.114

Mirzazadeah M, Fallanhkarkan M, Hossein J.Penile fracture epidemiology, diagnosis and management in Iran: a narrative review.Transl Androl Urol.2017;6(2):158–166. doi:10.21037/tau.2016.12.03

Sabharwal S, George AJP, Singh JC.Hidden penile fracture: an unusual presentation and review of literature.Urol Ann.2015;7(2):248–250. doi:10.4103/0974-7796.150495

Reis LO, Cartapatti M, Marmiroli R, de Oliveria Junior, Saade RD, Fregonesi A.Mechanisms predisposing penile fracture and long-term outcomes on erectile and voiding functions.Adv Urol.2014;2014:768158. doi:10.1155/2014/768158

Endo Pharmaceuticals.Xiaflex (collagenase clostridium histolyticum) for injection, for intralesional use.

Wang Y, Zhang J, Li Hi.Narrative review: pathogenesis, diagnosis, and treatment of sleep-related painful erection.Transl Androl Urol. 2021;10(12):4422-4430. doi:10.21037/tau-21-1045

Johnson MA, McNeillis V, Chiriaco G, Ralph DJ.Rare disorders of painful erection: a cohort study of the investigation and management of stuttering priapism and sleep-related painful erection.J Sex Med. 2021;18(2):376-384. doi:10.1016/j.jsxm.2020.11.010

Barber E, Domes T.Painful erections secondary to rare epithelioid hemangioma of the penis.Can Urol Assoc J.2014;8(9-10):E647–E649. doi:10.5489/cuaj.1833

Tow CM, Tang J, Chun CM, Chien JLK.A rare case of penile schwannomatosis presenting with painful nocturnal penile tumescence.Basic Clin Androl.2022;32:4. doi:10.1186/s12610-022-00154-y

Singh JP, Priyadarshi V, Goel HK.Penile lichen sclerosus: an urologist’s nightmare! - a single center experience.Urol Ann.2015;7(3):303–308. doi:10.4103/0974-7796.150490

Howard M, Hall A.Treatment of penile lichen sclerosus with topical corticosteroids for over 25 years’ duration: a case report,SAGE Open Med Case Rep.2018;6:2050313X18795047. doi:10.1177/2050313X18795047

Bunker CB, Shim TN.Male genital lichen sclerosus.Indian J Dermatol.2015;60(2):111–117. doi:10.4103/0019-5154.152501

Anele UA, Le BV, Resar LMS, Burnett AL.How I treat priapism.Blood.2015;125(23):3551–3558. doi:10.1182/blood-2014-09-551887

Panwar VK, Mavuduru RS, Devana SK, Vaiphei K, Bora GS.Priapism with penile gangrene: an unusual presentation of multiple myeloma.Indian J Urol.2017;33(3):251–252. doi:10.4103/iju.IJU_41_17

Muneer A, Alnajjar HM, Ralph D.Recent advances in the management of priapism.F1000Res.2018;7:37. doi:10.12688/f1000research.12828.1

Rezaee ME, Gross MS.Are we overstating the risk of priapism with oral phosphodiesterase type 5 inhibitors?J Sex Med. 2020;17(8):1579-1582. doi:10.1016/j.jsxm.2020.05.019

Douglawi A, Masterson TA.Updates on the epidemiology and risk factors for penile cancer.Transl Androl Urol.2017;6(5):785–790. doi:10.21037/tau.2017.05.19

National Cancer Institute.Penile cancer treatment (PDQ)–health professional version.

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