Sexual pain in men (including penile, testicular and post-ejaculatory pain)

Sexual pain in men is often under-recognised and can be distressing, confusing and anxiety-provoking. It may occur during erection, penetration, ejaculation or after sexual activity, and can have physical, psychological and relational contributors.

This page is for men experiencing pain, discomfort or unusual sensations associated with sexual activity or arousal.

How this may present

People often describe experiences such as:

  • Pain during erection or sustained arousal

  • Discomfort during or after ejaculation

  • Penile pain during sexual activity or masturbation

  • Testicular ache or pelvic discomfort linked to sexual activity

  • Burning, aching or pressure sensations during or after sex

  • Pain leading to avoidance of sexual activity

  • Anxiety or fear developing around sexual experiences

  • Reduced sexual confidence or arousal due to expectation of pain

  • Strain within relationships linked to sexual discomfort

Symptoms may be intermittent or consistent, and may vary depending on context, activity or stress levels.

Contributing factors

Sexual pain in men can arise from a combination of physical, muscular, neurological, psychological and relational factors.

Physical and medical factors may include:

  • Prostatitis or chronic pelvic pain syndrome

  • Urinary tract or genital infections

  • Inflammatory conditions affecting the prostate or pelvic region

  • Peyronie’s disease or penile tissue changes following injury

  • Post-surgical or post-procedural changes

  • Pelvic floor muscle dysfunction (including overactivity or spasm)

  • Dermatological or tissue sensitivity conditions

Muscular and functional factors may include:

  • Pelvic floor muscle tension or overactivation

  • Referred pain from pelvic or lower abdominal structures

  • Muscle guarding in response to anticipated pain

  • Reduced coordination of relaxation during arousal or ejaculation

Psychological factors may include:

  • Anxiety related to anticipation of pain

  • Increased bodily monitoring during sexual activity

  • Fear of injury or worsening symptoms

  • Past painful sexual experiences creating avoidance cycles

  • Stress amplifying bodily tension and pain perception

Relational and contextual factors may include:

  • Avoidance of communication about sexual discomfort

  • Pressure to continue sexual activity despite pain

  • Misunderstanding or lack of awareness within a relationship

  • Emotional distress linked to reduced sexual intimacy

  • Repetitive cycles of pain, anxiety and avoidance

In many cases, pain becomes maintained by a cycle of anticipation, muscular tension and increased sensitivity.

How I work

My approach is structured, clinically focused, and informed by an understanding of both sexual function and pain mechanisms.

1. Written clinical triage

The first step is a brief written intake. This provides an overview of symptoms, timing, relevant medical history and context before the first session.

2. Initial assessment session

The first session is a structured clinical consultation. We explore:

  • the pattern, location and timing of pain

  • medical history and any investigations or diagnoses

  • sexual function and response patterns

  • psychological and anticipatory factors

  • pelvic floor and functional contributors where relevant

  • impact on confidence, avoidance and relationships

From this, I develop a working formulation - a structured understanding of what is contributing to and maintaining the pain experience.

3. Ongoing work (if appropriate)

If we decide to continue, sessions focus on:

  • reducing pain-related anxiety and avoidance cycles

  • supporting understanding of bodily responses during arousal

  • addressing tension and protective responses

  • improving communication within relationships

  • integrating medical, physical and psychological perspectives on sexual pain

The aim is not to rush sexual activity or override pain, but to reduce distress, improve understanding and support safer, more comfortable sexual experiences.

Who this is suitable for

This work may be helpful if you:

  • Experience pain during erection, ejaculation or sexual activity

  • Notice pelvic, penile or testicular discomfort linked to sex

  • Avoid sexual activity due to fear or expectation of pain

  • Want a structured understanding of what may be contributing

  • Are in a relationship where sexual pain is affecting intimacy

It can be helpful for individuals and couples.

When this may not be the right fit

This may not be suitable if you are:

  • Experiencing acute or severe pain requiring urgent medical assessment

  • Seeking immediate urological investigation without psychological input

  • Looking for informal or non-clinical advice only

  • Not currently able to engage in structured therapeutic work

In many cases, referral to a GP or urologist may be recommended alongside psychosexual therapy.

Next step

If this reflects your experience, the first step is a brief written clinical triage.

This allows me to review your situation in context and recommend the most appropriate next step, which may be an initial assessment session or signposting to another service if needed.