Penis pain has many possible causes, ranging from infections and skin irritation to injuries and chronic conditions. The pain can show up during urination, during an erection, during sex, or even at rest, and where it falls on that spectrum is one of the biggest clues to what’s behind it.
Infections: The Most Common Cause
Sexually transmitted infections are among the first things to consider. Chlamydia and gonorrhea both cause burning pain during urination, often accompanied by discharge from the tip of the penis. Gonorrhea tends to produce thick, cloudy, or bloody discharge, while chlamydia discharge is usually lighter. Both can also cause swollen, painful testicles.
Genital herpes causes a different kind of pain. It typically starts with itching or tingling in the genital area, followed by small red bumps or blisters that can break open into painful sores. Urination can sting if urine contacts the sores. A first outbreak often comes with flu-like symptoms, including fever, muscle aches, and swollen lymph nodes in the groin.
Urinary tract infections and urethritis (inflammation of the tube that carries urine out of the body) can also cause pain during urination and sometimes during sex. These are less common in men than in women, but they do happen.
Balanitis: Inflammation of the Head
Balanitis is inflammation of the glans, the head of the penis. It causes redness, swelling, itching, tenderness, and sometimes a foul-smelling discharge under the foreskin. It’s far more common in uncircumcised men, and the single most frequent cause is simply poor hygiene allowing yeast (usually Candida) to overgrow. Men with diabetes are particularly prone to yeast-related balanitis.
Noninfectious triggers include chemical irritants like perfumed soaps, shower gels, detergents, fabric softeners, spermicides, and even petroleum jelly. Switching to fragrance-free products often resolves these cases without any other treatment.
Pain During Erections: Peyronie’s Disease
If the pain mainly shows up when you’re erect, Peyronie’s disease is a likely explanation. This condition develops when scar tissue (called plaque) forms inside the penis, usually after an injury during sex, sports, or an accident. The injury can be a single event or repeated minor trauma over time. As the plaque hardens, it pulls surrounding tissue and causes the penis to curve.
Peyronie’s moves through two phases. The acute phase lasts up to 18 months: the plaque is actively forming, the curve may be getting worse, and erections are often painful. Some men have pain even without an erection during this phase. In the chronic phase, which typically begins 12 to 18 months after symptoms start, the curve stabilizes and pain usually fades, though erectile dysfunction can develop or worsen.
Prevalence estimates vary widely. A U.S. population study found that about 0.5% of men had been formally diagnosed, but when researchers counted any man who reported symptoms, the rate jumped to 13.1%. Studies in Europe have found rates of 3% to 7% in men over 30, suggesting the condition is significantly underdiagnosed.
Injuries and Emergencies
A penile fracture is a rupture of the tough tissue that surrounds the erectile chambers. It happens when the erect penis bends forcefully, most often during vigorous sex. The signs are unmistakable: a popping or cracking sound, immediate loss of erection, and rapid swelling and bruising. This is a surgical emergency.
Straddle injuries, where the groin area strikes a hard surface like a bicycle crossbar, fence, or piece of furniture, are a relatively common cause of penile pain, especially in adolescents. The impact can bruise the urethra or the surrounding tissue.
Paraphimosis is another urgent situation. It occurs when the foreskin gets pulled back behind the head of the penis and can’t be returned to its normal position. The trapped foreskin acts like a tight band, cutting off blood flow and causing swelling and significant pain. This needs prompt medical attention to avoid tissue damage.
Priapism: A Prolonged Erection
Priapism is an erection that won’t go away on its own and is unrelated to sexual arousal. The ischemic type, where blood gets trapped in the erectile chambers and loses oxygen, is extremely painful and a true emergency. Tissue changes inside the penis begin around 6 hours after onset. Permanent structural damage to the smooth muscle starts after about 14 hours. If priapism lasts beyond 24 hours, up to 90% of men will not regain normal erectile function afterward. After 72 hours, normal function is considered unrecoverable.
Priapism can be triggered by sickle cell disease, certain medications (including some antidepressants and erectile dysfunction drugs), blood disorders, and recreational drug use.
Chronic Pelvic Pain and Referred Pain
Sometimes the source of penis pain isn’t in the penis at all. Chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) frequently cause pain felt at the tip of the penis, even though the problem originates deeper in the pelvis. The pain can also affect the perineum (the area between the scrotum and anus), the lower abdomen, and the rectum.
The causes of CP/CPPS are thought to be multifactorial. Pelvic floor muscle dysfunction plays a significant role in many cases: the muscles of the pelvic floor go into spasm or develop tight knots (trigger points), and this tension radiates pain to the genitals. Treatment often includes pelvic floor physical therapy with myofascial release and relaxation techniques, which can be surprisingly effective for a condition that feels like it should have a clear anatomical source.
Other conditions that can refer pain to the penis include inguinal hernias, pudendal nerve irritation, and problems in the scrotum like epididymitis (inflammation of the coiled tube behind the testicle) or, more urgently, testicular torsion.
When the Pain Pattern Points to a Cause
The timing and context of your pain narrows the possibilities considerably:
- Pain only when urinating: infection (STI, UTI, or urethritis) is the most likely cause.
- Pain only during erections: Peyronie’s disease or priapism.
- Pain with visible skin changes: balanitis, herpes, or a contact irritant reaction.
- Constant or unpredictable pain at the tip: chronic pelvic pain syndrome or referred pain from the prostate or pelvic floor.
- Sudden, severe pain after an injury: penile fracture, straddle injury, or paraphimosis.
Diagnostic testing depends on the suspected cause. For infections, a urine sample or urethral swab can identify specific bacteria or viruses. For structural problems like Peyronie’s disease, an ultrasound can map blood flow and locate scar tissue. For priapism, a small blood sample taken directly from the penis reveals whether the trapped blood is oxygen-deprived, which determines how urgently the situation needs to be treated.
Psychological factors can also contribute to genital pain, particularly in cases where no clear physical cause is found. This doesn’t mean the pain isn’t real. It means the nervous system may be amplifying or generating pain signals without an ongoing injury, and treatment approaches that address the nervous system directly, like pelvic floor therapy or pain-focused counseling, can help.