Penile Pain

Penile Pain

WHEN TO SEE YOUR DOCTOR

* A painful erection or erection-like swelling unrelated to sexual thoughts or arousal persists for an hour or more.

* You suffer any injury to your penis.

* Your penis painfully curves when it becomes erect.

What Your Symptom Is Telling You

Nature plays a cruel joke when the body's main source of pleasure becomes a focus of pain. Penile pain comes in several forms, most of which are apparent only when the penis is erect.

Prolonged penile swelling, called priapism, may start out as a normal erection, and it may look like one, but it actually isn't. "The penis is only acting like it's sexually aroused," says Irwin Goldstein, M.D., a professor of urology at Boston University School of Medicine. "What we're really looking at is a malfunction of the regulation of blood flow in and out of the penis." Priapism usually results from an injury or a medication. Some men with diabetes or sickle cell disease also are prone to priapism, according to Bruce H. Blank, M.D., a clinical associate professor at Oregon Health Sciences University School of Medicine in Portland.

An injury can actually break an erect penis, causing pain and even priapism. "I've treated people who have had a toilet seat fall on their erections," Dr. Goldstein says. "I've seen people who've had a door slam on their penises while having sex in a car."

It's also possible to miss the vagina during intercourse, cracking the erection against the woman's pelvis or thigh. "It just breaks. It's as simple as that," says E. Douglas Whitehead, M.D., E. Douglas Whitehead, M.D., a urologist, co-director of the Association for Male Sexual Dysfunction in New York City and an associate clinical professor of urology at Mount Sinai School of Medicine of the City University of New York.

"It sounds a little difficult to believe that that can happen, but it can. The penis actually breaks. It snaps, and you hear it." The penis also may turn black and blue, he says.

Once the initial pain of the injury subsides, you may smile smugly at what seems to be your new-found staying power, but that grin will soon give way to a grimace. Not even orgasm and ejaculation, which normally cause an erection to subside, will relieve a pseudo-erection. But there's nothing fake about the pain. "It's like a rubber band wound around your finger, only worse," says Dr. Goldstein. "It's horribly sore. The pressure is so great."

That pressure comes from a laceration of an artery inside the penis. Too much blood is flowing in and cannot flow out. The urethra, which carries urine from the bladder, also could be fractured, which can cause an infection.

The penis also can be harmed when not erect, and the blow doesn't have to hurt a lot or fall on the external portion of the organ to cause arterial damage that may eventually lead to impotence. "Blunt trauma anywhere from the tip of the penis to the anus can injure an artery and induce blockage," Dr. Goldstein says. "Most people fail to appreciate that there's just as much of the penile mechanism inside the pelvis as there is outside of it."

Fractured arteries or erectile tissue that don't result in priapism still might heal improperly or form scars. The scarring not only inhibits blood flow but also prevents uniform expansion of the penis. "Normally, the soft tissue expands in all directions," Dr. Goldstein says. "When a scar has formed, expansion can't occur there. It's like putting a piece of duct tape on a balloon and trying to blow it up."

Infection or inflammation in the urethra can also form scars, Dr. Whitehead says. And arterial hardening in the penis is often seen in men with an arthritic-like shortening or stiffening of the hands called Dupuytren's contracture.

No matter the cause of this scarring, the result is Peyronie's disease, a sometimes painful bend in the erect penis. The curve, not noticeable when flaccid, could be slight, or it could be so dramatic that the mechanics of intercourse become impossible. "I've seen guys with 90-degree bends to their erections," Dr. Goldstein says. "I've had some with curves of 120 degrees or more."

Symptom Relief

The biggest impediment to curing painful erections or swelling is not the problem itself but the hesitancy of men to seek help right away. In the absence of sexual arousal, "a prolonged erection is very dangerous, because it will destroy erectile tissue," according to Dr. Goldstein. "You'll have substantial erection problems if it's not treated in 4 hours. And the damage could be irreversible after 12 hours." For prolonged erections, "everybody's so embarrassed about having them that they delay and delay and delay, hoping that it'll go down," Dr. Goldstein says. "But the longer they delay, the more likely they'll get permanent tissue injury." Here's what to do.

Get to the emergency room. Swallow your pride and march yourself to the emergency room posthaste, urologists urge. "The chance of achieving long-term potency by having this medically managed immediately is virtually 100 percent," Dr. Goldstein says. "With no treatment, the chances of becoming impotent range from 25 to 75 percent."

Forget about self-treatment. Over the years, several home remedies for prolonged or painful erections have been suggested, some of them from authoritative medical journals, according to Dr. Goldstein. Cold showers, ice-water enemas, cold compresses—"none of that would be helpful," he says, "and the delay only increases the chances of permanent damage."

Pretend it's just a runny nose. If the prolonged erection is caused by drugs or the blood otherwise cannot drain out of the penis, a doctor probably will inject the penis with a medication that constricts the blood vessels. "The erect penis is like a runny, congested nose," Dr. Goldstein says. "The tissue is congested and swollen, and the treatment is like giving you a dose of Neo-Synephrine to constrict the tissue and allow blood to drain."

Don't let ice suffice. If the fracture is slight, with little bleeding and no urinary infection, doctors might send you home with ice packs and precautions to avoid intercourse until your penis has healed. Delighted as you are that you won't be having surgery, you may want to seek a second opinion, Dr. Blank says. "I've seen fewer incidences of impotence and deformity if you surgically treat the small fractures," he says.

Seek a less-invasive solution. When an artery is lacerated inside the penis, a doctor doesn't always have to operate. "We used to," Dr. Goldstein says, "but we found that's a little too invasive and injurious." Instead, a vascular radiologist often inserts a catheter into the artery and injects a blood clot to stop the bleeding. When the clot dissolves, the hole has healed.

If the urethra has been fractured, surgery may be required to divert the urine from pooling in the penis, according to Dr. Blank.

Check your medicines. Drugs also cause extended erections by interfering with normal blood flow, Dr. Goldstein says. Some antidepressants are common offenders, as are some drugs for head and back injuries. Improper use of drugs to help men achieve erections can also cause a painfully prolonged erection. Make sure your doctor knows about all the over-the-counter and prescription medications you're currently taking.

Getting Things Straightened Out

Peyronie's may be painful, but it's not always necessary to operate to take the kink out of the erection, doctors say.

Wait it out. In about half the cases, the pain, if not the curvature, goes away in a year or two. "It doesn't always need to be treated," Dr. Whitehead says, "if there is only a slight curvature and little pain. If it interferes with sex or if there's a lot of pain, then it's something we look at." This is not a decision you can make on your own, however. You need to get the go-ahead from your doctor.

Ask about E. High doses of vitamin E have proved to be helpful in treating Peyronie's disease, Dr. Whitehead says.

Ultrasound may be the ultimate. Ultrasound therapy may put some pliability back into the scarred tissue, Dr. Whitehead says. Injections of anti-inflammatory drugs also may help.

Straightening the bend. If surgery is necessary, the physician will cut out the hardened tissue and replace it with more pliant skin, Dr. Blank says. In severe cases, a penile implant may be necessary. Ask your doctor about these options.