Many men are distracted from and even denied effective sexual functioning by painful stimuli occasioned during or after sexual functioning.
The symptoms will be described in relation to the anatomical site of pain, the external anatomy, such as the surface of the penis and the scrotal sac, or the internal anatomy, such as the penile urethra, the prostate, or the bladder.
No attempt will be made to provide definitive discussion for the varieties of male-oriented dyspareunia. Situations are mentioned only to emphasize their existence and to provide the therapist with an awareness of the fact that, in truth, there are “badly mated” men.
External anatomy of the penis
Many men complain of severe sensitivity of the glans penis, not only to touch but to any form of containment (including intravaginal retention) immediately after ejaculation. This severity of glans pain recalls the intensely painful response that may be elicited from the clitoral glans when it is approached during forceful male manipulative attempts to incite sex-tension increment for his female partner.
Once a man is fully aware that immediately after his ejaculatory episode there may be exquisite tenderness of the glans, he realizes that he must immediately withdraw from intravaginal containment. Generally, there is marked variation in the severity of the individual response pattern.
Men noting variation in the severity of glans pain have no pre-ejaculatory warning of the intensity of the particular response pattern, which may range from minor irritation with containment to crippling pain with the slightest touch.
The glans occasionally is irritated rather than protected, as might be presumed, by a retained foreskin. Two men have been referred to the Foundation complaining that relief from painful stimuli immediately after ejaculation can be obtained only by retracting the foreskin well back over the glans and in this fashion relieving the irritation of glans confinement.
There are occasional irritative responses created by the retained foreskin of uncircumcised men. In almost all instances these irritative responses have to do with a lack of effective hygienic habits.
Primarily, smegma and, secondarily, various bacterial, trichomonal, or fungal infections sometimes collect beneath the foreskin. If the foreskin is not retracted regularly and the area is washed with soap and water, chronic irritation can easily develop.
With chronic irritation or even frank infection present, there usually will be pain with coital thrusting or with any form of penile containment. In almost all instances the dyspareunia responds readily to adequate cleansing principles.
Phimosis
A tightness or constriction of the orifice of the prepuce clinically is marked by a foreskin that cannot be retracted over the glans penis.
With an excessively constrained foreskin, infection is almost always present to at least a minor degree, and penile irritation is a consistent factor for men so afflicted. Adhesions frequently develop between the foreskin and the glans proper so that there is no freedom of movement between the two structures.
Engorgement of the penis with sex-tension increment may bring pressure to bear on the foreskin constraint of the glans. Without freedom of foreskin movement, this constriction frequently causes local pain with penile erective engorgement.
When any male is diagnosed as having a degree of clinical phimosis sufficient for chronically recurrent infectious processes and/or pain or irritation with coital connection, circumcision certainly is in order.
There are also occasional men with a true hypersensitivity of the penile glans. These men are almost constantly irritated by underclothes or by body contact. They are continually aware of a multiplicity of irritants and are particularly susceptible to trauma to the glans.
One man referred for consideration found glans constraint in the vaginal environment intolerable. There was constant blistering and peeling of the superficial tissues of the glans surface. Despite a history of numerous changes in sexual partners, the postcoital results were identical. This individual simply could not tolerate the natural pH levels of the vagina.
Since the reaction was confined to the glans area and never involved the penile shaft, there is room for the presumption that if he had not been circumcised routinely, he might not have been so handicapped. Protective coating of the glans area precoitally resolved his problem but was a nuisance factor for him and possibly for his sexual partners.
There are occasional instances of referred pain from the posterior urethra (usually occasioned by posterior urethritis) that produce pain in the glans penis. Very rarely, this type of glans pain is a factor in coition.
Peyronie’s disease
Produced by induration and fibrosis of the corpora cavernosa of the penis and evidenced as an upward bowing of the penis, plus a gradually increasing angulation to the right or left of the midline, makes coital connection somewhat difficult, and in advanced stages coition is virtually impossible.
There also may be pain attached to attempts at coital connection due to the unusual angulation of the penis creating resultant penile shaft strain, both with inserting and with thrusting experience.
Penile chordee
Downward bowing or curved penis, is seen rarely in situations of penile trauma and only occasionally with neglected gonorrheal urethritis. Consultation has been requested by four men with severe penile chordee as a post-traumatic residual.
In two instances the fully erect penis was struck sharply by an angry female partner. The remaining two men each described severe pain with a specific coital experience. During uninhibitedly responsive coital connection with the female partner in a superior position, the penis was lost to the vaginal barrel.
In each case, the women tried to remount rapidly by sitting down firmly on the shaft of the penis. The vaginal orifice was missed in the hurried insertive attempt and the full weight of the woman’s body was sustained by the erect penis.
Each of the four men gave the remarkable verbal description that he felt or heard “something snap.” Shortly thereafter an obvious hematoma appeared on the anterior or posterior wall or lateral walls of the penile shaft.
Over a period of weeks, as the local hemorrhage was absorbed, fibrous adhesions developed, and with subsequent scar formation, there slowly developed a downward bowing and (in three cases) mild angulation of the penis.
Urologists state that due to the type of tissue involved in the penile trauma, there is little to offer in the way of clinical reprieve for men afflicted with these embarrassing erective angulations (Peyronie’s disease or chordee).
Attempts at surgical correction currently are of relatively little value and do not infrequently make the situation worse. Any of these situations create responses of pain and tenderness during both masturbation and coital connection.
It always should be borne in mind that the erect penis can be traumatized by a sudden blow, by rapidly shifting coital position, by applying sudden angulation strain to the shaft, or from violent coital activity that places sudden weight or sudden pressure on the fully erect penis. The unfortunate residuals of such trauma have been described above.
Direct trauma of the penis occasioned by major accidents, war injuries, or direct physical attack sometimes requires that treatment for sexual dysfunction be patterned to include marked variation in the anatomical structuring of the penis. In anatomical deformity of the penis, the complaint of dyspareunia can be raised by either the male or female sexual partner.
