Male dyspareunias

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Dyspareunias, or pain during sexual intercourse, most frequently affect women but rarely her partner. Nevertheless, male dyspareunias also exist, although less frequent.

Often underestimated, the pain felt in male dyspareunia consists of pain of the penis during sex, excluding ejaculation. This pain, although mostly benign, turns out to be quite worrying for men.

Psychological and psychosomatic male dyspareunias can be compared to feminine psychogenic dyspareunias. It is important to eliminate organic factors, in order to avoid missing carcinogenic pathologies.

– Acquired curvatures of penis or fibrous cavernitis

In this case, a plate of fibrosis of the enveloppe of corpora cavernosa (which can progressively thicken and calcify curving more or less the erect penis) makes penetration difficult and sometimes even impossible.

This deformation, moderate at first, can evolve little by little, within several years, towards a more important deformation. Pain can occur during erection, along with erection difficulties.

The fibrous cavernitis is a benign affection that evolves on approximately a four-five years period. In 25 % of the cases, the plate declines spontaneously without treatment. Others will require a surgical treatment if the deformation is too important affecting penetration or in case of severe dyserection.

-Dyspareunias repair post-surgery of The Peyronie

-Penile fracture must not be confused with the fibrous cavernitis.

Penile fracture sometimes occurs during coitus, in case of a too rough or too fast position change on an erect penis. This rough deformation of the penis comes along with very intense pain.

-Phimosis or stenosis of the preputial ring

During the erection, the prepuce cannot be retracted behind the penis glans, causing dyspareunias. Phimosis can be the result of a narrow prepuce, damages due to forced retractions, infections, tumors of the penis, diabetes…

Sometimes, phimosis is reduced by manual retraction of the prepuce, with a possible lubrication or disinfection. For more important phimosis, a simple intervention enlarging the prepuce is sufficient. In even more severe cases, circumcision remains the best option.

Phimosis can cause a specific complication: the paraphimosis.

-Paraphimosis

Paraphimosis is a physiological and medical situation : prepuce stays blocked on the penis, behind the glans. The paraphimosis is a medical emergency, but a rather effective and simple procedure can be tried beforehand: pouring some cool water (not frozen) on the penis reducing its volume, then compressing the edematized glans between the thumb and the fingers in order to replace the prepuce back on glans. A medical lubricant will facilitate the procedure.

-Penis brake rupture

This rupture arises suddenly on very short penis brake during sexual intercourse.  Intense pain and important but benign bleeding then occur. Penis brake can heal and rupture several times. The residual cicatrices sometimes ache and chronicisent the dyspareunia after the traumatic  episode. A plastic surgery of penis brake elongation under local anesthetic resolves the problem.

-Dermatological and infectious penis affections as scléro-atrophic Lichens, lichen plan(shot), irritating dermatitis (due to the lack of hygiene), caustic dermatitis (by excess of hygiene) and chronic balanites (glans inflammation  under the prepuce owed to a deficient or excessive hygiene) can cause dyspareunias especially by means of a phimosis or of a paraphimosis.

Some dyspareunias are related to a hyper-responsiveness of the glans associated to other sexual difficulties or to psychogenic factors.

What about pain during  ejaculation?

They are often of infectious origins (IST, urinary tract infection, urethritis, epididymitis, prostatitis) or related with a stenosis or an urethral stenosis (post-surgical, post-infectious, congenital, benignant prostate hypertrophy. They are often associated with mictional disorders (urinary burns, mictional embarrassment).

In conclusion dyspareunias can seriously disturb sexuality and relationships, it is thus important to consult and to speak about it because a medical or surgical treatment can be effective.

Dr. Sandrine Atallah

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