Male Dyspareunia

Male dyspareunia is defined as a condition where a male experiences recurrent or persistent pain in the genitalia or pelvic region during sexual intercourse for a period of three months or more. Although widely unreported because of the social stigma attached to it, it is believed that one percent of men suffer from this condition.

Classification of Male Dyspareunia

Male dyspareunia has been classified under sexual pain disorder by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).It has been classified into four categories. They are:

• Isolated painful ejaculation
• Chronic prostatitis/chronic pelvic pain
• Medical causes
• Other causes

Isolated Painful Ejaculation

Painful ejaculation can present as pain in the penis, pain in the perineal region or pain in the suprapubic region. The pain is experienced either during or after ejaculation. It usually presents as sudden pain in the testicular area or glans penis, or occurs later as a spasm in the perineal region. The pain cause of painful ejaculation is obstruction in the ejaculatory duct.Painful ejaculation has a deep psychological impact on a man’s self-esteem and may lead to erectile dysfunction because of lack of desire for sexual intercourse.

Chronic Prostatitis or Chronic Pelvic Pain

Certain inflammatory as well as non-inflammatory conditions of the prostate gland may lead to pain in the pelvic region associated with pain during intercourse.

Medical Causes of Male Dyspareunia

There are several medical conditions which may cause pain during intercourse. These include:

• Peyronie’s disease which may alter the normal curvature of the penis leading to painful intercourse.
• Phimosis of the penis may lead to inability to properly retract the foreskin during intercourse.
• Shortened frenulum may hamper the glans penis during erection leading to pain.
• Repair of inguinal hernia may lead to painful intercourse in a few patients.
• Entrapped pudendal nerve may cause sexual discomfort.
• Infection of the genitalia, prostate gland or urethra may cause burning sensation following ejaculation. Sexually transmitted diseases may also be associated with painful intercourse.
• Interstitial cystitis is also a common cause of male dyspareunia. The compression of the urinary bladder during intercourse may cause pain which, in turn, may interfere with sexual activity.
• Medications like antipsychotics and antidepressants have been found to be associated with male dyspareunia.

Other Causes

Psychological trauma due to incompatibility with partner, low self-esteem and child abuse can also be a cause behind male dyspareunia.

Diagnosis of Male Dyspareunia

There are no specific diagnostic tests to identify male dyspareunia. It is diagnosed on the basis of a thorough clinical history and physical examination. The patient should be examined for the presence of Peyronie’s plaques, lesions on the surface of the penis, phimosis, short frenulum, etc. Prostate gland should be examined to rule out infection of the gland. The curvature of the penis should be noted. Examination should include urinary flow, cystoscopy, ultrasonography of the lower abdomen and specific tests to rule out congenital deformities, abdominal tumors, etc.

Treatment of Male Dyspareunia

Treatment is based on treating the underlying cause of the condition. Alpha-blockers have an important role in treating painful ejaculation as well as improving the movement of vas deferens after hernia operation. Sometimes surgery may play a role, especially in cases of Peyronie’s plaque, phimosis and pudendal nerve entrapment. In case no obvious physical cause is found, the patient can benefit from psychotherapy.Reference:“Male Dyspareunia,” by Mathew Oommen and Wayne JG Hellstrom. Published on July 29, 2010, accessed on April 26, 2015.