Penile pain can be confusing—and understandably concerning. If you are experiencing burning, aching, tingling, sensitivity, or pain in the penis but testing has not revealed an infection or other obvious medical cause, you may wonder, “Why does my penis hurt when nothing is wrong?”
The answer may be related to the muscles, nerves, joints, or tissues surrounding your pelvis.
While penile pain should always be evaluated appropriately by a physician or urologist, pelvic floor dysfunction can sometimes contribute to penile pain, even when the penis itself is healthy.
At Magic City Physical Therapy, our physical therapists and occupational therapists work with men experiencing a variety of pelvic health concerns. We look beyond the location of pain to help determine what structures and movement patterns may actually be contributing to your symptoms.
Can pelvic floor dysfunction cause penile pain?
Yes. The pelvic floor is a group of muscles located at the base of the pelvis. These muscles help control urination, bowel movements, sexual function, and pelvic stability.
Just like other muscles in the body, the pelvic floor can become weak, but it can also become overactive, tense, or unable to relax normally.
When pelvic floor muscles remain contracted for prolonged periods, they can develop tender areas and trigger points. Because some of these muscles and their surrounding nerves are connected to structures in the pelvis and genital region, irritation or tension can sometimes be perceived as pain in the penis.
This is one reason that treating only the location where you feel pain may not resolve the problem.
What does musculoskeletal penile pain feel like?
Penile pain related to pelvic floor or musculoskeletal dysfunction can present in many different ways. Some men describe:
- Burning or aching in the penis
- Tingling or pins-and-needles sensations
- Increased sensitivity of the penis
- Pain at the tip or shaft of the penis
- Pain following sexual activity or ejaculation
- Perineal or pelvic pressure
- Pain that comes and goes throughout the day
- Symptoms that become worse with prolonged sitting
- Pain that changes depending on position or activity
Some men may also experience urinary urgency, difficulty starting or stopping the urine stream, pelvic pain, testicular discomfort, or pain with ejaculation.
The combination of symptoms and what makes them better or worse can provide important clues about what may be contributing to the problem.
The pelvic floor and the pudendal nerve
One potential contributor to genital pain is irritation or increased sensitivity of the pudendal nerve.
The pudendal nerve travels through the pelvis and provides sensation to portions of the perineum and external genital region. It also has important connections with the pelvic floor muscles.
When the muscles surrounding the nerve are excessively tense or irritated, the nervous system can become more sensitive. This may contribute to burning, tingling, aching, or pain in the genital region.
Importantly, nerve-related pelvic pain does not necessarily mean that the nerve itself is damaged. Sometimes the problem is related to mechanical irritation, muscle tension, prolonged compression, or an overly sensitive nervous system.
Your hips and lower back may also play a role
The pelvis does not work in isolation.
The hip muscles, abdominal muscles, low back, pelvic floor, and surrounding connective tissues all work together to provide movement and stability. Restrictions or dysfunction in one area can sometimes influence another.
For example, muscles such as the obturator internus are located along the inside of the pelvis and have an intimate relationship with the pelvic floor and pudendal nerve. Hip or pelvic dysfunction can therefore contribute to symptoms that are ultimately felt in the perineum or genital region.
This is why a thorough pelvic health evaluation should look beyond the pelvic floor itself.
Why Kegels aren’t always the answer
Many men are told that pelvic floor exercises—or Kegels—are the solution to pelvic health problems.
But if your pelvic floor is already too tight, repeatedly contracting those muscles may not be helpful.
In some cases, the goal is not to make the pelvic floor stronger. The goal is to teach it to relax, lengthen, coordinate with breathing, and respond appropriately to movement and activity.
Your pelvic floor should be able to contract when necessary and relax when appropriate.
A physical therapist or occupational therapist with pelvic health training can help determine whether weakness, overactivity, poor coordination, or a combination of factors may be contributing to your symptoms.
How can pelvic health therapy help penile pain?
Treatment depends on what your evaluation reveals. Your therapist may assess:
- Pelvic floor muscle tone and coordination
- Hip mobility and strength
- Abdominal and core function
- Breathing mechanics
- Low-back and pelvic movement
- Posture and movement patterns
- Nerve sensitivity
- Activities that reproduce your symptoms
Treatment may include techniques designed to reduce pelvic floor muscle tension, improve mobility, normalize breathing and pressure management, desensitize irritated tissues, and improve coordination between the pelvic floor and surrounding muscles.
The goal is not simply to treat the penis or pelvic floor in isolation. The goal is to identify why your symptoms are occurring and address the contributing factors.
When should you see a doctor?
Penile pain should not automatically be attributed to pelvic floor dysfunction.
A physician or urologist should evaluate new, severe, persistent, or unexplained genital pain, particularly when symptoms are accompanied by blood in the urine or semen, fever, significant swelling, skin changes, trauma, discharge, difficulty urinating, or other concerning symptoms.
Once serious medical causes have been appropriately evaluated, pelvic floor therapy may be an important part of treatment when musculoskeletal dysfunction is contributing to symptoms.
You don’t have to live with unexplained pelvic pain
Pain in the penis does not always mean that something is wrong with the penis itself. In some men, the source of the problem may involve the pelvic floor, hips, nerves, or surrounding musculoskeletal structures.
If you have persistent penile or pelvic pain despite normal testing, a pelvic health evaluation may help identify contributing factors that have been overlooked.
At Magic City Physical Therapy in Hoover, Alabama, our team of physical therapists and occupational therapists works with men experiencing pelvic pain, sexual dysfunction, urinary symptoms, and other pelvic health concerns in a private, individualized setting.
If you’re experiencing unexplained penile or pelvic pain, you don’t have to simply “live with it.” Understanding the muscles, nerves, and movement patterns contributing to your symptoms can be an important step toward recovery.
