Painful Erection

It’s the middle of the night, and you’re fast asleep. But as you roll over from your back, you realize a nocturnal erection has kicked in, along with an unpleasant sensation down below. You have a painful erection.

Could prescription ED medications or those sex pills you picked up at the gas station be the culprit?

Whatever the cause of your penile pain, you’re probably stressing over whether to seek medical attention and want to know what will make it stop. 

Let’s break down the possible causes of a painful erection,what you can do about it and when to seek urgent medical attention. 

What Does a Painful Erection Mean?

Erections should feel good — not painful. If yours hurts, it could be due to an infection, injury, or other medical issue. 

In this guide, we’ll cover everything you need to know about the symptoms of painful erections, possible causes, and, most importantly, how to find relief.

How Common Are Painful Erections?

It’s hard to say exactly how many men deal with painful erections because the causes and types vary widely.

Take sleep-related painful erections, for example. They’re very rare — affecting less than one percent of men with erection issues — but can occur multiple times a night during the REM sleep stage. 

While this can happen at any age, it typically starts around 40.

Priapism, a prolonged and often painful erection that requires emergency medical attention, affects about five per 100,000 males each year. It’s more common in people with blood-related conditions like sickle cell disease. 

More common is Peyronie’s disease, a connective tissue disorder that affects the penis and can cause penile curvature and length loss in addition to painful erections. This condition affects roughly 13 percent of men over 18, and one of its early symptoms is a painful erection.

Besides pain, are there any other symptoms or physical signs you should know about when it comes to painful erections?

Sometimes the presence of other symptoms or signs can provide clues as to the underlying cause of penile irritation or pain. For example, the presence of skin redness near the head of the penis could indicate a foreskin infection like balanitis; or daytime fatigue could be the result of sleep-related painful erections that are disrupting REM sleep. .

Symptoms of a Painful Erection

Here’s a brief look at what kind of pain you may experience with a painful erection:

• Pain that awakens you from sleep

• Pain during intercourse or when you’re aroused

• Superficial pain coming from the foreskin or skin on the shaft of the penis

• Localized pain to one part of the penis during erection

• Pain involving the entire penile shaft

We’ll talk more about the different types of painful erections below and what causes them so you can get a better idea of the symptoms associated with each.

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Why Do My Erections Hurt Sometimes?

What’s going on with painful erections? Is it something dangerous? Is it a sign I am at risk of erectile dysfunction? 

The following clinical conditions can cause pain during erections:

• Sleep-related painful erections

• Priapism

• Peyronie’s disease

• Penile fracture

• Infections

• Phimosis

• Friction burn

• Hard flaccid syndrome

Learn more about each potential cause below.

Sleep-Related Painful Erections

Sleep-related painful erections (SRPE) occur several times a night, with each erection lasting anywhere from a few minutes to 1-2 hours. 

Unlike priapism — a medical emergency where erections last over 4 hours — the erections that occur in SRPE resolve on their own and do not cause lasting harm. 

With SRPE, erection frequency, duration and penile pain can gradually worsen throughout the night, often peaking in the early morning. This pattern matches the normal sleep cycle, in which there is a natural increase in REM sleep later in the night. The association of SRPE symptoms with REM sleep has led many experts to classify SRPE as an REM sleep disorder. While it can be uncomfortable, SRPE isn’t dangerous. 

Experts don’t know exactly why SRPE happens but believe the following may play a role: 

• Obstructive sleep apnea

• Abnormal increases in testosterone during sleep

• Nerve and endocrine disorders

• Mental health conditions

Painful sleep-related erections can happen up to five times a night, disrupting your sleep and taking a toll on your body and mind. Loss of sleep can cause insomnia, irritability, trouble functioning during the day, and even a drop in libido. 

Priapism

Priapism is a prolonged, often painful erection that isn’t linked to sexual arousal or stimulation. 

While the duration of a typical erection is highly variable — anywhere from a few seconds to well over 45 minutes – an erection lasting more than 90 minutes could signal priapism. 

Priapism is a serious medical emergency. If left untreated, it can cause permanent erectile tissue damage and long-term ED.

There are three types of priapism:

• Low-flow priapism (ischemic). A medical emergency where blood gets trapped in the penis, creating dangerously high pressures that limit blood flow and deprive tissues in the penis of oxygen and nutrients. If left untreated, death of erection tissue in the penis can start to occur within 6 hours, potentially leading to permanent ED. 

• Non-ischemic priapism (high-flow). A rare condition caused by unregulated blood flow, often due to pelvic trauma. With this type of priapism, the penis isn’t usally fully hard and doesn’t hurt. Unlike low-flow priapism, high flow priapism is not an emergency. 

• Recurrent priapism (stuttering). Short, repeated episodes of ischemic priapism, more common in people with blood disorders. 

Read more about priapism in our guide.

Peyronie’s Disease

Peyronie’s disease is a surprisingly common connective tissue disorder of the penis that causes penile pain and shape changes of the erect penis (curvatures, shortening or indentations). It happens when scar tissue, or plaque, forms inside the penis. It can be triggered by an injury (usually during sex), but commonly happens without any identifiable triggering event. It is more common in patients with other connective tissue or autoimmune disorders, but can happen to anyone. 

The scars or plaques that develop in the penis from Peyronie’s disease can stop the penis from stretching and expanding the way it normally does during erections. The result is penile curvatures or other shape changes that are only noticeable during erections. It is important to know that not all curved penises are a result of Peyronie’s disease. Congenital curvatures are totally normal and nothing to worry about unless they are severe and making sexual activity difficult. 

Penile pain typically occurs during the early stages of Peyronie’s disease as scar tissue forms. The pain might be constant when flaccid or only noticeable during erections. Peyronie’s disease can make erections painful and make it challenging or impossible to have sex.

If you’re experiencing penile pain along with changes in the shape of your erect penis or notice a new lump inside, it’s a good idea to get checked out by a urologist. 

Penile Fracture

Yes, you can break your penis. 

Penile fractures happen when the erect penis is forcibly bent, often during sex. 

Despite the name, it’s not a bone breaking — it’s a tear in the connective tissue that surrounds the erection tissues in the penis (corpora cavernosa). In severe cases, the urine tube (urethra) can also be damaged.  

A penile fracture is usually quite painful and causes an instant loss of erection, along with dramatic bruising or swelling that can spread to the scrotum or thighs or remain confined to the penis, depending on the location and extent of the injury.

If you think you have a penile fracture, get medical attention right away. You’ll likely need surgery to repair the injury and it’s more effective if done within 48-72 hours.

Infections

Is there a painful erection-STD connection? Sexually transmitted infections (STIs) can cause pelvic or penile pain. But this discomfort often occurs regardless of an erection. 

Genital herpes (HSV) can cause pain in affected areas, sometimes appearing a day or two before characteristic small red bumps (AKA vesicles) show up.  

Another possible culprit is balanitis, an inflammation of the foreskin and head of the penis triggered by bacterial or fungal infections — especially in people with poor hygiene. 

Balanitis symptoms include:

• Redness 

• Swelling

• Itching

• Soreness 

All of this can make for painful erections when inflamed skin stretches. 

Treatment typically involves topical antibiotics, antifungals, or steroids. In severe cases, circumcision may be necessary to prevent it from coming back.

Phimosis

Phimosis is a condition in which the foreskin is too tight to pull back over the head of the penis. It can be something you’re born with or develop later due to scarring, inflammation, or infection.

For some, it can cause pain during erections because the tight foreskin hurts when it stretches out. In more severe cases, it can lead to issues like tears, infections, or even paraphimosis — a medical emergency where the retracted foreskin gets stuck and blocks blood flow to the head of the penis. 

Treatment for phimosis involves topical steroids or circumcision. 

Friction Burn

Don’t worry — frequent solo or partnered sex won’t rub the skin off your penis. But too much rubbing can cause a friction burn or irritation. And if your skin scrapes against something hard, it could lead to an abrasion or mild burn. 

Hard Flaccid Syndrome

Hard flaccid syndrome is controversial and poorly understood. It’s a condition where the penis stays semi-hard, often causing pain and erectile dysfunction symptoms.  

People who report hard flaccid syndrome often say penile pain is worse when standing.

Painful erections have different risk factors based on what’s causing them. A risk factor makes you more likely to develop a medical condition.

Painful Erection Risk Factors

Let’s break down the risk factors by potential cause:

• Sleep-related painful erections. Risk factors for sleep-related painful erections include insomnia, sleep apnea, and anxiety. Conditions affecting the prostate and urethra can also increase your risk.

• Priapism. People with blood disorders that affect blood flow, like sickle cell anemia, have an increased risk of priapism. Taking certain medications for depression (e.g., trazodone),  injectable ED medications, and certain recreational drugs (e.g., cocaine) can also increase your risk. Oral ED medications also increase risk very slightly.

• Peyronie’s disease. Risk factors for Peyronie’s disease include older age, diabetes, smoking, obesity, autoimmune diseases, and a family history of the condition.

• Penile fracture. Engaging in rough sexual activity can increase your risk of penile fracture. Prior history of a penile fracture or Peyronie’s disease also increases risk.

• Infections. Not using condoms or other forms of protection increases your risk of STDs that can cause penile pain. Poor hygiene and diabetes are risk factors for balanitis. 

• Friction burn. Poor hygiene habits and having lots of sex in a short amount of time without lube puts you at risk of friction burn.

While some painful erection causes are more serious than others, you shouldn’t delay asking your healthcare provider, “Why does my erection hurt?” 

Painful erections could be a sign of something serious and should be evaluated sooner rather than later.

Diagnosing a Painful Erection

If your painful erection lasts more than 4 hours, it might be low-flow priapism, which is a true medical emergency. Seek emergency medical care right away. Left untreated, priapism can lead to permanent ED or other sexual problems. 

You don’t necessarily need to go to the emergency room for painful erections that are much shorter in duration and resolve on their own. 

But it’s a good idea to schedule an appointment with your primary provider or a urologist to uncover the root cause. 

To figure out why you’re having pain, your provider may do any of the following:

• Physical examination. During a physical exam, a provider will examine your penis and ask questions about your symptoms.

• Health and medical history review. A provider will ask about your medical history and the medications you’re currently taking to understand the possible causes of your penile pain.

• Blood and urine tests. A provider may run blood or urine tests to check for underlying conditions, such as sickle cell disease or infections.

• Ultrasound. An ultrasound can check for abnormal lumps, tears, or blood flow issues and helps diagnose conditions like high-flow priapism or Peyronie’s disease.

The first thing you should do if you’re experiencing painful erections is talk to a medical provider. They can determine what’s happening and recommend the appropriate treatment.

Painful Erection Treatment Options

Treatment for painful erection depends on the cause:

• Sleep-related painful erections. CPAP (continuous positive airway pressure) therapy for sleep apnea may help resolve painful erections during sleep. Other treatments include pelvic physiotherapy and medications that inhibit erections or improve sleep.

• Priapism. Some successful treatments for priapism include medications like pseudoephedrine, saline irrigation, and phenylephrine injections into the penis. Surgery may be an option when other treatments fail.

• Peyronie’s disease. Some treatment options that may reduce pain include nonsteroidal anti-inflammatory medications like ibuprofen, penile traction therapy, and medication injections into the Peyronie’s plaque within the penis. Even if you do nothing, pain typically resolves within 3-9 months after the acute phase of Peyronie’s disease ends. 

• Penile fracture. Penile fractures should be surgically repaired within 72 hours of injury. At-home care, like cold compresses or anti-inflammatory drugs, may also help with pain.

• Infections. Treatment for STIs usually requires taking antibiotic or antiviral medications. Balanitis treatment involves topical antibacterial or antifungal agents and topical steroids. In some cases, a circumcision can help prevent future infections.

• Friction burn. The best treatment for friction burn is also the simplest: Give it time. Most erection pain due to friction burn is temporary and goes away on its own.

• Hard flaccid syndrome. There’s no established treatment protocol for this condition because it’s not officially recognized as a medical issue in the first place. Pelvic floor physical therapy may help. Other potential treatments may include ED medication like Cialis Together® (or generic tadalafil).

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Unfortunately, you can’t always prevent a painful erection if the cause is a medical condition outside of your control.

But you can take steps to prevent painful erections resulting from penile trauma or infections.

Painful Erection Prevention Tips

To prevent getting painful erections, try to:

• Always use protection during sex

• Only use medications as prescribed 

• Use lube during sex

• Manage chronic health conditions like diabetes, sickle cell disease, or sleep apnea

As always, let your healthcare provider know if you’re in pain or are worried about symptoms.

Painful Erection: Next Steps

You clicked on this article for one of two reasons: Either you’re experiencing a painful erection right now, or you’re worried you took too much Viagra Connect® (sildenafil) and may experience bad side effects.

Let’s recap what we know about painful erections:

• The causes vary. Though priapism and penile fractures are emergencies, most other causes of penile pain during erection aren’t dangerous and you can easily manage them with the help of a healthcare provider.

• If you have a painful erection that has lasted more than 4 hours, go to the nearest emergency room immediately. You might have low-flow priapsim, which could cause permanent sexual dysfunction if not promptly treated.

• Treatment depends on the underlying cause. Depending on what’s causing your painful erections, a provider may prescribe medication, pelvic floor therapy, or even surgical repair. In some cases, painful erections go away on their own.

• You can’t always prevent painful erections. But you can take steps to avoid penile trauma or certain infections that can cause painful erections.

Although penile pain when erect isn’t a common concern for men, it can happen. Sometimes it is the sign of a serious underlying medical condition, but it is more often self-limited and non-threatening. Talking to a healthcare professional about your penile pain and medical history is the best way to understand what is happening, access treatment options and hopefully return to a pain-free penis.