Pain at the Base of the Penis During Sexual Arousal - Urology

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Experiencing pain at the base of the penis during sexual arousal can be concerning and may stem from various underlying issues. Based on your description, it seems that the pain occurs as you approach the point of ejaculation, particularly on the left side of the base of the penis, and sometimes on the right side as well. Importantly, the pain does not intensify during ejaculation but subsides afterward when the penis becomes flaccid.
There are several potential explanations for this phenomenon:
1. Pelvic Floor Tension: The pelvic floor muscles play a crucial role in sexual function. If these muscles are overly tense or strained, they can cause discomfort or pain during arousal. This tension can be exacerbated by anxiety or prolonged periods of arousal without ejaculation.

2. Nerve Sensitivity: The area around the base of the penis is rich in nerve endings. Increased sensitivity or irritation of these nerves during sexual arousal could lead to discomfort. This might be more pronounced if there is any underlying nerve irritation or compression.

3. Blood Flow Dynamics: During arousal, blood flow to the penis increases significantly. If there are any issues with the blood vessels, such as venous leakage or arterial insufficiency, this could lead to discomfort. However, since you mentioned that the pain does not worsen during ejaculation, it is less likely that this is the primary cause.

4. Cavernous Body Issues: The penis contains two cavernous bodies (corpora cavernosa) that fill with blood during an erection. If there is any structural issue or injury to these tissues, it could result in pain during arousal. Given your history of trauma to the area, this is a possibility worth exploring further.

5. Psychological Factors: Sometimes, psychological factors such as anxiety or stress related to sexual performance can manifest as physical symptoms, including pain. If you are feeling anxious about your sexual performance or health, this could contribute to the discomfort you are experiencing.

6. Infection or Inflammation: Although less likely given your description, infections or inflammatory conditions affecting the penis or surrounding areas (such as prostatitis or epididymitis) could also cause pain during arousal.
Given these possibilities, it is essential to consult a healthcare professional, preferably a urologist, who can perform a thorough examination and possibly recommend imaging studies or other diagnostic tests to rule out any serious conditions. They may also suggest pelvic floor therapy if muscle tension is suspected or recommend lifestyle changes to reduce anxiety related to sexual performance.

In the meantime, consider keeping a journal of your symptoms, noting when the pain occurs, its intensity, and any associated activities or feelings. This information can be valuable for your healthcare provider in determining the underlying cause and appropriate treatment.
Remember, experiencing pain during sexual arousal is not uncommon, and many men face similar issues at some point in their lives. Seeking professional advice is the best course of action to address your concerns and ensure your sexual health.