Pain with Sex in Men

Sex should feel pleasurable but for many men, it can be the opposite. Whether it’s pain during anal sex, penile pain with penetration, or discomfort after ejaculation, these symptoms are more common than you think and they are almost always treatable.

As pelvic floor physiotherapists, we often work with men experiencing pain during or after sex and your pelvic floor muscles are often at the centre of the problem.

What Is the Pelvic Floor and Why Does It Matter?

The pelvic floor is a group of muscles that sit at the base of the pelvis. They support the bladder, bowel, and reproductive organs, and are involved in urination, defecation, erection, ejaculation — and crucially, sexual comfort.

For sex to be pain-free, the pelvic floor needs to respond to arousal, relax with penetration, and contract with orgasm. When these muscles are too tight, overactive, or dysfunctional, they can contribute to or directly cause pain.

Two Common Types of Pain with Sex in Men

1. Pain During or After Anal Sex

Pain during anal sex can present as:

• Sharp, burning pain with penetration

• A feeling of “hitting a wall”

• Cramping or aching during or after sex

• Pain with bowel movements after sex

• A lingering sense of tightness or spasm around the anus

This is often caused by:

• Pelvic floor overactivity or guarding

• Poor communication or preparation between partners

• Fear, shame, or anxiety causing unconscious tension

• History of constipation or straining

• Previous trauma or negative sexual experiences

Overactive pelvic floor muscles can clamp down or reflexively contract when penetration is attempted, leading to high-tone dysfunction and pain.

What can help:

• Pelvic floor physiotherapy to retrain muscle relaxation, desensitisation, and comfort with penetration

• Breath work, mobility, and body scanning to reduce guarding

• Dilators can be used under physio guidance to gradually retrain tolerance
  

• Pelvic floor wands can help release deep trigger points internally and around the anal sphincter
  

• Lubrication, communication, and adequate arousal are also key to safe and comfortable anal sex

2. Penile Pain During Penetration or Ejaculation

Penile pain may be:

• Localised to the tip or shaft

• Felt deep in the perineum (between scrotum and anus)

• Triggered by erection or ejaculation

• Described as sharp, burning, aching, or spasmodic

Common causes:

• Tight pelvic floor muscles pulling on nerves that travel to the penis (like the pudendal nerve)

• Myofascial trigger points in pelvic or groin muscles referring pain to the penis

• Prolonged tension or gripping through the pelvic floor or lower abs

• Scar tissue or tension after prostate surgery or pelvic trauma

• Emotional stress, performance anxiety, or unresolved tension linked to the pelvic floor

What can help:

• A pelvic floor physiotherapy assessment to identify tight or reactive muscles

• Manual therapy to release deep pelvic tension internally and externally

• Use of a pelvic floor wand for trigger point release
  

• Breath retraining and downtraining techniques

• Gentle mobility and body awareness work to reduce guarding and increase trust in the body