There are different presentations of chronic pelvic pain in men that involve pain in the penis. Three typical presentations are: pain mainly at the tip of the penis, pain at the base of the penis, and Hard Flaccid Syndrome. Let’s examine each of these individually, keeping in mind that they can overlap.

Pain at the tip of the penis (glans penis) can be burning, itching, sharp, shooting, dull, achy, or a feeling of heaviness along the glans penis. It may happen with repeated sexual activity, prolonged sitting or standing or walking, specific positions or movements, stress, or a combination of any of these factors. Compression of the dorsal nerve to the penis (there is a right and left dorsal nerve) can be a part or the main issue, resulting from gripping or tightness of the pelvic floor, or there might be scar tissue affecting one or both of these nerves from sports injuries. Spinal problems can be the culprit, causing pressure on branches of the sacral nerves that fuse to form the dorsal nerves. Occasionally, muscle spasms of the pelvic floor muscles (aka levator ani muscles) can refer pain to the glans penis.

Pain at the base of the penis is a very common part of chronic pelvic pain in men and, just like tip of penis pain, can be aggravated by the same activities and stress. The pain can be achy or dull, and is usually associated with gripping of the pelvic floor muscles. Sometimes this happens after having one or more prostate infections where the muscle reaction to the pain of the infection does not subside even though the infection has cleared.

Hard Flaccid Syndrome is a condition of having a semi-rigid penis during the flaccid state when there is no arousal or desire, plus a cluster of other symptoms: altered sensation of the penis, difficulty maintaining an erection, and pain with ejaculation and/or urination. Initial causes are unclear but men often report an initiating trauma to the base of the penis, and typically present with pelvic floor and hip tightness affecting the nerves and blood flow to the penis.

In all three types of penis pain there may be spinal involvement, or scar tissue from prior injuries
as mentioned above with pain at the tip of the penis.

Pelvic floor physiotherapy and osteopathy assesses both locally and globally. Treatment has to address the layering of factors, including stress and anxiety. The result is a program of treatment including myofascial release, visceral manipulation, nerve glides, trunk mobility and core strengthening, cranial osteopathy, breath work, and stress reduction.