Research Profile – Easing the Pain

Unravelling the mysteries of genital-pelvic pain in men

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Sex isn’t always a pleasure.

Pain related to intercourse, also known as dyspareunia, is generally thought of as a women’s health problem. But men can experience this condition too, and there may be various underlying causes.

Now a team of Montreal researchers is working to unravel the numerous mysteries of dyspareunia in men.

Between 5% and 15% of adult men experience chronic genital pain at some point, according to Dr. Seth Davis, a postdoctoral fellow at the University of Montreal. It’s a condition that hasn’t been well studied.

“Historically, the pain has been conceptualized as a prostate problem, possibly due to an infection or inflammation,” he said. Most men are treated with antibiotics, often ineffectively.

“But as we explore this, we find most men who have the pain don’t have a prostate problem,” he says.

Dr. Davis and his colleagues are trying to better define the underlying causes of pain, why some pain becomes chronic, why some men experience only short-term pain, how pain differs between patients, and what sorts of treatments might be effective.

Initial work suggests there may be subtypes of the condition. For instance, men may experience “a diffuse sort of dull pain that's always present,” says Dr. Davis. “Other men might have a sharp burning pain that happens only after ejaculation and lasts for a day or two, but they don't really feel pain at other times.”

The pain may be centred in the pelvic region in some, while in others it feels like bladder pain, and in others still it may occur in the testicle perineum or even on the penis.

“We’re trying to classify different types of pain to help uncover clues as to what might be causing it,” he says.

The researchers performed a study of 183 men with genital-pelvic pain. Patients entered in the study all had genital-pelvic pain that had lasted for six months or more. They had an average age of 41 and the cause of the pain was not known.

The men filled out extensive questionnaires asking details about the pain, its location and intensity, and about their sexual function, quality of life and other factors. They underwent a physical examination by a urologist (a physician who specializes in treating the male reproductive system) and were tested for the presence of infections and other medical issues. Their threshold or sensitivity to physical pain was also assessed.

“We found that these men have lower pain thresholds not only in the genital pelvic region, but also in other areas of the body such as in the palms, in the triceps, and the thigh. This suggests perhaps there is something at a more central nervous level that's happening,” he said.

From here, the next steps are to find underlying causes. It may be that in some cases, the pain is an indicator of other medical problems, such as inflammation in the bladder, pelvic floor muscle dysfunction, fibromyalgia or other issues.

In the meantime, the researchers are working to help people better manage pain. They are also starting work on psychosocial issues related to pain, exploring whether cognitive behaviour therapy can offer patients some relief.

Psychosocial issues can have a big impact on how well people with chronic pain cope, and this is an important area to address in the care of these patients, according to Dr. Davis.

“As we explore this, we find most men who have the pain don’t have a prostate problem.”
– Dr. Seth Davis, University of Montreal