erection pain

I am a 52 years old with average height and weight.
I have been seeing a urologist for the past four years for elevated PSA ( 6.5 to 15.5) and possible prostititis and BPH. Have taken numerous courses of anti-biotics. Currently on Flomax and Proscar with improvment with urgency and nocturia.
Had five prostrate biopsies - Negative for cancer. First two showed Prostititis. Third one -PIN. Last two clean. Also taking Zocor for cholestrol.  Urine cultures negative. Prostate moderately large . Only relations have been with wife for past 25 years.

Last PSA was 6.5.  New symptoms has developed past 6/8 months which are painful erections. No pain during urination or ejaculation. Intercourse is now becoming more painful. Not sure what is going on. Urologist thinks Pyronies Disease folowing examination, but I do not feel or observe any hard tissue masses usually associated with the  disease. Curvature is about the same. Last cystascope was about 4years ago.

I sense something is being missed. Please advise your thoughts and ideas. Thank you.

[Kevin Pho, MD]

Causes of erectile pain would certainly include Peyronie's disease.  Other causes may include nerve trauma or irritation, or a penile mass.  

With Peyronie's disease, you don't necessarily have to feel any masses or plaques that are usually associated with the disease - especially in the milder form.  The fact that you have pain only during erection supports this cause.  If this is truly the cause, treatment can involve injection of certain medications into the plaque, radiation therapy or surgery.

However, to be on the safe side, you may want to consider imaging studies to define any possible lesions - either an ultrasound or MRI.  

To evaluate for nerve irritation, a referral to a neurologist can be considered for possible electrodiagnostic testing.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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