Causes of penile pain during intercourse and precautions for sexual activity in people with high blood pressure

What causes penile pain during intercourse?

**Dr. Cao:**

Since the beginning of this year, I've experienced penile swelling and pain during intercourse with my wife, which is very uncomfortable and has never happened before. I'm very distressed but can't figure out the cause. My family also says I've been irritable lately and get angry easily. What kind of illness do you think I might have?

Xu XX

Mr. Xu:

Based on the symptoms you described in your letter, you are suffering from "penile dysphagia." For a definitive diagnosis, please come to the hospital for examination and diagnosis. Penile dysphagia is a condition characterized primarily by pain in the penis during intercourse. It is caused by emotional distress, liver qi stagnation, exposure to wind and cold, disharmony of the penile meridians, excessive sexual activity, or damage to the penile meridians.

Traditional Chinese medicine believes that the penis is the meeting point of the tendons and ligaments, and that "the liver governs the tendons and ligaments," with the Foot Jueyin Liver Meridian encircling the genitals. If emotions are not properly regulated and liver qi stagnates, the Foot Jueyin Liver Meridian will not flow smoothly. If intercourse occurs under these circumstances, penile pain may occur. Clinical manifestations include penile swelling and pain during intercourse, accompanied by symptoms of liver qi stagnation such as emotional depression, hypochondriac pain, frequent sighing, and irritability.

Because of a generally weak constitution, if the weather is cold and the room temperature is too low, or if the bath water is too cold before sexual intercourse, cold pathogens may invade the liver and kidney meridians, causing disharmony of the penile vessels. If intercourse occurs under these circumstances, penile pain may occur. Clinically, it is characterized by cold pain in the penis upon intercourse, manifesting as penile pain, coldness in the genital area, lower abdominal distension, or even penile retraction, and even general chills and shivering-symptoms of wind-cold binding the exterior. The location of the disease is in the liver and the surface of the body, belonging to the deficiency-cold syndrome.

In addition, excessive sexual activity, irregular sexual intercourse, or frequent masturbation can lead to kidney deficiency and damage to the penile vessels, which is also one of the causes of penile pain during intercourse. Clinical manifestations include dull pain in the penis during intercourse, which may vary in intensity, accompanied by dizziness, tinnitus, soreness and weakness in the lower back and knees, fatigue, and even premature ejaculation, seminal emission, and impotence.

The nature of penile pain during intercourse varies depending on the underlying cause. Pain caused by liver qi stagnation is often described as distending pain; pain caused by cold congealing the liver meridian is often described as cold pain; and pain caused by excessive sexual activity damaging the kidneys is often described as a dull, aching pain. Distinguishing the nature of the pain helps in analyzing the cause and identifying the pathogenesis.

Penile dysphagia refers to penile pain that occurs during sexual intercourse, and is a condition specific to the environment and conditions in which the disease occurs. It should be distinguished from pre-existing penile disorders such as balanitis, prostatitis, Peyronie's disease, and other urogenital system diseases.

The fundamental measures to prevent this disease are to strengthen physical exercise, improve physical fitness, and enhance the body's disease resistance; to maintain a cheerful mood to avoid anger and resentment damaging the liver; and to moderate sexual activity and abstain from masturbation to prevent damage to kidney qi. Once this disease occurs, it is important to limit sexual activity, regulate emotions, avoid excessive stress, and actively cooperate with treatment.

In addition, attention should be paid to diet. Spicy and fatty foods should be avoided, alcohol should be avoided, and a regular lifestyle should be maintained. If you have this disease, you and your spouse should care for and be considerate of each other, and at the same time actively find the cause and treat the symptoms accordingly.

**Cao Kaiyong**

What should people with high blood pressure pay attention to regarding their sex life?

**Dr. Cao:**

My blood pressure has been rising in recent years as I've gotten older. I've heard that sexual activity can cause blood pressure to rise and is harmful to health. What precautions should people with high blood pressure take when engaging in sexual activity?

Fu XX

Mr. Fu:

Blood pressure in healthy individuals varies with age and fluctuates under different physiological conditions. Sexual activity can lead to an increase in blood pressure, as both systolic and diastolic blood pressure rise during intercourse. However, for individuals with hypertension, the range of blood pressure fluctuations is much wider; blood pressure can rise significantly during intercourse, and if their baseline blood pressure is already high, the rise during sexual activity will be even greater.

Sexual activity is not only physically demanding but also an emotionally charged experience involving excitement and tension. During intercourse, heart rate increases, cardiac output rises, and the excitability of the sympathetic nervous system is enhanced, all of which can lead to an increase in blood pressure. For hypertensive patients, increased catecholamine activity, concerns that sexual activity will worsen their condition, and even psychological depression resulting from past sexual failures can all cause blood pressure to rise.

The increase in blood pressure caused by sexual intercourse only lasts for a very short time, a few minutes, and generally does not affect the body's normal physiological functions. During sexual intercourse and orgasm, the activity of the cardiovascular and respiratory systems increases, resulting in a significant increase in heart rate, respiratory rate, and blood pressure. This has no effect on healthy individuals, and even for middle-aged men, the physiological exertion during intercourse is not significant; the oxygen consumption is equivalent to climbing only a few flights of stairs. However, it can pose a certain risk to patients with hypertension.

To reduce the risks of sexual activity for hypertensive patients, the first step is to appropriately lower blood pressure. Maintaining blood pressure at or near normal levels will reduce the risks associated with sexual activity. Since resting blood pressure changes are not significant and do not accurately reflect changes during intercourse, it is recommended that hypertensive patients undergo a stress test to assess their blood pressure levels during intercourse and thus estimate their tolerance for blood pressure fluctuations. Hypertensive patients should avoid vigorous and prolonged sexual activity; avoid sexual activity after a large meal or drink to reduce the burden on the heart muscle, especially strictly prohibiting intercourse after drinking alcohol; avoid holding one's breath during intercourse and in hot, humid environments; and especially avoid sexual activity after physical activity or when emotionally stressed. This can reduce factors that can trigger a hypertension attack. If chest pain, chest tightness, or headache occurs during sexual activity, sexual activity should be stopped, the cause investigated, and medical attention sought promptly.

**Cao Kaiyong**