I shared your letter with Dr. Ashley Winter, a urologist in private practice in Portland, Oregon, and the cohost of The Full Release, a sex, health and relationship podcast. Dr. Winter wanted to note that her comments are a general discussion of a medical topic and NOT individual medical advice. She wanted me to emphasize this point—which she also emphasizes at the top of her terrific podcast—because Dr. Winter is a responsible doctor and not a card-carrying member of the Amalgamated Advice Columnists of America. (Membership in the AACA entitles advice columnists to say pretty much whatever they want.)
“There are three issues at play here,” said Dr. Winter. “First, the pain or ‘cringey’ sensation only associated with vaginal and Fleshlight penetration. Second, being too quick to come. And third, erectile dysfunction. HARDPART insightfully suggests his ED may be related to his performance anxiety as well as anticipated pain, and I would agree with this. I would add that his quick ejaculation is most likely also caused by a mix of ED and pain—the body adapts to pain and erection loss by letting the swimmers off the hook early.”
But why do you experience this pain only during penetrative sex? What is it about PIV (penis in vagina) or PIF (penis in Fleshlight) that causes those painfully cringey feelings?
“If he thrusts more during these activities than he does during oral or hand stimulation, I would expect that either pelvic floor muscle dysfunction or a nerve issue related to the lower spine could be causing the flairs,” said Dr. Winter. “If he were my patient, I would want to know if he has less pain when his partner is on top, which would mean his pelvis is moving less. Also, does he have chronic low back pain? Bowel or bladder issues?”
Dr. Winter and I continued to generally discuss the medical topics raised by your question, HARDPART, and we generally discussed—this is not, again, individual medical advice, but a general discussion—two things someone with your particular issue might want to think about doing. First, a guy with your problem could try taking Viagra—or a related drug—while also using a penis numbing spray. And a guy with your problem should also have his pelvic floor checked out. A urologist can help a guy with a problem like yours determine if there’s something wrong with the complex web of muscles and nerves that crowd together around your junk and, if it is a pelvic floor issue, refer him to a pelvic floor physical therapist.
Finally, a suggestion from me, the person with the AACA card: A guy with a problem like yours—a guy whose dick works a certain way and has worked that way for decades—could save himself the hassle of physical therapy and the side effects of Viagra by accepting his dick and the way his dick works. There are women out there who prefer oral and outercourse to PIV, HARDPART, and you could bed those women with confidence.
Follow Dr. Ashley Winter on Twitter @AshleyGWinter, and check out The Full Release podcast, which she cohosts with comedian Mo Mandel, at thefullreleasepod.com.