Can Male Masturbation Cause Abdominal Pain?
Masturbation itself does not typically cause abdominal pain in healthy males, but complications from excessive or traumatic masturbation practices, as well as underlying urological conditions that may be exacerbated during sexual activity, can result in abdominal or pelvic pain.
Direct Mechanisms of Pain from Masturbation
While masturbation is a normal sexual behavior over which men typically maintain voluntary control 1, certain practices can lead to complications:
Traumatic injury from excessive or aggressive masturbation can cause tissue damage, with one case report documenting Fournier's gangrene (a life-threatening necrotizing fasciitis) in a 29-year-old healthy male who engaged in excessive masturbation with soap as lubricant, resulting in recurrent penile erythema and skin abrasions 2
Foreign body insertion during masturbation can cause bladder perforation and subsequent abdominal pain, as documented in case reports, though this is exceedingly rare 3
Cardiovascular events triggered by sexual activity, including masturbation, can present with abdominal or back pain; one case documented acute aortic dissection following masturbation, presenting with severe low back, chest, and hip pain 4
Underlying Urological Conditions That May Present with Pain
When evaluating a male patient with abdominal pain potentially related to masturbation, consider these differential diagnoses:
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
Pain characteristics: Suprapubic pain, perineal pain, testicular pain, or penile tip pain that may be exacerbated by ejaculation 5
Associated symptoms: Urinary frequency, sense of incomplete bladder emptying, and pain as the primary defining characteristic 5
Clinical overlap: Men can have symptoms meeting criteria for both interstitial cystitis/bladder pain syndrome (IC/BPS) and CP/CPPS, with pain perceived as bladder-related 5
Therapeutic consideration: Regular ejaculation (including through masturbation) may actually be beneficial for some men with chronic non-bacterial prostatitis, with one study showing 11% complete relief and 33% marked improvement in symptoms when patients masturbated at least twice weekly 6
Epididymitis
Presentation: Unilateral testicular pain and tenderness, with hydrocele and palpable epididymal swelling typically present 7
Diagnostic evaluation: Gram-stained smear of urethral exudate and first-void urine examination for leukocytes 7
Imaging: Ultrasound with Doppler shows enlarged epididymis with increased blood flow 7
Treatment failure threshold: Lack of improvement within 3 days requires reevaluation of diagnosis and consideration of alternative pathology, including intra-abdominal sources 7
Testicular Torsion (Surgical Emergency)
Key distinguishing features: Abrupt onset of severe scrotal pain, more common in adolescents, occurs without evidence of inflammation or infection 7
Emergency indicators: Sudden pain onset, severe pain intensity, and test results not supporting urethritis or urinary tract infection warrant emergency evaluation for torsion 7
Time-critical intervention: Testicular viability is compromised if not treated within 6-8 hours of symptom onset 8
Radiculopathy
Unusual presentation: Lumbosacral radicular pain can occur during orgasm (51.4% of affected patients), micturition (34.3%), or defecation (14.3%) 9
Underlying pathology: Most commonly due to radiculopathy from lumbar to sacral spine, but can also indicate conus medullaris lesions 9
Associated symptoms: Lower urinary tract symptoms (70%), sexual disorders (63.3%), and bowel disorders (60%) 9
Clinical Evaluation Algorithm
History Taking
Duration and timing: Relationship of pain to masturbation activity, onset characteristics (sudden vs. gradual)
Pain location and radiation: Suprapubic, testicular, perineal, lower abdominal, or radiating to back/legs 5, 9
Masturbation practices: Frequency, use of objects or lubricants that might cause trauma, any history of penile/scrotal injury 2
Associated symptoms: Urinary symptoms (frequency, dysuria, incomplete emptying), fever, scrotal swelling, hematuria, hematospermia 5, 7, 4
Sexual function assessment: Presence of masturbatory erections helps distinguish psychogenic from organic erectile dysfunction if present 1
Physical Examination
Vital signs: Assess for fever, tachycardia, hypotension suggesting systemic infection or cardiovascular event 5
Abdominal examination: Assess for peritonitis, masses, or tenderness 5
Genital examination: Inspect for erythema, edema, skin lesions, or signs of trauma; palpate for testicular tenderness, epididymal swelling, or masses 5, 7
Digital rectal examination: Not required for ED evaluation but may be indicated if prostatitis suspected 5
Laboratory and Imaging Studies
Initial laboratory tests: Urinalysis with microscopy, urine culture if infection suspected 7
Inflammatory markers: Complete blood count, C-reactive protein if systemic infection or inflammation suspected 5
Scrotal ultrasound with Doppler: First-line imaging for acute scrotal pain to differentiate epididymitis, torsion, and other causes 7
Additional imaging: CT abdomen/pelvis if intra-abdominal pathology suspected or if foreign body insertion reported 3
Common Pitfalls and Clinical Pearls
Do not delay surgical consultation when testicular torsion is suspected based on clinical presentation, even if imaging is pending, as the 6-8 hour window is critical 8
Consider embarrassment as a barrier: Patients may delay seeking care or not initially disclose masturbation-related activities due to embarrassment, requiring a high index of suspicion and professional, non-judgmental questioning 5
Recognize that normal urinalysis does not exclude serious pathology: Normal urinalysis does not rule out testicular torsion or other urological emergencies 8
Assess for psychiatric comorbidity: In patients with unusual foreign body insertion or excessive behaviors, psychiatric evaluation may be warranted 3
Differentiate IC/BPS from CP/CPPS in males: When pain is perceived as bladder-related, consider IC/BPS diagnosis; treatment approaches can include therapies for both conditions when symptoms overlap 5