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Recently, a newlywed twenty-something-year-old male consulted me regarding numerous lesions on his penis. He related that he had not been sexually active prior to marriage but after his wedding he made up for lost time with frequent sexual intercourse. Physical exam showed numerous superficial penile abrasions that were red, raw, and irritated. These were classic friction burns and he was instructed to refrain from sexual activity until healed and apply petroleum jelly as an emollient.
“Road rash” is the term used for an unpleasant abrasive skin injury caused by accidental contact with road surfaces, well known to cyclists, bikers, in-line skaters, and skateboarders. Similarly, genital friction rash is an abrasive genital skin injury that results from vigorous or prolonged sexual activity, often with insufficient lubrication.
As a piston of an engine moves repetitively within a cylinder, requiring proper fitting of the component parts and sufficient lubrication to avoid excessive friction, so a mechanical view of sexual activity — whether solitary or partnered — is that it involves moving parts that need to be lubricated and fit together optimally.
When two surfaces rub against each other for a prolonged time or at repeated intervals and/or there is insufficient lubrication, friction burns may result. Masturbation or partnered sex is usually responsible for these burns, particularly when it is vigorous, rough, or prolonged. Men who suffer with delayed ejaculation (and their partners) are particularly susceptible to friction burns. Penile skin is necessarily thin and mobile to allow it to move freely and accommodate erections and when this skin is rubbed to the extent that it becomes raw, abraded, and sore, friction rashes result. In addition to redness, irritation, chafing and discomfort, it can sometimes result in blistering. Similarly, vaginal friction burns may occur to females exposed to vigorous, rough, or prolonged sex.
Genital friction burns can easily be confused with lesions due to sexually transmitted infections (STIs); however, genital friction burns are noticed immediately following or during sexual activity, as opposed to lesions from STIs that take a variable amount of time to manifest.
The key to preventing genital friction burns is to use adequate lubrication, avoid overly rough sexual activity, and to cease if experiencing pain. Although the typical patient with a genital friction burn is a young person who is extremely sexually active, the situation can occur at any age and to older adults, including post-menopausal females and/or their partners if sufficient lubrication is not used to help the vaginal dryness, vaginal wall thinning, and diminished lubrication that often accompanies menopause.
Nature and time allow genital abrasions to heal spontaneously. It is important to avoid sexual activity until the friction burns are fully healed. Wearing loose-fitting, breathable underwear and applying petroleum jelly to the burns twice daily can facilitate the healing process. If the abrasions are infected, a topical antibiotic can be helpful. If the genital friction burns do not heal satisfactorily with conservative measures and avoidance of sexual activity, a consultation with a dermatologist is in order.
Bottom Line: Genital friction burns can occur when sex is rough, prolonged, repeated, or unlubricated. This situation can be avoided by using sufficient lubrication, refraining being overly rough, and ceasing when and if pain is experienced.
