What is painful ejaculation?
Ejaculation is the release of semen from the penis during the male orgasm. It is normally a pleasurable experience and shouldn’t be uncomfortable.
Yet ejaculation can sometimes be painful, and it’s not an uncommon problem. A review article published in the journal, Translational Andrology and Urology, reported that up to 10% of men have had painful ejaculation at some point in their lives. Among those with prostate issues, that rate climbed to 30% to 75%.
The sensations of painful ejaculation vary. It may feel like pain or burning in the perineum (the area between the anus and genitals), the urethra, or scrotum. The pain may begin during sex and become more severe when you climax, or it may be painful only when you ejaculate.
Painful ejaculation can be a symptom of an infection, inflammation, or blockage of the lower urinary tract (bladder, prostate, seminal vesicles, or urethra). One of the most common causes is prostatitis, an inflammation of the prostate.
Ejaculation could also be painful because of psychological and emotional factors. Discuss painful ejaculation, and any other symptoms, such as discharge or pain, with your doctor.
Causes
1. Prostatitis
Symptoms
- Erectile dysfunction
- Painful ejaculation
- Painful urination
- Feeling like you have to urinate frequently
- Pain in your pelvic area
Prostatitis is an inflammation of the prostate gland, which is located between the bladder and penis. The inflammation may be acute (short-lived) or chronic (symptoms last 6 weeks or longer).
The severity of symptoms varies. Acute prostatitis symptoms are more severe than chronic prostatitis, which can be bothersome but bearable.
Prostatitis can be infectious or non-infectious. Infectious prostatitis is caused by a bacterial infection. Non-infectious prostatitis is an inflammation of the prostate without any signs of infection.
Your doctor will diagnose prostatitis based on urine and blood tests. Non-infectious prostatitis may go away on its own, while infectious prostatitis needs to be treated with antibiotics.
What questions will the doctor ask?
“I first want to determine if the pain is with erections, sex, or just isolated to ejaculation. Next, I try to rule out infections such as UTIs or STIs. I would then ask if they noticed anything different about the ejaculate. I then try to determine if there is a larger, psychosocial reason. Next, I ask about surgical history, looking for recent groin or hernia surgery. I also query their medications for any recent additions or increases of doses, particularly antidepressants.”—Dr. Jason Chandrapal
2. Cystitis
Symptoms
- Painful ejaculation
- Painful urination
- Cloudy, foul-smelling urine
- Urgent need to urinate
- Pain in your lower abdomen
- Blood in your urine
Cystitis is an infection of the bladder. Though it’s more common in women, cystitis can occur in men, particularly in men who have difficulty urinating (such as those who have an enlarged prostate.) The infection occurs when bacteria that line the inside of the bladder enter the bladder tissue, causing inflammation.
Cystitis is treated with antibiotics. If you leave it untreated, it can lead to complications such as a kidney or blood infection.
3. Sexually transmitted infections
Symptoms
- Painful ejaculation
- Painful urination
- Pain around the penis
- Discharge from the penis that may be green or milky
- Sores or blisters around the penis and genital area
- Feeling like you have to urinate frequently
Painful ejaculation is a symptom of several sexually transmitted infections (STIs). Common bacterial STIs that may cause painful ejaculation include:
STIs need to be treated by your doctor. A blood test or a sample of fluid from your penis will determine if you have one. STIs are treated with antibiotics.
If you’re diagnosed with an STI, you should let your sexual partners know and encourage them to get tested.
4. Interstitial cystitis (painful bladder syndrome)
Symptoms
- Pain during ejaculation or intercourse
- Bladder pain
- Frequent urge to urinate
- Discomfort or pain in your lower abdomen
Interstitial cystitis (IC), or painful bladder syndrome, is a chronic condition that causes pain and discomfort in the urinary tract. It may be mild or severe.
The cause of IC is unknown, though it’s thought to be an autoimmune disorder. It often occurs in people with fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. IC is more common in women than in men but can happen to anyone.
The doctor will do several tests, including blood and urine tests, and sometimes a cystoscopy, where they look in your bladder with a scope. You may also need to have a digital rectal examination.
While there is no cure for IC, there are ways to control your symptoms. Treatments include lifestyle changes, pelvic floor physical therapy, oral medication, bladder instillations (bladder washes), or surgery.
Does painful ejaculation need to be treated?
"Painful ejaculation is not a one-time thing and may not go away on its own." —Dr. Chandrapal
5. Epididymo-orchitis
Symptoms
- Painful ejaculation
- Painful urination
- Swelling of the testicles
- Fever
- Nausea
- Vomiting
- Pain in the testicles
Epididymo-orchitis is an infection of the epididymis, a tube in the testicle that stores and transports sperm. In some cases, the testicles are also affected. Epididymo-orchitis is usually caused by bacterial infections (such as STIs) or a virus.
Symptoms are similar to the symptoms of testicular torsion, which is a serious condition that may require surgery—see your doctor right away.
Your doctor will do an ultrasound and take a urine sample to confirm the diagnosis. Treatment depends on the cause. If it’s bacterial, you will be given antibiotics. Viral epididymo-orchitis may go away on its own. You can ease any pain with over-the-counter pain medications.
6. Urethral stricture
Symptoms
- Painful ejaculation
- Painful urination
- Frequent need to urinate
- Low flow or “dribbling” while urinating
- Unable to start urinating
- Weak stream
- Incomplete bladder emptying
Urethral stricture is when there is scarring that blocks the urethra, the tube that empties the bladder. The blockage decreases the flow of urine and makes it difficult to empty your bladder completely. Because semen also passes through the urethra, a stricture can block some or all of the ejaculate during orgasm, causing pain.
The scarring develops from inflammation in the urethra. The inflammation may be caused by an infection (such as an STI), previous surgery, or if you’ve had multiple urinary catheters.
A specialist, such as a urologist, can diagnose you by measuring your urine flow, measuring the post-void residual (the amount of urine that is left in your bladder after you urinate), and X-rays. Treatments include urethral dilation—a procedure to stretch the sides of the urethra—and surgery.
7. Blocked ejaculatory duct
Symptoms
- Painful ejaculation
- Less ejaculate than normal
- Blood in the semen
- Pain in the perineum, penis, or scrotum
The ejaculatory duct is the channel semen travels through on its way from the testicles to the urethra, where it’s released from the penis. Though not common, the ejaculatory duct can sometimes become blocked, causing pain and decreasing your normal amount of ejaculate.
A blockage can develop from recent groin surgery, small stones, inflammation, or scarring.
Surgery is usually needed to remove the blockage.
Other possible causes
Other conditions that can cause painful ejaculation include:
- Nerve damage from recent hernia surgery.
- Side effects of medications used to treat depression.
- Psychosocial causes such as a history of anxiety, post-traumatic stress disorder, or sexual abuse.
When to call the doctor
Painful ejaculation can interfere with your quality of life and may be a sign of a more serious medical condition. See your doctor if you have:
- Pain when you ejaculate
- Pain when you urinate
- Discharge from your penis
- Blood in your semen or urine
- Abdominal discomfort
- Trouble controlling the flow of urine
- Trouble ejaculating
Don’t be afraid to talk to your doctor
"One of the first things I would say is: Thank you for being honest and coming to me with this problem. I understand it is a difficult subject and appreciate your trust. The goal of my questions is not to interfere in your private life or personal relationships. I am trying to help." —Dr. Chandrapal
Should I go to the ER for painful ejaculation?
You should go to the ER if you have any of these signs of a more serious problem:
- Extreme pain in the genital area
- Sudden pain and swelling of the testicle
- Difficulty urinating with fever or chills
Treatments
- Lifestyle changes
- Pelvic floor physical therapy
- Prescription medication to treat underlying infections
- Surgery
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