Painful Ejaculation

What Is Painful Ejaculation?

Sexual activity is supposed to be enjoyable. So when you reach what you anticipate to be the pinnacle of pleasure only to feel pain instead, the experience can be frightening. Fortunately, treatments are available — but, first you have to figure out what’s happening.

Also known as dysorgasmia or orgasmalgia, painful ejaculation refers to the pain or discomfort that some men feel during or after ejaculation. The pain may be felt in the penis, scrotum, perineum, or perianal areas, and it can feel like a throbbing or burning sensation.

Painful ejaculation may be a sign of an underlying medical condition, ranging from urinary tract infections and inflammation of the prostate to medication side effects and nervous system disorders. Psychological issues also can cause pain when ejaculating.

If you’re experiencing pain or discomfort during or after ejaculation, keep reading to get answers to all of your questions about ejaculatory pain, including:

• Why does it burn when I ejaculate?

• Can painful ejaculation cause sexual dysfunction?

• What treatment options are available?

In addition to common causes and treatments, we’ll discuss what you can do at home to lower your risk of experiencing painful ejaculation in the future for better, more pleasurable sex.

How Common Is Painful Ejaculation?

Studies show that painful ejaculations affect around one to 25 percent of the general population, with pain ranging from a dull ache to unbearable. In some cases, pain during ejaculation is an isolated symptom, and in other cases, the pain is associated with urinary symptoms or pelvic pain outside of sexual activity. Despite its prevalence, painful ejaculation is a vastly under-reported symptom.

Symptoms of Painful Ejaculation

Symptoms of painful ejaculation vary from person to person. Some men have mild discomfort, while others experience excruciating pain. To make things more complicated, some men only experience pain when having sexual intercourse with a partner but not while masturbating.

This pain can start immediately before, during, or after ejaculation and last between two to 24 hours. For many men, painful ejaculations can reduce their self-esteem and sex drive, resulting in decreased quality of life.

Symptoms of painful ejaculation may include:

• Pain immediately before, during, or after ejaculation

• Pain in or around the genitals, including penile pain, testicular pain, or pain in surrounding areas like the urethra, perineum, rectum, or lower abdomen

• Pain during urination, particularly right after ejaculating

Depending on the underlying cause, painful ejaculation may occur alongside other symptoms like discharge from a sexually transmitted infection (STI) or frequent urination from a urinary tract infection. We’ll cover these related symptoms when we discuss painful ejaculation causes.

Complications of Painful Ejaculation

Painful ejaculation is often a symptom of an underlying medical condition that may require treatment. Over time, painful ejaculation may lead to impaired sexual function and other complications if left unaddressed.

Painful ejaculation complications can include:

• Sexual dysfunction. Painful ejaculation can negatively impact your sexual function, leading to issues like low sex drive or avoidance of sex. There also appears to be a link between painful ejaculation and erectile dysfunction (ED). In one study of men with benign prostatic hyperplasia experiencing pain when ejaculating, 72 percent of men also reported erectile dysfunction.

• Relationship problems. If painful ejaculation has led to sexual dysfunction or an avoidance of sex, it can cause problems in your relationship.

• Infertility. Avoidance of sex can also lead to infertility, but so can some of the underlying causes related to painful ejaculation if they’re not addressed, like cysts or stones in the ejaculatory duct or chronic prostatitis.

• Mental health issues. Painful ejaculation can take a toll on your mental health, causing anxiety, depression, low self-esteem, and diminished quality of life.

Causes of Painful Ejaculation

Painful ejaculation may occur for a variety of reasons, ranging from sexually transmitted infections to stones in the prostate.

The most common causes of painful ejaculation include:

• Urinary tract infections

• Sexually transmitted infections (STIs)

• Prostatitis 

• Urethritis

• Pelvic floor dysfunction

• Chronic pelvic pain syndrome

• Ejaculatory duct obstruction fMedication side effects

• Neurological disorders

• Poor hygiene

• Psychological issues

Urinary Tract Infections

Urinary tract infections (UTIs) are more common in women due to their short urethra, but men aren’t immune to them. 

If you experience burning after ejaculation and after you pee, you may be dealing with a UTI. Other UTI symptoms include frequent urination, urinary urgency, painful urination, cloudy or foul-smelling urine, fatigue, and fever.

Left unaddressed, UTIs can lead to complications like prostate or kidney infections and sepsis.

Sexually Transmitted Diseases

Sexually transmitted infections (STIs), also called sexually transmitted diseases (STDs), can cause pain during or after ejaculation. These infections typically involve the urethra and sometimes the prostate. 

STIs that can cause pain during or after ejaculation include:

• Chlamydia

• Gonorrhea

• Syphilis

• Trichomoniasis

• Herpes (HSV)

It’s essential to seek early treatment if you suspect you’ve been infected with an STI. Untreated infections can be passed to sexual partners and may result in severe complications, including but not limited to infertility for you or your partner.

Inflammatory Conditions

Inflammatory conditions that affect the reproductive tract can cause painful ejaculation. They may be caused by bacterial, viral, or fungal infections; or may be caused by non-infectious inflammatory or autoimmune conditions. These inflammatory conditions are named according to the involved organ.

• Urethritis. Urethritis refers to inflammation of the urethra, the tube that carries urine and semen from your pelvis to the tip of the penis. Urethritis can cause pain during urination or ejaculation as urine or semen passes through the inflamed tube. Affected patients often have discharge from the penis, penile swelling, or itching.

• Prostatitis. Prostatitis refers to inflammation of the prostate gland. The prostate is an organ under the bladder that produces about 30% of the fluid that comes out with each ejaculation. Prostate inflammation can cause significant pain with ejaculation. Around 30 to 75 percent of men who suffer from chronic pelvic pain/chronic prostatitis experience persistent pain during ejaculation. Prostatitis may also cause hematospermia, or bloody sperm.

• Epididymitis. Epididymitis is inflammation of the epididymis, the small organ attached to each testicle that stores sperm. In order for sperm to get out, the epididymis contracts rhythmically at the time of ejaculation. If it is inflamed, those contractions can cause pain in the scrotum or testicles that may range from from mild discomfort to severe, unrelenting pain. Epididymitis can be the acute result of a bacterial or viral infection, or may be a chronic issue. Certain activities, including ejaculation, can worsen the pain in patients with chronic epididymitis.

• Orchitis. Orchitis refers to inflamed testicles. The condition can result from infectious, vascular, or systemic inflammatory conditions. It may involve one or both testicles, and the pain from orchitis can be exacerbated during ejaculation. 

Ejaculatory Duct Obstruction

Fluid and sperm from the testicles, epididymis and seminal vesicles flow into the part of the urethra near the prostate through small tubes called the ejaculatory ducts. These small tubes can get blocked by stones, cysts or scar tissue from prostate surgery. If the ejaculatory ducts are blocked, pressure from fluid build up and pelvic muscular contractions can cause significant pain during ejaculation. This pain can be felt in the pelvis, the perineum, the testicles and the penis. Other symptoms that may be present include low semen volume and blood in the semen. Ejaculatory duct obstruction can also cause infertility, which can be mild if the blockage is partial or severe if the blockage is complete.

Surgical Complications

Some surgical procedures can lead to painful ejaculation. Prostate, bladder and penis surgeries can cause scar tissue to form that can block the flow of semen during ejaculation. Vasectomies and even hernia surgeries can cause ejaculatory pain by irritating the sensitive sensory nerves near the testicles and penis, which makes them sensitive to the intense muscular contractions that occur during ejaculation. 

Medication Side Effects

Side effects of certain drugs may cause painful ejaculation. Medications that can have these impacts include:

• Tricyclic antidepressants like amoxapine, clomipramine, desipramine, imipramine, and protriptyline

• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine

• Muscle relaxants like cyclobenzaprine

Neurological Disorders 

Certain specific neurological disorders can cause painful ejaculation. Pudendal nerve entrapment, in which the main nerve responsible for sexual sensation gets trapped and compressed, is a good example. Chronic pelvic pain syndrome (CPPS), which is a poorly understood mixed inflammatory and neurological disorder, can also cause ejaculatory pain. Interestingly, some men with CPPS find relief through ejaculation, while others find their pain exacerbated.

Poor Hygiene

If you experience pain after ejaculating too much, the problem may have more to do with hygiene than tissue or nerve damage. Masturbating or having sex multiple times in a short window without washing up or using sufficient lubrication can lead to friction burn and bacterial skin infections such as balanitis that can make sex and ejaculation uncomfortable. 

Psychological Issues

If you’ve seen a medical provider about your pain and they haven’t determined a physiological cause, there’s a chance that psychological issues may be at play. Stress, anxiety, shame, and guilt can all take a toll on your sexual health.

One of the biggest signs that your ejaculatory pain is psychological is if it only occurs during sex and not while masturbating. Speaking to a therapist is the best course of action here.

Risk Factors for Pain After Ejaculation

Risk factors for painful ejaculation include:

• Medical conditions like prostate cancer, Peyronie’s disease, and diabetes

• History of urological surgery on the penis, prostate or bladder

• Chronic infections of the genitourinary tract

• Autoimmune disorders 

• Neurological disorders, especially involving peripheral nerves

• Congenital genitourinary tract conditions like Zinner syndrome

• High risk sexual behaviors

• Poor penile hygiene

Diagnosing Painful Ejaculation

Have you been trying to avoid your doctor so you don’t have to ask, Why does it hurt when I ejaculate? If so, you’re not alone. According to a 2019 Cleveland Clinic survey, 72 percent of men would rather do household chores than go to the doctor. And around 20 percent of the men who go to the doctor are not fully honest with their healthcare providers.

Knowing what to expect when it comes to diagnosing painful ejaculation may help squash your fear.

To diagnose the cause of painful ejaculation, a urologist or other healthcare provider will typically take a detailed medical history and perform a physical exam, which may include a digital rectal exam and an examination of your penis and testicles. They may also recommend additional tests, such as a urinalysis and semen analysis, ultrasound, STI testing, and pelvic floor examination.

When your provider has a clearer idea of what’s causing your pain, they’ll provide a treatment plan, which may include medication or physical therapy for underlying conditions.

Treatment Options for Painful Ejaculation

The treatment of painful ejaculation depends on the underlying cause and may include medication, physical therapy, or even psychotherapy. In some cases, your provider may recommend adjusting medications, though you should never stop taking prescribed medication without medical advice first.

Some of the most common treatments for painful ejaculation include:

• Antibiotics. Antibiotics may be prescribed if your pain is caused by a bacterial infection, such as a UTI or STI.

• Alpha-blockers. Alpha-blockers like tamsulosin relax the muscles inside the prostate. These medications have been shown to lower orgasmic pain intensity and increase libido in men with painful ejaculation.

• Anti-inflammatory medications. Anti-inflammatory drugs like NSAIDs may be helpful if the cause of your pain is an inflammatory condition like orchitis or urethritis. These drugs are typically administered with antibiotics if a bacterial infection is present.

• Nerve blocks. Pudendal nerve blocks may relieve pain related to nerve issues, such as pudendal nerve entrapment and chronic pelvic pain.

• Pelvic floor physical therapy. Pelvic floor exercises help treat pelvic floor dysfunction, which may help relieve ejaculatory pain. Studies show that painful ejaculation is the most common sexual problem for men with a tight pelvic floor, which occurs in around 39 to 58 percent of men with chronic prostatitis/chronic pelvic pain syndrome.

• Prostate massage. In one study, prostate massage was as effective as biofeedback and electrical stimulation in treating the pain associated with chronic prostatitis /chronic pelvic pain syndrome, common causes of painful ejaculation. Even better results were seen when the two therapeutic methods were used simultaneously.

• Counseling. If the root of ejaculatory pain is psychological, talking to a psychotherapist, counselor, or sex therapist can be helpful.

How to Prevent Discomfort After Ejaculation

You can’t always prevent discomfort during or after ejaculation if a medical condition causes it. However, simple lifestyle changes may help lower your risk of experiencing painful ejaculation.

You might try the following:

• Wear condoms to prevent STDs and STIs

• Do pelvic floor exercises regularly

• Practice good personal hygiene

• Eat a healthy, balanced diet

• Hydrate often

• Avoid smoking

• Exercise regularly

• Maintain a healthy weight

• Seek early treatment for unusual sores, discharge, or other symptoms

Feel Pain When Ejaculating? Next Steps

Feeling pain when ejaculating can be frustrating or maybe even alarming. Fortunately, treatments are available, but you need to determine what’s causing your pain first.

If you are experiencing pain with ejaculation, I recommend consulting a urologist to figure out the most appropriate treatment and to manage symptoms effectively.

If painful ejaculation is causing sexual dysfunction issues like erectile dysfunction or low libido, talk to your healthcare provider about what options are available. Even when you treat underlying conditions, you may still be reluctant to have sex to avoid feeling pain. Working with a counselor or considering erectile dysfunction medication may be beneficial.

Do you think you’re suffering from another type of ejaculatory disorder? Read more about premature ejaculation, delayed ejaculation, and retrograde ejaculation.