9 Possible Causes for Painful Ejaculation

Medically reviewed by Graham Rogers, MD on June 26, 2017Written by Ann Pietrangelo

Overview

Painful ejaculation, also known as dysorgasmia or orgasmalgia, can range from mild discomfort to severe pain during or after ejaculation. The pain can involve the penis, scrotum, and perineal or perianal area.

Painful ejaculation can have a serious impact on your sex life.

Continue reading to find out why you shouldn’t ignore painful ejaculation and why communication is key.

What causes it?

Following are nine common causes for painful ejaculation:

1. Prostatitis

Prostatitis is the term for inflammation or infection of the prostate gland. It’s the most common urologic problem in men under 50 years old.

It can cause painful or frequent urination, so it’s easy to mistake for a urinary tract infection. Other symptoms include lower abdominal pain and difficulty getting an erection.

Risk factors for prostatitis may include:

2. Surgery

Some types of surgery can cause a number of side effects, including painful ejaculation. One of these is radical prostatectomy, a procedure to remove all or part of the prostate and some nearby tissue. It’s used to treat prostate cancer. Risks of the procedure include erectile dysfunction, and penile and testicular pain. Surgery to repair a hernia (inguinal herniorrhaphy) can also cause painful ejaculation.

3. Cysts or stones

It’s possible to develop cysts or stones in the ejaculatory duct. They can block ejaculate, causing infertility and painful ejaculation.

4. Antidepressant drugs

Antidepressant drugs can cause sexual dysfunction, including painful ejaculation. The types that are most likely to cause sexual side effects are:

5. Pudendal neuropathy

Pudendal neuropathy is a condition in which there’s some damage to a nerve in the pelvis. That can lead to genital and rectal pain. Some things that can affect the pudendal nerve are injury, diabetes, and multiple sclerosis (MS).

6. Prostate cancer

Though often asymptomatic, prostate cancer can cause painful ejaculation. Other symptoms may include urination problems, erectile dysfunction, or blood in your urine or semen.

7. Trichomoniasis

Trichomoniasis is a sexually transmitted infection that can also cause burning or pain during urination.

8. Radiation therapy

Radiation therapy to the pelvis can result in erectile dysfunction, including pain on ejaculation. These side effects are usually temporary.

9. Psychological issues

In some cases, the cause can’t be determined. If you don’t have pain when you masturbate, it could be emotionally based. Consider seeing a therapist to explore this further.

When to call your doctor

Make an appointment to see your general physician if you have painful ejaculation. A physical examination and a few tests may be all you need to get to the root of the problem.

Your doctor can refer you to a urologist or fertility specialist, if necessary.

How is it diagnosed?

You’ll need a physical, including a digital rectal exam. Be prepared to give a complete medical history and to answer a few questions such as:

  • How long have you experienced pain with orgasm?
  • How long does it last?
  • Do you produce ejaculate or do you have dry orgasm?
  • What other symptoms do you have?
  • Does it hurt or burn when you urinate?
  • Does your urine look normal?
  • Are you currently taking any medications?
  • Have you ever been treated for cancer?
  • Is there a family history of prostate cancer?
  • Do you have diabetes?

Diagnostic testing may include:

Depending on the results, additional tests, such as blood work or imaging tests, may be needed.

Are there possible complications?

Painful ejaculation is usually a symptom of a larger problem that needs to be treated. Getting the treatment you need will help you avoid serious complications.

Untreated, painful ejaculation can have an adverse effect on your sexual behaviors.

How is it treated?

Treatment will depend on the cause. Underlying diseases, such as diabetes and MS, must also be addressed.

Treatment for bacterial infection

  • An extended course of oral antibiotics is usually necessary.
  • Over-the-counter NSAIDs or prescription pain medications can help reduce swelling and ease pain.
  • For serious infection, you may need intravenous antibiotics or even hospitalization.

When it’s a side effect of surgery

  • Some side effects are temporary and improve slowly.
  • Your doctor will assess the specifics of your condition to see if there are any remedies. These may include medications or additional surgeries.

Treatment for cysts or stones

  • Blockages can be surgically removed in a procedure called transurethral resection of the ejaculatory ducts.

When the cause is antidepressant medications

  • Don’t stop taking your medications without doctor supervision. Doing so can make your depression worsen.
  • Work with your doctor to find an alternative drug. It may take some time to find the right drug and dosage.

Treatment for pudendal neuropathy

  • Nerve blockers, numbing agents, and steroids can help control pain.
  • A physical therapist can instruct you on how to strengthen your pelvic floor muscles.
  • In some cases, surgery can be performed on the compressed nerve.

Learn more: Kegel exercises for men »

Treatment for prostate cancer

  • Treatment options depend on type, stage, and aggressiveness of the cancer.
  • Some prostate cancers are very slow growing, requiring minimal treatment along with active surveillance.
  • Prostate cancer can be treated with radiation therapy, hormone therapy, vaccine treatment, and chemotherapy.
  • Surgery may be needed to remove part or all of the prostate.

Treatment for trichomoniasis

  • Treatment with antibiotics is usually all that’s needed.
  • Because trichomoniasis is an STD, sexual partners should be checked and treated.

When it’s caused by radiation therapy

  • Side effects may resolve once treatment is finished.
  • Talk to your doctor if it becomes an ongoing problem.

When it’s caused by emotional or psychological issues

If there’s an emotional or psychological reason behind painful ejaculation, therapy may prove beneficial.

Outlook

Your doctor can give you an idea of what to expect based on the cause and treatment.

Sexual problems can affect both you and your partner. If you don’t talk about it, your partner may come to some erroneous conclusions about your relationship. That’s why open communication is crucial.

Here are a few tips for talking to your partner:

  • Find a time when you’re both unhurried and relaxed.
  • Explain that the problem is physical pain when you ejaculate, not a problem with intimacy.
  • Express how this affects you sexually and emotionally.
  • Take the other person’s concerns seriously.

Your partner may also take comfort in hearing that you plan to see a doctor.

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