Painful ejaculation, medically known as dysorgasmia or orgasmalgia, is the experience of discomfort, aching, or a burning sensation during or immediately after reaching orgasm. This pain can be felt in the penis, scrotum, perineum, or lower abdomen and can range from mild to severe. While an isolated instance of discomfort may not be a concern, persistent or severe ejaculatory pain often indicates an underlying medical issue that requires professional evaluation. Studies suggest this condition affects a significant portion of the male population, with reported prevalence ranging from approximately 1% to 25%.
Inflammatory and Infectious Conditions
The most frequent causes of ejaculatory discomfort involve inflammation or infection within the genitourinary tract. Prostatitis, inflammation of the prostate gland, is a common culprit and occurs in acute or chronic forms. Acute bacterial prostatitis presents with fever and chills, while chronic prostatitis is often linked to chronic pelvic pain syndrome and causes persistent discomfort even without an ongoing infection. Inflammation of the urethra (urethritis), often caused by STIs, leads to a burning sensation as semen passes through the irritated tube. Other infectious causes include epididymitis and urinary tract infections (UTIs); treating these underlying infections with antibiotics is the primary path to resolution.
Structural and Obstructive Issues
Painful ejaculation can arise from physical blockages or anatomical abnormalities that create increased pressure during semen emission. Ejaculatory duct obstruction (EDO) occurs when the small tubes transporting seminal fluid through the prostate become blocked. Blockages can be caused by scar tissue from a previous infection, or by the presence of prostatic or seminal vesicle cysts. When ducts are obstructed, the fluid build-up and muscular contractions during orgasm result in significant pelvic or perineal pain.
Another impediment is a urethral stricture, a narrowing of the urethra usually caused by injury or scarring, where the forceful passage of ejaculate causes friction and intense pain. Small stones can also form in the seminal vesicles, leading to an obstruction that prevents smooth fluid flow. Unlike infectious causes, these structural issues often require imaging, such as an ultrasound, and may necessitate a surgical procedure for correction.
Nerve Damage and Post-Treatment Factors
A different category of causes involves damage to the nerves controlling the ejaculatory process or side effects from medical treatments. Neuropathy, or nerve damage in the pelvic region, interferes with the signals and muscle contractions involved in orgasm; conditions like diabetes can cause this peripheral neuropathy. Medical interventions targeting the pelvic area can also result in painful ejaculation.
Radiation therapy directed at the prostate or bladder can cause nerve and tissue damage, as can post-surgical complications following procedures like a transurethral resection of the prostate (TURP) or radical prostatectomy. Certain medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), are known to cause ejaculatory pain as a side effect, related to the drug’s impact on nerve signaling and muscle function.
Seeking Professional Diagnosis and Treatment
Anyone experiencing persistent or severe ejaculatory pain, especially if accompanied by symptoms like blood in the semen (hematospermia) or fever, should seek medical attention. The diagnostic process begins with a detailed medical history and physical examination, including a digital rectal exam to assess the prostate. Diagnostic tests often include a urinalysis and semen culture to check for infection or inflammation. Imaging tests, such as a transrectal ultrasound, may be ordered to identify structural causes like cysts or blockages. Treatment is focused on the underlying cause identified through this diagnostic workup:
- For infectious causes, antibiotics are typically prescribed.
- If inflammation is the primary issue, anti-inflammatory medications or alpha-blockers may be used.
- Structural issues like urethral strictures may require minimally invasive surgical correction.
- Switching medications is necessary if the pain is attributed to a pharmacological side effect.