Pain in the testicles, scrotum, or groin immediately following ejaculation is known as post-ejaculatory scrotal pain. This discomfort can range from a mild, temporary ache to a sharp, persistent throbbing. While the symptom can feel intense, it is often linked to common, temporary physiological responses rather than a serious underlying condition. The pain location varies, sometimes concentrating in the testicles or radiating into the lower abdomen or the perineum.
Temporary Pain Related to Sexual Arousal
The most frequent cause of temporary post-ejaculatory pain involves vascular and muscular mechanics related to sexual arousal. During excitement, the body directs increased arterial blood flow to the genital area to maintain an erection. This heightened blood flow restricts the veins that drain the region, causing temporary pooling of blood.
This vascular engorgement increases pressure in the structures surrounding the testes, particularly the epididymis. The medical term for this pressure buildup is epididymal hypertension, commonly known as “blue balls.” If arousal is prolonged without orgasm, the sustained pressure leads to an uncomfortable, dull ache or sensation of heaviness. Ejaculation triggers rapid muscular and vascular relaxation, allowing the pooled blood to drain and relieving the hypertension.
In some instances, the intense muscular contractions that accompany orgasm can themselves be the source of pain. The pelvic floor muscles, which are heavily involved in ejaculation, can spasm or become overly tense during the process. This muscle tension in the perineum or pelvic region can radiate pain directly to the testicles, felt immediately after climax. This muscular discomfort is transient, subsiding as the body returns to a relaxed state, much like a mild cramp.
Pain Caused by Underlying Medical Conditions
When post-ejaculatory pain is persistent, severe, or consistently recurs, it often points to an inflammatory or structural issue aggravated by orgasm. One common condition is epididymitis, the inflammation of the epididymis. This condition is frequently caused by a bacterial infection, often a sexually transmitted infection like chlamydia or gonorrhea in younger men, or a urinary tract infection (UTI) in older individuals. Ejaculation contractions irritate the inflamed tissue, causing sharp or throbbing pain.
Another cause is prostatitis, inflammation of the prostate gland located just below the bladder. Because the prostate is involved in producing seminal fluid and contracting during ejaculation, inflammation here can cause pain that radiates to the testicles, groin, and lower back. Prostatitis can be acute or chronic, with chronic pelvic pain syndrome being a common diagnosis when no specific infection is found. The muscle spasms and fluid expulsion during orgasm strain the inflamed prostate tissue, resulting in discomfort.
Structural issues in the scrotum can also intensify pain with ejaculation. A varicocele, an enlargement of the veins within the scrotum, can cause a dull ache or heavy sensation that worsens when blood flow increases during arousal and subsequent ejaculation. Likewise, a hydrocele, a collection of fluid surrounding the testicle, or a spermatocele, a cyst on the epididymis, may cause pressure that is aggravated by the muscular and vascular changes of the sexual response cycle. These conditions are made symptomatic by the physical strain of orgasm.
Symptoms That Require Immediate Medical Care
While many instances of post-ejaculatory pain are benign, certain symptoms signal a serious medical problem requiring prompt attention. The most urgent symptom is the sudden onset of severe, escalating testicular pain, the hallmark of testicular torsion. Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply, and requires emergency surgery to prevent organ loss.
Other red flags requiring immediate medical evaluation include pain accompanied by systemic symptoms like fever or chills, suggesting an active infection such as acute epididymitis or prostatitis. The presence of blood in the semen (hematospermia) or blood in the urine (hematuria) following ejaculation warrants urgent investigation. Noticeable changes to the scrotum, such as significant swelling, redness, or tenderness, should not be ignored.
For less severe but persistent pain that does not resolve within a few hours, conservative management strategies can offer relief. These include taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), wearing supportive undergarments, or applying a warm compress or taking a warm bath to relax the pelvic floor muscles.