Painful ejaculation, medically termed dysorgasmia or orgasmalgia, is discomfort experienced during or immediately after climax. This symptom is experienced by an estimated 1% to 25% of men, though the true prevalence is thought to be underreported. The pain can manifest as a burning sensation, a sharp ache, or a throbbing feeling in the penis, scrotum, or perineum, lasting from a few minutes to several hours. While the symptom is alarming, its causes are diverse, ranging from localized inflammation to broader systemic issues, and the underlying condition is often identifiable and treatable.
Causes Related to Infection and Inflammation
The most frequent causes involve inflammation or infection within the male reproductive and urinary tracts. Prostatitis, inflammation of the prostate gland, is a leading cause, especially in men under 50. This inflammation can be caused by a bacterial infection, but it often falls under Chronic Pelvic Pain Syndrome (CPPS) when no clear infectious agent is found. The prostate and seminal vesicles contract forcefully during ejaculation, and when these organs are swollen or irritated, the muscle contractions can intensify the pain.
Inflammatory conditions in other nearby structures also commonly lead to pain. Urethritis, inflammation of the urethra, causes a burning sensation as semen is expelled. Epididymitis, inflammation of the coiled tube that stores and transports sperm, can cause discomfort radiating to the testicles and abdomen. Sexually transmitted infections (STIs) such as Chlamydia and Trichomoniasis are common culprits, often triggering urethritis or epididymitis.
Structural and Mechanical Issues
Painful ejaculation can result from physical obstructions or anatomical changes that interfere with the normal flow of semen. Blockages in the ejaculatory ducts, small tubes that pass through the prostate, can cause pain due to a buildup of pressure during the emission of seminal fluid.
These obstructions may be caused by stones or calcifications forming within the seminal vesicles or the ducts themselves. When surrounding muscles contract during orgasm, the resulting pressure against the obstruction causes sharp pain. Scarring, known as strictures, can also develop in the urethra or ejaculatory ducts from previous infections, procedures, or trauma. Changes following surgical interventions, such as a radical prostatectomy or hernia repair, can alter the local anatomy or cause nerve irritation, leading to pain.
Systemic and Musculoskeletal Factors
Painful ejaculation can stem from broader issues affecting the nervous system or muscular function. The pelvic floor muscles play a significant role in the orgasmic process by contracting rhythmically to propel semen. When these muscles are chronically tight or hypertonic, often associated with chronic pelvic pain syndrome, the intense contractions during ejaculation can trigger spasms and pain. This discomfort is due to muscle dysfunction and trigger points that can refer pain to the penis, perineum, or rectum.
Certain medications can also contribute by affecting nerve signaling or muscle tone. Some antidepressant classes, particularly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, are known to cause sexual side effects, including painful ejaculation. Additionally, conditions that cause nerve damage, such as peripheral neuropathy associated with long-term diabetes, can disrupt the nerve signals involved in orgasm, leading to a painful or altered sensation.
When Immediate Medical Attention is Necessary
While many causes of painful ejaculation are treatable, certain accompanying symptoms require prompt professional evaluation. Severe, incapacitating pain that does not resolve quickly is a reason to seek urgent care.
Immediate medical attention is necessary if the pain is accompanied by:
- A sudden, high fever and chills, which may indicate an acute bacterial infection requiring immediate antibiotic treatment.
- Blood in the semen (hematospermia) or blood in the urine.
- Difficulty or inability to urinate (urinary retention), suggesting a serious obstruction.
- Any new swelling, lumps, or severe tenderness in the testicles or groin area.