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Top 7 Causes of Painful Ejaculation

Painful ejaculation can affect your sexual life, and may be a sign of an infection, blockage, or inflammation.
Last updated April 15, 2021

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What is painful ejaculation?

Ejaculation is the release of semen from the penis during the male orgasm. It is normally a pleasurable experience and shouldn’t be uncomfortable.

Yet ejaculation can sometimes be painful, and it’s not an uncommon problem. A review article published in the journal, Translational Andrology and Urology, reported that up to 10% of men have had painful ejaculation at some point in their lives. Among those with prostate issues, that rate climbed to 30% to 75%.

The sensations of painful ejaculation vary. It may feel like pain or burning in the perineum (the area between the anus and genitals), the urethra, or scrotum. The pain may begin during sex and become more severe when you climax, or it may be painful only when you ejaculate.

Painful ejaculation can be a symptom of an infection, inflammation, or blockage of the lower urinary tract (bladder, prostate, seminal vesicles, or urethra). One of the most common causes is prostatitis, an inflammation of the prostate.

Ejaculation could also be painful because of psychological and emotional factors. Discuss painful ejaculation, and any other symptoms, such as discharge or pain, with your doctor.

Causes of painful ejaculation

1. Prostatitis

Pro Tip

I first want to determine if the pain is with erections, sex, or just isolated to ejaculation. Next, I try to rule out infections such as UTIs or STIs. I would then ask if they noticed anything different about the ejaculate. I then try to determine if there is a larger, psychosocial reason. Next, I ask about surgical history, looking for recent groin or hernia surgery. I also query their medications for any recent additions or increases of doses, particularly antidepressants. —Dr. Jason Chandrapal

Symptoms

  • Erectile dysfunction
  • Painful ejaculation
  • Painful urination
  • Feeling like you have to urinate frequently
  • Pain in your pelvic area

Prostatitis is an inflammation of the prostate gland, which is located between the bladder and penis. The inflammation may be acute (short-lived) or chronic (symptoms last 6 weeks or longer).

The severity of symptoms varies. Acute prostatitis symptoms are more severe than chronic prostatitis, which can be bothersome but bearable.

Prostatitis can be infectious or non-infectious. Infectious prostatitis is caused by a bacterial infection. Non-infectious prostatitis is an inflammation of the prostate without any signs of infection.

Your doctor will diagnose prostatitis based on urine and blood tests. Non-infectious prostatitis may go away on its own, while infectious prostatitis needs to be treated with antibiotics.

Painful ejaculation questionnaire

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Painful ejaculation symptom checker

2. Cystitis

Symptoms

Cystitis is an infection of the bladder. Though it’s more common in women, cystitis can occur in men, particularly in men who have difficulty urinating (such as those who have an enlarged prostate.) The infection occurs when bacteria that line the inside of the bladder enter the bladder tissue, causing inflammation.

Cystitis is treated with antibiotics. If you leave it untreated, it can lead to complications such as a kidney or blood infection.

3. Sexually transmitted infections

Symptoms

  • Painful ejaculation
  • Painful urination
  • Pain around the penis
  • Discharge from the penis that may be green or milky
  • Sores or blisters around the penis and genital area
  • Feeling like you have to urinate frequently

Painful ejaculation is a symptom of several sexually transmitted infections (STIs). Common bacterial STIs that may cause painful ejaculation include:

STIs need to be treated by your doctor. A blood test or a sample of fluid from your penis will determine if you have one. STIs are treated with antibiotics.

If you’re diagnosed with an STI, you should let your sexual partners know and encourage them to get tested.

4. Interstitial cystitis (painful bladder syndrome)

Pro Tip

A common misconception is that painful ejaculation is a one-time thing and may go away on its own. —Dr. Chandrapal

Symptoms

  • Pain during ejaculation or intercourse
  • Bladder pain
  • Frequent urge to urinate
  • Discomfort or pain in your lower abdomen

Interstitial cystitis (IC), or painful bladder syndrome, is a chronic condition that causes pain and discomfort in the urinary tract. It may be mild or severe.

The cause of IC is unknown, though it’s thought to be an autoimmune disorder. It often occurs in people with fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. IC is more common in women than in men but can happen to anyone.

The doctor will do several tests, including blood and urine tests, and sometimes a cystoscopy, where they look in your bladder with a scope. You may also need to have a digital rectal examination.

While there is no cure for IC, there are ways to control your symptoms. Treatments include lifestyle changes, pelvic floor physical therapy, oral medication, bladder instillations (bladder washes), or surgery.

5. Epididymo-orchitis

Symptoms

Epididymo-orchitis is an infection of the epididymis, a tube in the testicle that stores and transports sperm. In some cases, the testicles are also affected. Epididymo-orchitis is usually caused by bacterial infections (such as STIs) or a virus.

Symptoms are similar to the symptoms of testicular torsion, which is a serious condition that may require surgery—see your doctor right away.

Your doctor will do an ultrasound and take a urine sample to confirm the diagnosis. Treatment depends on the cause. If it’s bacterial, you will be given antibiotics. Viral epididymo-orchitis may go away on its own. You can ease any pain with over-the-counter pain medications.

6. Urethral stricture

Symptoms

  • Painful ejaculation
  • Painful urination
  • Frequent need to urinate
  • Low flow or “dribbling” while urinating
  • Unable to start urinating
  • Weak stream
  • Incomplete bladder emptying

Urethral stricture is when there is scarring that blocks the urethra, the tube that empties the bladder. The blockage decreases the flow of urine and makes it difficult to empty your bladder completely. Because semen also passes through the urethra, a stricture can block some or all of the ejaculate during orgasm, causing pain.

The scarring develops from inflammation in the urethra. The inflammation may be caused by an infection (such as an STI), previous surgery, or if you’ve had multiple urinary catheters.

A specialist, such as a urologist, can diagnose you by measuring your urine flow, measuring the post-void residual (the amount of urine that is left in your bladder after you urinate), and X-rays. Treatments include urethral dilation—a procedure to stretch the sides of the urethra—and surgery.

Painful ejaculation questionnaire

Use our free symptom checker to find out what's causing your pain.

Painful ejaculation symptom checker

7. Blocked ejaculatory duct

Symptoms

  • Painful ejaculation
  • Less ejaculate than normal
  • Blood in the semen
  • Pain in the perineum, penis, or scrotum

The ejaculatory duct is the channel semen travels through on its way from the testicles to the urethra, where it’s released from the penis. Though not common, the ejaculatory duct can sometimes become blocked, causing pain and decreasing your normal amount of ejaculate.

A blockage can develop from recent groin surgery, small stones, inflammation, or scarring.

Surgery is usually needed to remove the blockage.

Other possible causes

Other conditions that can cause painful ejaculation include:

  • Nerve damage from recent hernia surgery.
  • Side effects of medications used to treat depression.
  • Psychosocial causes such as a history of anxiety, post-traumatic stress disorder, or sexual abuse.

When to call the doctor

Painful ejaculation can interfere with your quality of life and may be a sign of a more serious medical condition. See your doctor if you have:

  • Pain when you ejaculate
  • Pain when you urinate
  • Discharge from your penis
  • Blood in your semen or urine
  • Abdominal discomfort
  • Trouble controlling the flow of urine
  • Trouble ejaculating

Dr. Rx

One of the first things I would say is: Thank you for being honest and coming to me with this problem. I understand it is a difficult subject to talk about and appreciate your trust. The goal of my questions are not to interfere in your private life or personal relationships. I am trying to help.  —Dr. Chandrapal

Should I go to the ER for painful ejaculation?

You should go to the ER if you have any of these signs of a more serious problem:

  • Extreme pain in the genital area
  • Sudden pain and swelling of the testicle
  • Difficulty urinating with fever or chills

Treatments

  • Lifestyle changes
  • Pelvic floor physical therapy
  • Prescription medication to treat underlying infections
  • Surgery
Hear what 1 other is saying
Mystery painPosted April 16, 2021 by W.
So for about three months now I have had pain in my testicles, in my bladder area, and my sides. I went to the doctor and they sent me for an ultrasound of my testicles, bladder, and kidneys, checked my urine for UTI and bladder infection and also sent urine for std testing. prescribed doxycycline for ten days twice a day. I took the full course as prescribed, went back to get my results of std test and ultrasound to find negative std test and nothing wrong on the ultrasound. I was referred to a urologist. While waiting to see the urologist my ejaculate had changed consistency. It had become thicker than normal and doesn’t all come out. I have to work it out like you would toothpaste out of the tube. I went to the urologist and he prescribed an anti-inflammatory, which has helped, but I still have pain when I ejaculate. It doesn’t hurt but thirty minutes to an hour later the same pain I have been having increases. The pain on some days is constant and some days comes and goes. Since this all started I have had maybe four days with no pain, none of which have been consecutive. The pain ranges from mild discomfort to very distracting

Dr. Chandrapal is the current Interprofessional Advanced Clinical Simulation Fellow at the VA medical center in Durham, NC. Prior to his current position he was a urology resident at Duke University. Originally from Houston, TX he went to undergrad at the University of Texas in Austin, followed by a masters degree from the University of Texas Health Science Center in San Antonio, and medical school at Texas Tech Health Science Center. He interested in adult learning, emotional intelligence, systems thinking, and biotechnology/innovation. In his free time he enjoys fly fishing and playing tennis.

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