Painful Ejaculation (Male Dysorgasmia)

It can be alarming to experience pain with ejaculation. In some people, the condition can be persistent or severe.

Painful ejaculation, also known as male dysorgasmia, is a relatively common condition affecting up to 10% of people with penises, either in acute (sudden and short-lasting) episodes or on a chronic (ongoing or recurrent) basis.

Painful ejaculation is also sometimes referred to as dysejaculation, odynorgasmia, or orgasmalgia.

The causes of dysorgasmia are many, ranging from infections and prostate problems to nervous system disorders and medications. Because of this, it is important to see a healthcare provider to pinpoint the exact cause and access the right treatment.

This article looks at the symptoms and causes of painful ejaculation and walks you through the various ways the condition is diagnosed and treated. It also highlights the signs and symptoms that warrant immediate medical care.

Symptoms of Painful Ejaculation

Painful ejaculation is a common yet largely unreported symptom in those with penises. The pain can occur during one or both stages of ejaculation:

1. The emission phase is when sperm and fluids are simultaneously ejected from the testicles, prostate gland, and seminal vesicles to create semen.
2. The expulsion phase is when muscles in the pelvic floor contract repeatedly to propel semen through the urethra (the tube through which urine also exits the body).

While dysorgasmia generally refers to pain in the penis and urethra, the pain might also extend to⁠—or, in some cases, be isolated to⁠—the testicles, scrotum, lower abdomen, rectum, and perineum (the space between the anus and genitals).

In addition to pain, there may also be evidence of blood in semen, referred to as hematospermia.

What differentiates dysorgasmia from other types of pain in the male reproductive tract is that the pain arises as the direct result of orgasm and ejaculation.

Causes of Painful Ejaculation

Painful ejaculation can occur for many different reasons, and, in some cases, the cause may be unknown (idiopathic). Though few causes are ever life-threatening, dysorgasmia can significantly impair a person's self-esteem, quality of life, and sexual function.

Here are six possible causes that healthcare providers will commonly investigate if faced with symptoms of male dysorgasmia.

Lower Urinary Tract Infections

A 2020 review published in the journal Cureus reported that 1 in 4 males experience painful ejaculation as part of a lower urinary tract infection.

Lower urinary tract infections are those that involve the bladder, bladder neck, urethra, prostate gland, and muscles called urinary sphincters that regulate the flow of urine.

Most urinary tract infections (UTIs) are caused by a bacteria known as Escherichia coli (E. coli) that is naturally present in the body (especially the intestinal tract). But other types of bacteria may be the cause. Risk factors in males include diabetes, using a urinary catheter, or having an enlarged prostate.

Inflammatory Conditions

Bacterial, viral, or fungal infections can affect the male reproductive tract, including the testicles, prostate, urethra, and epididymis (the narrow tubes through which sperm exit the testicles). These include sexually transmitted infections (STIs) like chlamydia, gonorrhea, syphilis, and trichomoniasis.

Further, bacteria can be present in the semen/seminal fluid. This semen infection can lead to symptoms of prostatitis and painful ejaculation.

These infections can trigger inflammation in different reproductive organs, leading to:

• Orchitis: Inflammation of the testicles
• Prostatitis: Inflammation of the prostate gland
• Urethritis: Inflammation of the urethra
• Epididymitis: Inflammation of the epididymis

There are also noninfectious causes of these conditions, including prior urinary tract surgery, chemical irritants, and prolonged cycling or horse riding.

Irrespective of the cause, the inflammation of these reproductive organs can easily trigger ejaculation pain.

Enlarged Prostate

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a condition commonly affecting older males that can cause pain with urination, frequent urination, nighttime urination, and other urinary symptoms. Prostate enlargement can also cause pain after ejaculation.

Obstructive Conditions

Certain conditions can block the passage of sperm and/or seminal fluid from the body. When the flow is obstructed during ejaculation, the forceful pressure can cause extreme shooting pain and even urethral bleeding.

Possible causes of obstruction include:

• Urethral stricture: This is the narrowing of the urethra caused by infection, injury, or inflammatory diseases.
• Ejaculatory duct obstruction: The blockage of the ejaculatory duct (which transports sperm to the urethra) can occur with a urinary tract infection, urinary cysts, or epididymitis.
• Seminal vesicle calculi: Similar to kidney stones, these are hardened deposits of minerals that can obstruct the seminal vesicles (specialized glands that produce seminal fluid).
• Inguinal hernia repair: The repair of a hernia in the groin can sometimes cause nerve compression and/or the scarring or kinking of the vas deferens.
• Vasectomy: This surgical method of birth control blocks the flow of sperm by cutting or sealing the vas deferens (the vessel that receives sperm from the epididymis).
• Radical prostatectomy: Used in people with prostate cancer, this involves the surgical removal of the prostate gland, seminal vesicles, and parts of the vas deferens.
  
• Pelvic radiation: Radiation therapy commonly used to treat prostate cancer can cause scarring and narrowing of the vessels and ducts in the male reproductive tract.

Pudendal Neuropathy

Pudendal neuropathy, also known as pudendal neuralgia, is chronic pain caused by damage to the main nerve servicing the pelvis, called the pudendal nerve. It is most often caused by nerve compression or entrapment.

During orgasm, the contraction of ejaculatory muscles can cause pain mostly in the perineum and lower buttocks. Around 1 in 4 males with pudendal neuropathy experience painful ejaculation.

Causes of pudendal neuropathy include prolonged sitting, cycling, and horse riding (usually over course of months or years). Chronic constipation and pelvic fractures can also lead to pudendal neuropathy.

What Medications Can Cause Painful Ejaculation?

Painful ejaculation is commonly linked to certain classes of antidepressant drugs used to treat depression and chronic pain. Stopping the drugs will usually improve symptoms.

Antidepressants known to cause male dysorgasmia include:

• Anafranil (clomipramine)
• Asendin (amoxapine)
• Effexor XR (venlafaxine)
• Norpramin (desipramine)
• Prozac (fluoxetine)
• Tofranil (imipramine)
• Vivactil (protriptyline)

Muscle relaxants with a similar chemical structure to tricyclic antidepressants, such as Flexeril (cyclobenzaprine), have also been known to cause painful ejaculation.

How to Treat Painful Ejaculation

The treatment of painful ejaculations varies by the underlying cause. Treating the underlying cause will often resolve the symptom, and, in some cases, no treatment is needed other than time.

There are few direct means of treating male dysorgasmia that offer consistent results. Even so, if a cause cannot be found, healthcare providers may opt to prescribe muscle relaxants, pelvic floor muscle exercises, anticonvulsant drugs, or opioid drugs to help minimize symptoms.

The following chart outlines some of the options used to treat the underlying causes of painful ejaculation.

Are There Tests to Diagnose the Cause of Painful Ejaculation?

Because painful ejaculation is a nonspecific condition with many possible causes, the diagnosis will start with a review of your medical history and a physical exam. Any medications you take and other symptoms you are experiencing will also be noted.

As part of the physical exam, the healthcare provider will want to examine your genitals and may request a digital rectal exam (DRE), which involves the insertion of a gloved finger into your rectum to examine your prostate gland.

Other common tests and procedures include:

• Prostate-specific antigen (PSA) test: This blood test detects protein, called prostate-specific antigen, that increases whenever the prostate gland is inflamed.
• Urinalysis: This test evaluates a urine sample for evidence of infection, bleeding, high blood sugar, or kidney disease.
• Urine culture: This test is used to isolate and identify specific bacteria, fungus, or viruses by culturing (growing) them from a urine sample.
• Pelvic ultrasound: This noninvasive imaging technique uses reflected sound waves to produce detailed images of internal organs, such as the testicles and epididymis.
• Transrectal ultrasound: This is a type of ultrasound inserted into the rectum that can visualize the prostate gland or check for obstruction of the ejaculatory duct or seminal vesicles.
• Cystoscopy: This involves the insertion of a thin, flexible scope (called a cystoscope) into the urethra to check for urethral stricture or injury.
• Urethrogram: This is a specialized form of X-ray in which a contrast dye is delivered via a urinary catheter to visualize the urethra and adjacent structures better.

Additional tests may be ordered based on the findings.

When to See a Healthcare Provider

Painful ejaculation may be a worrisome condition but is usually not one that requires emergency care.

With that said, a lower urinary tract infection can sometimes turn serious if it migrates to the organs of the upper urinary tract (including the ureters and kidneys). If left untreated, these types of infections can lead to kidney damage, acute kidney failure, and sepsis (a potentially life-threatening inflammatory reaction to infection).

Seek immediate medical care if the symptoms of a urinary tract infection are accompanied by more serious signs, such as:

• High fever with chills
• Uncontrollable shaking
• Nausea or vomiting
• Severe back or side (flank) pain
• Blood in urine

Summary

Painful ejaculation, also known as male dysorgasmia, can be caused by many conditions affecting the penis, urethra, testicles, scrotum, prostate gland, or epididymis.

Causes include infections, enlarged prostate, and the obstruction or inflammation of the organs of the lower urinary tract or male reproductive tract. Certain antidepressants and a nerve disorder called pudendal neuropathy can cause painful ejaculation.

Painful ejaculation is typically diagnosed and treated by a urologist. Treating the underlying cause (or discontinuing the offending drug) will often resolve the symptom. With that said, some cases have no known cause and can be difficult to treat.

A Word From Verywell

Painful ejaculation is usually a symptom of a larger problem that needs to be treated. While you may be reluctant to discuss the problem with a healthcare provider (or assume that it is not serious), avoiding a diagnosis may lead to complications if the underlying condition is not treated. Untreated STIs, for example, can sometimes lead to male infertility.

Even if a cause cannot be found, managing the symptoms under the care of a urologist may improve both your sex life and overall sense of well-being.