Painful ejaculation can harm relationships, undermine self-esteem, and turn one of life’s pleasures into a source of frustration. It can be a scary experience, but it is nothing to be ashamed of. For most men, it manifests as pain during or immediately following ejaculation.
Some men feel embarrassed when ejaculation is painful, but it is a relatively common symptom. It is also highly treatable and can be the first symptom of another problem, such as swelling in the prostate.
Various studies have found that between 1–10 percent of men experience this symptom. As many as 30–75 percent of men with a condition called prostatitis experience pain during ejaculation.
In this article, we examine the symptoms and causes of painful ejaculation, along with what can be done to treat them.
- What is painful ejaculation?
- What causes it?
- Painful ejaculation and urination
Painful ejaculation can appear in several forms. For example:
- Some men experience painful ejaculation only when having sex with a partner, others only when they masturbate, and yet others during both situations
- The pain can be mild to severe and last a few minutes or up to 24 hours after ejaculation
- Pain can occur during or immediately following ejaculation
- Pain can be focused in or around the penis, rectum, or bladder
- The pain can begin shortly before or after ejaculation
- Pain also may occur during urination, especially immediately after ejaculation
Following are common causes for painful ejaculation:
Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.
Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.
Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn’t identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.
Depending on the cause, prostatitis can come on gradually or suddenly. It might improve quickly, either on its own or with treatment. Some types of prostatitis last for months or keep recurring (chronic prostatitis).
2 Benign prostatic hyperplasia
Benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland, is the most common benign tumor found in men.
As is true for prostate cancer, BPH occurs more often in the West compared to Eastern countries, such as Japan and China, and may be more common among blacks. Not long ago, a study found a possible genetic link for BPH in men younger than age 65 who have a very enlarged prostate: Their male relatives were four times more likely than other men to need BPH surgery at some point in their lives, and their brothers had a six-fold increase in risk.
BPH produces symptoms by obstructing the flow of urine through the urethra. Symptoms related to BPH are present in about one in four men by age 55, and in half of 75-year-old men. However, treatment is only necessary if symptoms become bothersome. By age 80, some 20 to 30% of men experience BPH symptoms severe enough to require treatment. Surgery was the only option until the recent approval of drugs that can relieve symptoms either by shrinking the prostate or by relaxing the prostate muscle tissue that constricts the urethra.
3 Other prostate issues
4 Use of medications
The medications most often associated with painful ejaculation are antidepressants. Classes of antidepressants reported to cause this side effect include tricyclics (e.g., amoxapine, clomipramine, imipramine, protriptyline), selective serotonin reuptake inhibitors (e.g., fluoxetine), venlafaxine, and MAOIs. If you are taking any of these drugs and experiencing painful ejaculation, talk to your doctor about making a change in your medication.
5 Sexually transmitted infections (STIs)
The two sexually transmitted diseases that are commonly associated with uncomfortable or painful ejaculation are chlamydia and trichomoniasis, although others can be culprits as well. If you have any reason to suspect you have a sexually transmitted disease, see a medical professional for testing as soon as possible.
6 Prostate cancer
Though often asymptomatic, prostate cancer can cause painful ejaculation. Other symptoms may include urination problems, erectile dysfunction, or blood in your urine or semen.
7 Radiation therapy
Radiation therapy to the pelvis can result in erectile dysfunction, including pain on ejaculation. These side effects are usually temporary.
8 Psychological issues
In some cases, the cause can’t be determined. If you don’t have pain when you masturbate, it could be emotionally based. Consider seeing a therapist to explore this further.
9 Pudendal neuropathy
Pudendal neuropathy is a condition in which there’s some damage to a nerve in the pelvis. That can lead to genital and rectal pain. Some things that can affect the pudendal nerve are injury, diabetes, and multiple sclerosis (MS).
Some people who experience painful ejaculation may also experience painful urination. When this happens, the cause may be one of these underlying problems:
Many nerves and tissues are involved in both ejaculation and urination. As a result, any conditions, injuries, or procedures that affect this area of the body could result in painful ejaculation and urination.
Painful ejaculation is not dangerous, but it can undermine a man’s quality of life. Men who experience painful ejaculation may also report:
- loss of interest in sex
- relationship issues
- self-esteem issues
- fertility concerns
Treatment for painful ejaculation depends on the cause.
An examination should begin with a complete medical history that includes questions about a man’s mental health and relationships. The doctor will ask about medications used currently and in the past, as well as any current or previous history of STIs. Comprehensive testing for STIs can also be helpful.
A pelvic exam, including a prostate exam, can assess for prostatitis, BPH, and injuries. The doctor may also perform blood work to test for prostate-specific antigen (PSA). This substance tends to rise in men with certain prostate conditions, including prostate cancer.
In most cases, treating the underlying cause also fixes symptoms of painful ejaculation. Some treatment options may include:
- antibiotics to treat a prostate infection or STI
- switching medications if the culprit is a drug
- surgery to treat prostate cancer and other prostate problems
- psychotherapy and lifestyle changes to address relationship and emotional problems
Nerve damage may be irreversible, but a doctor will probably still want to treat the underlying cause. Doing so can prevent nerve damage from getting worse.
When treatment fails, or a doctor cannot figure out the cause, a man can try some alternative strategies that may reduce the pain. Some options include:
- sex therapy
- pelvic floor exercises to strengthen the muscles involved in ejaculation
- pain medication
- muscle-relaxant medications
- anticonvulsant medications