Painful ejaculation: Causes and Treatment

Painful ejaculation
Medically reviewed by Richard Honaker M.D.

Overview

Are you experiencing pain while ejaculating? Painful ejaculation, also known as dysorgasmia or orgasmalgia, is a condition where males experience a burning sensation or severe pain after ejaculating. It can have severe effects on a person’s sexual activity, emotional well-being, and overall quality of life. There are various medical conditions that can cause painful ejaculations, such as infections, cysts, nerve damage, medications, or cancer. The pain can affect the penis, urethra, testicles, scrotum, rectum, perineum, and lower abdomen. 

Treatment will vary depending on the underlying cause. Prescription medications are required for infections, inflammatory conditions, and toxicity. In severe cases, surgery can help improve painful ejaculations. Therefore, getting a proper diagnosis from a doctor is essential. This blog explores the possible causes and treatments to deal with the burning sensation and pain experienced when ejaculating.

Why does it burn when I ejaculate?

Various reasons, including medical conditions or certain medications, can cause a burning feeling after ejaculation. Men can experience this after the age of 30, but they can present at a younger age due to prostate problems. Here are some of the possible reasons for painful ejaculation.

Infections

Infections are a common cause of painful ejaculations. These infections can be bacterial, fungal, and viral infections in the reproductive and urinary tract

Various sexually transmitted diseases (STDs), such as chlamydia, syphilis, and trichomoniasis, can also cause discomfort during ejaculation. Symptoms may include pain and a burning sensation during ejaculation or urination, pain in the penis, sores and blisters in the genital area, and milky or green discharge. 

While less common in men, lower urinary tract infections (UTIs) can be the source of this pain. E.coli infections and other bacterial UTIs are more common culprits in males. 

“Painful ejaculation is a common problem in men, and the severity of pain can range from mild discomfort to agonizing pain. It impacts the individual’s self-esteem and sexual desire and can significantly reduce the quality of life.”, shares Dr. Richard Honaker

Lower urinary tract infections are one of the leading causes of painful ejaculation.

Inflammatory conditions

Inflammatory conditions of the reproductive tract can cause painful ejaculations. Inflammation usually comes with infections but can also be from non-infectious causes such as surgeries and injuries. Several inflammatory conditions can cause this, including:

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

Prostate disorders

Disorders of the prostate gland lead to swelling and testicular pain after ejaculation. It can be inflammation, enlargement, or unusual growth in the prostate gland.

  • Prostatitis

UTIs and other infections can cause inflammation of the prostate, also known as prostatitis. As a result, other symptoms accompany painful ejaculations, like a burning sensation while urinating, pain in the pelvic area, and, in severe cases, erectile dysfunction and nerve damage. Men with diabetes are more at risk of prostatitis due to nerve damage. Research done in 2016 found 30-75% of painful ejaculations in men were caused by prostatitis.

  • Benign prostate hyperplasia (BPH)

BPH is the enlargement of the prostate, commonly due to a noncancerous tumor. It causes frequent and painful urination and pain when ejaculating.

A study done in 2020 showed that patients with benign prostate hyperplasia (BPH) experience more painful ejaculations as compared to other people. 

  • Prostate cancer

Prostate cancer is the cancerous growth in the prostate gland. It causes testicular pain after ejaculation, blood in semen, blood in urine, pelvic pain, weight loss, and erectile dysfunction. If left untreated, it can spread to other organs. 

Cysts or stones

Cysts, stones, and other obstructions in the ejaculatory duct or urethra can block the tubes, leading to pain after ejaculation. Common obstructions causing pain during ejaculation include

  • Seminal vesicle stones: Hardened mineral deposits in the seminal vesicles
  • Seminal vesicle calculi: Cyst in the ejaculatory duct with impaired drainage. 
  • Ejaculatory duct obstruction: Blockage of the ejaculatory duct

Medication

Certain classes of medications are also associated with painful ejaculations. Antidepressants, specifically tricyclic antidepressants like Amitriptyline(Elavil) and selective serotonin reuptake inhibitors (SSRIs) like Escitalopram (Lexapro), cause painful discharge in men. These medications also cause loss of sex drive (libido) and erectile dysfunction. Muscle relaxants, while uncommon, can also cause painful ejaculation. 

Pudendal neuropathy

The pudendal nerve is the main nerve in the pelvis. Damage to the pudendal nerve (pudendal neuropathy) causes pain when ejaculatory muscles contract, leading to painful orgasms and burning after ejaculation. The damage is caused by conditions like constipation and pelvic fractures or activities like sitting for long periods, cycling, and horse riding. 

Mercury toxicity 

Inhaling mercury vapors can lead to respiratory and reproductive problems. Some symptoms include fatigue, fevers, shortness of breath, and ejaculatory pain. Mercury poisoning more commonly affects welders but consuming large amounts of fish can also lead to mercury poisoning. 

Surgery

Pelvis surgeries can damage the nerves, tissues, and surrounding organs, leading to painful orgasms. The most common procedures responsible for this are vasectomy, surgical removal of the prostate (radical prostatectomy), and surgical repair of hernia (inguinal herniorrhaphy). Complications of getting these procedures done cause testicular and penile pain, erectile dysfunction, and pain when ejaculating. 

Other causes

Other conditions that cause pain when ejaculating as a side effect include:

  • Pelvic radiation for prostate cancer
  • Painful bladder syndrome
  • Psychosocial problems such as anxiety and post-traumatic stress disorder

How to treat painful ejaculation? 

Depending on the underlying health condition, treatment for painful ejaculation is provided. Let’s explore the best-suited option for your condition.

Treatment for infections and inflammation

Different medications are prescribed depending on the source of the infection. If the underlying cause is a bacterial infection, antibiotics are given; antifungals are given for fungal infections, and antivirals for viral ones. 

Gonorrhea, Chlamydia, and other STI infections are treated with antibiotics such as Azithromycin, Amoxicillin, and Doxycycline. Get your partner checked to get them immediate treatment as well. 

Over-the-counter drugs, such as non-steroidal anti-inflammatory drugs, help control inflammation and pain. If the pain becomes unbearable, your doctor may also prescribe pain relievers (analgesics).

STDs can impact a person’s sexual health and lead to infertility. Get proper treatment now!

Treatment for cysts and stones

Cysts and stones in the prostate or reproductive tract require a surgical procedure. For example, blockage in the ejaculatory ducts is surgically removed through a procedure called transurethral resection of the ejaculatory ducts to relieve painful orgasms.

Treatment for side effects of medications

Suddenly, stopping a medication can have severe adverse effects. Don’t suddenly stop taking any medication, such as antidepressants, without your doctor’s supervision. Consult a healthcare provider to find an alternative drug and follow their direction to avoid worsening your condition.

Treatment for pudendal neuropathy

  • Numbing agents, nerve blockers, and steroid injections are given to control the pain-related symptoms. 
  • A physical therapist may recommend pelvic exercises, as the pudendal nerve supports pelvic muscles. Pelvic floor exercises help improve muscle tone, bowel movements, and pain relief.
  • Surgery is performed as a last-case alternative to treat the compressed nerve.

Treatment for mercury toxicity

Chelation therapy is provided over weeks to months if pain when ejaculation is caused by mercury poisoning. Chelating agent medications such as meso-dimercaptosuccinic acid (DMSA) are given over a period to remove the toxic mercury from the body. 

Treatment for psychosocial problems

Psychological and mental health issues look different for all individuals. If an emotional reason is behind painful ejaculation, then seek help from a qualified therapist.

Treatment for prostate cancer

Prostate cancer is commonly slow-growing and can be treated with radiation therapy, chemotherapy, and hormonal therapy. If the tumor is aggressive or in the later stages, surgery may be done to remove the prostate. 

When should I see a doctor?

Experiencing pain when ejaculating is not an everyday occurrence and can be a symptom of a serious underlying health condition. If left untreated, it can affect sexual activity and cause fertility problems and erectile dysfunction. If the cause is cancer or infections, then they can migrate to other organs and lead to life-threatening diseases such as kidney failure. Consult a doctor and get a proper diagnosis and treatment of painful ejaculation. 

10% of men experience painful ejaculation at some point in their life. Get a professional diagnosis within minutes.

FAQs about Painful ejaculation

Why does it burn when I ejaculate but not when I pee?

Enlarged prostate and reproductive disorders cause painful ejaculation. Experiencing pain while peeing is a relatively common symptom of these conditions but may not always be the case.

Why does my left testicle hurt when I ejaculate?

Your testicles are sensitive and can feel a bit sore when you ejaculate. Typically, it is caused by a strained muscle and can go away after resting and abstaining from sexual conduct. If your testicles hurt or you experience consistent discomfort, it may signal a more serious health condition.

Can ejaculating too much cause pain?

Ejaculating too much can cause your genitals to feel sore or swell a little. It is not a source of concern, but if the tingling persists over a couple of days, get it checked out by a doctor.

Your Doctors Online uses high-quality and trustworthy sources to ensure content accuracy and reliability. We rely on peer-reviewed studies, academic research institutions and medical associations to provide up-to-date and evidence-based information to the users.

  • Ilie, Cristian P., Dan L. Mischianu, and Richard J. Pemberton. “Painful ejaculation.” BJU international 99.6 (2007): 1335-1339.
  • Parnham, Arie, and Ege Can Serefoglu. “Retrograde ejaculation, painful ejaculation and hematospermia.” Translational andrology and urology 5.4 (2016): 592.
  • Nickel, J. Curtis, et al. “Benign prostatic hyperplasia (BPH) and prostatitis: prevalence of painful ejaculation in men with clinical BPH.” BJU international 95.4 (2005): 571-574.
  • Sundar, Raghav, and Gaurav Sundar. “Zinner syndrome: an uncommon cause of painful ejaculation.” Case Reports 2015 (2015): bcr2014207618.

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