Painful Ejaculation

Some male might have experienced this issue, a pain following orgasm or following ejaculation on a few separate occasions. Some of us when they experience such symptoms will take it as a trivial matter and won’t pay a lot of attention to it. So, if you ever experienced such signs, and you wondered what can be the reason for this recurrent pain that disturbed your joy, well this article is for you.

Although it may sound like unheard of topic, painful ejaculation (PEJs), dysorgasmia, orgasmalgia also referred to as post-orgasmic pain; have been described many decades ago and it’s considered as a sexual dysfunction component as it significantly affects the emotional and physical satisfaction of sexual intercourse, and as result it will lead to avoid intercourse which will eventually affect relationships and marriages in 88-91% of affected individuals.

Painful ejaculation has not been properly reported; thus, numbers of incidence or prevalence have not been consistent in medical studies reviewing this topic. However, those reviews had mentioned occurrence rates that ranged between 1-9%. The condition was more prevalent in individuals who had medical conditions like prostate enlargement (benign prostatic hypertrophy BPH) 17% or inflammation of prostate (prostatitis) 58%.

So, what are the possible causes for painful ejaculation?

As mentioned earlier, causes for painful ejaculation are not well understood and there have been many speculations regarding the probable medical and pathological conditions leading to this issue. Among those conditions are:

  1. Prostatitis: Prostatitis or inflammation of the prostate gland is one of the common pathologies that are associated with painful ejaculation. Person may have a wide range of symptoms ranging between lower abdomen, penile or scrotal pain. Symptoms of urinary tract infection such as urgency, frequency and painful urination, other symptoms are painful ejaculation that can occur in 30-75% of the patients who suffer from chronic prostatitis.
  2. Benign Prostatic Hypertrophy (BPH): BPH is a very common condition in men above 45 year-old. About 5-19% of individuals suffering from BPH may experience pain or discomfort on ejaculation, those patients who had worst BPH symptoms that others usually experienced more severe and frequent painful ejaculation than others. It has also been recorded that 16% of those patients with BPH might have exhibited symptoms of prostatitis during that for one reason or another might have gone through without being detected.
  3. Pudendal nerve neuropathy: Pudendal nerve is one of the major nerves supplying the pelvic region, the nerve passes through a designated canal in the pelvis. Nerve entrapment or compression  will lead to unspecific pain that can radiate to the tip of the penis, testicles, and around the anal opening. Reason for nerve compression can be due to physical activity such as frequent sit ups, leg presses, climbing or even pelvic movement during intercourse. Those patients usually will not show any sign of infection previously. Some conditions such as prostate cancer that cause prolonged nerve compression will lead to similar outcomes. Patients who suffer from diabetes might suffer from pelvic pains and as well as PEJs due to pudendal neuropathy.
  4. Stones: Occasionally stones might develop in the seminal vesicles (glands secreting fluid that composes part of the semen) and the ejaculatory ducts. The pain is due to the obstruction caused by those stones, and they usually develop following inflammation of those glands.
  5. Medications: Groups of medications including antidepressants, premature ejaculation (selective serotonin reuptake inhibitors/ SSRIs) and BPH (Benign Prostatic Hypertrophy) medications are known to possibly cause ejaculation pain as part of their side effects, among other side effects are loss of libido and erectile dysfunction.
  6. Surgery: History of operation to the pelvis that might result in damage to the pudendal nerve that is usually associated with long-term “chronic” pelvic pain. Radical prostatectomy has been described to result in orgasmalgia. Pelvic radiation might lead to identical issues.
  7. Sexually Transmitted Infection (STIs): Wide range of STIs can lead to painful ejaculation among usual causes are chlamydia and trichomoniasis.
  8. Miscellaneous: Some individuals suffer from painful ejaculation occasionally, those usually won’t manifest the symptoms, this can be attributed to psychological reasons such as problems in relationship, depression, stress and anxiety as well. Some have suggested mercury toxicity or ciguatera fish toxicity. Diagnosis of orgasmic or ejaculatory pain is important as it may affect relationships and lead to low self-esteem as well as infertility due to loss interest in sex.

How to manage PEJs?

Individuals who experience such problems should consult their physicians. Your doctor in return will have to acquire a detailed history, medication taken and previous surgeries should be properly investigated. Previous exposure to sexually transmitted infections, symptoms of prostatitis and BPH should be excluded.

In presence of mixed symptoms; relative investigations have to be carried out to determine the most likely cause. Management varies in accordance to underlying pathology.

Most of the studies published with regards to a painful ejaculation have reported that patients will respond well to treatment with tamsulosin (an alpha blocker used to relax the prostate in BPH and prostatitis). Other studies have published good responses of patients who have PEJs secondary to nerve damage or compression to analgesics or by image guided block of the compressed or damaged nerve.

Patients who have ejaculatory duct or seminal vesicle blockage can be treated with surgical excision of the blocked vesicle or balloon dilatation of the ducts. Patients who are believed to suffer from nerve compression due to excessive exercise are advised to modify their lifestyle or to refrain from certain training or movements that aggravate the issue. Those individuals will notice a gradual improvement of the condition.

Finally, we understand that such issue can be a source of embarrassment and may be hard to talk about or reach out to ask for assistance or advise, thus talking to a professional will be a good first step towards finding a solution.

Next read: Premature Ejaculation

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