Table of ContentsView AllTable of ContentsSymptomsCausesTreatmentDiagnosisWhen to See a Healthcare ProviderFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Treatment
Diagnosis
When to See a Healthcare Provider
Frequently Asked Questions
It can be alarming to experience pain withejaculation. 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 inacute(sudden and short-lasting) episodes or on achronic(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.
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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:
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, andperineum(the space between the anus and genitals).
What Is Dysorgasmia Pain Like?With male dysorgasmia, the ejaculation pain can range in severity from a dull ache to excruciating pain depending on the underlying cause. The pain may last for a few seconds or up to two days.
What Is Dysorgasmia Pain Like?
With male dysorgasmia, the ejaculation pain can range in severity from a dull ache to excruciating pain depending on the underlying cause. The pain may last for a few seconds or up to two days.
In addition to pain, there may also be evidence of blood in semen, referred to ashematospermia.
What differentiates dysorgasmia from other types of pain in themale reproductive tractis that the pain arises as the direct result oforgasm and ejaculation.
Possible Causes of Testicle Pain
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 journalCureusreported that 1 in 4 males experience painful ejaculation as part of alower urinary tract infection.
Lower urinary tract infections are those that involve the bladder, bladder neck, urethra, prostate gland, and muscles calledurinary sphinctersthat regulate the flow of urine.
How Urinary Tract Infections Differ in Men
Inflammatory Conditions
Bacterial, viral, or fungal infections can affect the male reproductive tract, including the testicles, prostate, urethra, andepididymis(the narrow tubes through which sperm exit the testicles). These includesexually transmitted infections (STIs)likechlamydia,gonorrhea,syphilis, andtrichomoniasis.
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 triggerinflammationin different reproductive organs, leading to:
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.
Chronic Prostatitis and Painful EjaculationAccording to a 2018 review inTranslational Andrology and Urology,no less than 30% of people with chronic prostatitis, also known as chronic pelvic pain syndrome (CPPS), experience painful ejaculation.
Chronic Prostatitis and Painful Ejaculation
According to a 2018 review inTranslational Andrology and Urology,no less than 30% of people with chronic prostatitis, also known as chronic pelvic pain syndrome (CPPS), experience painful ejaculation.
What’s Causing My Abdominal Pain When Peeing? 14 Potential Reasons
Enlarged Prostate
An enlarged prostate, also known asbenign prostatic hyperplasia(BPH), is a condition commonly affecting older males that can causepain with urination,frequent urination,nighttime urination, and other urinary symptoms.Prostate enlargement can also cause pain after ejaculation.
Do I Have an Enlarged Prostate or Prostate Cancer?
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:
Pudendal Neuropathy
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.
Tricyclic antidepressantsandselective serotonin reuptake inhibitors (SSRIs)are the two classes most commonly associated with painful ejaculation. Other sexual side effects include aloss of libido(sex drive) anderectile dysfunction(inability to achieve or maintain an erection sufficient for penetration).
Antidepressants known to cause male dysorgasmia include:
Muscle relaxants with a similar chemical structure to tricyclic antidepressants, such as Flexeril (cyclobenzaprine), have also been known to cause painful ejaculation.
Drugs That Cause Erectile Dysfunction
How to Treat Painful Ejaculation
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 prescribemuscle relaxants,pelvic floor muscle exercises,anticonvulsant drugs, oropioid drugsto help minimize symptoms.
The following chart outlines some of the options used to treat the underlying causes of painful ejaculation.
What Is the Cause of Delayed 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 adigital 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:
Additional tests may be ordered based on the findings.
Who Diagnoses Painful Ejaculation?
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 theuretersandkidneys). If left untreated, these types of infections can lead to kidney damage,acute kidney failure, andsepsis(a potentially life-threatening inflammatory reaction to infection).
When to Call 911
Summary
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.
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.
What to Know About Telehealth With a Urologist
Frequently Asked QuestionsThere is a condition called epididymal hypertension—better known as “blue balls”—that can cause blood to build up in the testicles after prolonged sexual abstinence. Symptoms include a dull ache or pain and a feeling of heaviness in the testicles. Painful ejaculation is typically not a symptom and, in fact, can relieve pain once you have had an orgasm.Learn MoreWhat Are Blue Balls?It is possible to develop cysts or stones in the ejaculatory ducts that deliver sperm to the urethra. If these are blocked, infertility and painful ejaculation may occur. With that said, ejaculatory duct obstruction is a rare and reversible cause of male infertility.Yes. Anywhere from 30% to 75% of males with chronic prostatitis will experience persistent painful ejaculation.Also known as chronic pelvic pain syndrome (CPPS), the condition tends to affect younger men, causing pain in the genitals and groin that can sometimes be unrelenting.Learn MoreChronic Pelvic Pain Syndrome
There is a condition called epididymal hypertension—better known as “blue balls”—that can cause blood to build up in the testicles after prolonged sexual abstinence. Symptoms include a dull ache or pain and a feeling of heaviness in the testicles. Painful ejaculation is typically not a symptom and, in fact, can relieve pain once you have had an orgasm.Learn MoreWhat Are Blue Balls?
There is a condition called epididymal hypertension—better known as “blue balls”—that can cause blood to build up in the testicles after prolonged sexual abstinence. Symptoms include a dull ache or pain and a feeling of heaviness in the testicles. Painful ejaculation is typically not a symptom and, in fact, can relieve pain once you have had an orgasm.
Learn MoreWhat Are Blue Balls?
It is possible to develop cysts or stones in the ejaculatory ducts that deliver sperm to the urethra. If these are blocked, infertility and painful ejaculation may occur. With that said, ejaculatory duct obstruction is a rare and reversible cause of male infertility.
Yes. Anywhere from 30% to 75% of males with chronic prostatitis will experience persistent painful ejaculation.Also known as chronic pelvic pain syndrome (CPPS), the condition tends to affect younger men, causing pain in the genitals and groin that can sometimes be unrelenting.Learn MoreChronic Pelvic Pain Syndrome
Yes. Anywhere from 30% to 75% of males with chronic prostatitis will experience persistent painful ejaculation.Also known as chronic pelvic pain syndrome (CPPS), the condition tends to affect younger men, causing pain in the genitals and groin that can sometimes be unrelenting.
Learn MoreChronic Pelvic Pain Syndrome
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gray M, Zillioux J, Khourdaji I, Smith RP.Contemporary management of ejaculatory dysfunction.Transl Androl Urol.2018;7(4):686–702. doi:10.21037/tau.2018.06.20Parnham A, Serefoglu EC.Retrograde ejaculation, painful ejaculation and hematospermia.Transl Androl Urol.2016;592:601. doi:10.21037/tau.2016.06.05Wagar M, Omar K, Moubasher A, Brunckhorst O, Ahmed K.Painful ejaculation - an ignored symptom.Cureus. 2020;12(10):e11253. doi:10.7759/cureus.11253Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ.Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nat Rev Microbiol. 2015;13(5):269–284. doi:10.1038/nrmicro3432National Institute of Diabetes and Digestive and Kidney Diseases.Definition and facts of bladder infection in adults.McConaghy JR, Panchal B.Epididymitis: an overview.AFP. 2016;94(9):723-726.National Institute of Diabetes and Digestive and Kidney Diseases.Prostate enlargement (benign prostatic hyperplasia).Aoun F, Alkassis M, Abi Tayeh G, et al.Sexual dysfunction due to pudendal neuralgia: a systematic review.Transl Androl Urol.2021;10(6):2500–2511. doi:10.21037/tau-21-13Rothmore J.Antidepressant-induced sexual dysfunction.Med J Aust.2020;212(7):329-34. doi:10.5694/mja2.50522Kraus MB, Wie CS, Gorlin AW, Wisenbaugh ES, Rosenfeld DM.Painful ejaculation with cyclobenzaprine: a case report and literature review.Sex Med.2015;3:343–345. doi:10.1002/sm2.93Chiles KA.Musings on male dysorgasmia.J Sex Med. 2017;14(4):489-490. doi:10.1016/j.jsxm.2017.01.019National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of urinary retention.Ayad BM, Van der Horst G, S Du Plessis S.Revisiting the relationship between the ejaculatory abstinence period and semen characteristics.Int J Fertil Steril. 2018;11(4). doi:10.22074/ijfs.2018.5192Modgil V, Rai S, Ralph D, et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol.2016;13:13-20. doi:10.1038/nrurol.2015.276Zhang J, Liang CZ, Shang X, Li H.Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis.Am J Mens Health.2020 Jan-Feb;14(1):1557988320903200. doi:10.1177/1557988320903200
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gray M, Zillioux J, Khourdaji I, Smith RP.Contemporary management of ejaculatory dysfunction.Transl Androl Urol.2018;7(4):686–702. doi:10.21037/tau.2018.06.20Parnham A, Serefoglu EC.Retrograde ejaculation, painful ejaculation and hematospermia.Transl Androl Urol.2016;592:601. doi:10.21037/tau.2016.06.05Wagar M, Omar K, Moubasher A, Brunckhorst O, Ahmed K.Painful ejaculation - an ignored symptom.Cureus. 2020;12(10):e11253. doi:10.7759/cureus.11253Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ.Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nat Rev Microbiol. 2015;13(5):269–284. doi:10.1038/nrmicro3432National Institute of Diabetes and Digestive and Kidney Diseases.Definition and facts of bladder infection in adults.McConaghy JR, Panchal B.Epididymitis: an overview.AFP. 2016;94(9):723-726.National Institute of Diabetes and Digestive and Kidney Diseases.Prostate enlargement (benign prostatic hyperplasia).Aoun F, Alkassis M, Abi Tayeh G, et al.Sexual dysfunction due to pudendal neuralgia: a systematic review.Transl Androl Urol.2021;10(6):2500–2511. doi:10.21037/tau-21-13Rothmore J.Antidepressant-induced sexual dysfunction.Med J Aust.2020;212(7):329-34. doi:10.5694/mja2.50522Kraus MB, Wie CS, Gorlin AW, Wisenbaugh ES, Rosenfeld DM.Painful ejaculation with cyclobenzaprine: a case report and literature review.Sex Med.2015;3:343–345. doi:10.1002/sm2.93Chiles KA.Musings on male dysorgasmia.J Sex Med. 2017;14(4):489-490. doi:10.1016/j.jsxm.2017.01.019National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of urinary retention.Ayad BM, Van der Horst G, S Du Plessis S.Revisiting the relationship between the ejaculatory abstinence period and semen characteristics.Int J Fertil Steril. 2018;11(4). doi:10.22074/ijfs.2018.5192Modgil V, Rai S, Ralph D, et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol.2016;13:13-20. doi:10.1038/nrurol.2015.276Zhang J, Liang CZ, Shang X, Li H.Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis.Am J Mens Health.2020 Jan-Feb;14(1):1557988320903200. doi:10.1177/1557988320903200
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gray M, Zillioux J, Khourdaji I, Smith RP.Contemporary management of ejaculatory dysfunction.Transl Androl Urol.2018;7(4):686–702. doi:10.21037/tau.2018.06.20Parnham A, Serefoglu EC.Retrograde ejaculation, painful ejaculation and hematospermia.Transl Androl Urol.2016;592:601. doi:10.21037/tau.2016.06.05Wagar M, Omar K, Moubasher A, Brunckhorst O, Ahmed K.Painful ejaculation - an ignored symptom.Cureus. 2020;12(10):e11253. doi:10.7759/cureus.11253Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ.Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nat Rev Microbiol. 2015;13(5):269–284. doi:10.1038/nrmicro3432National Institute of Diabetes and Digestive and Kidney Diseases.Definition and facts of bladder infection in adults.McConaghy JR, Panchal B.Epididymitis: an overview.AFP. 2016;94(9):723-726.National Institute of Diabetes and Digestive and Kidney Diseases.Prostate enlargement (benign prostatic hyperplasia).Aoun F, Alkassis M, Abi Tayeh G, et al.Sexual dysfunction due to pudendal neuralgia: a systematic review.Transl Androl Urol.2021;10(6):2500–2511. doi:10.21037/tau-21-13Rothmore J.Antidepressant-induced sexual dysfunction.Med J Aust.2020;212(7):329-34. doi:10.5694/mja2.50522Kraus MB, Wie CS, Gorlin AW, Wisenbaugh ES, Rosenfeld DM.Painful ejaculation with cyclobenzaprine: a case report and literature review.Sex Med.2015;3:343–345. doi:10.1002/sm2.93Chiles KA.Musings on male dysorgasmia.J Sex Med. 2017;14(4):489-490. doi:10.1016/j.jsxm.2017.01.019National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of urinary retention.Ayad BM, Van der Horst G, S Du Plessis S.Revisiting the relationship between the ejaculatory abstinence period and semen characteristics.Int J Fertil Steril. 2018;11(4). doi:10.22074/ijfs.2018.5192Modgil V, Rai S, Ralph D, et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol.2016;13:13-20. doi:10.1038/nrurol.2015.276Zhang J, Liang CZ, Shang X, Li H.Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis.Am J Mens Health.2020 Jan-Feb;14(1):1557988320903200. doi:10.1177/1557988320903200
Gray M, Zillioux J, Khourdaji I, Smith RP.Contemporary management of ejaculatory dysfunction.Transl Androl Urol.2018;7(4):686–702. doi:10.21037/tau.2018.06.20
Parnham A, Serefoglu EC.Retrograde ejaculation, painful ejaculation and hematospermia.Transl Androl Urol.2016;592:601. doi:10.21037/tau.2016.06.05
Wagar M, Omar K, Moubasher A, Brunckhorst O, Ahmed K.Painful ejaculation - an ignored symptom.Cureus. 2020;12(10):e11253. doi:10.7759/cureus.11253
Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ.Urinary tract infections: epidemiology, mechanisms of infection and treatment options.Nat Rev Microbiol. 2015;13(5):269–284. doi:10.1038/nrmicro3432
National Institute of Diabetes and Digestive and Kidney Diseases.Definition and facts of bladder infection in adults.
McConaghy JR, Panchal B.Epididymitis: an overview.AFP. 2016;94(9):723-726.
National Institute of Diabetes and Digestive and Kidney Diseases.Prostate enlargement (benign prostatic hyperplasia).
Aoun F, Alkassis M, Abi Tayeh G, et al.Sexual dysfunction due to pudendal neuralgia: a systematic review.Transl Androl Urol.2021;10(6):2500–2511. doi:10.21037/tau-21-13
Rothmore J.Antidepressant-induced sexual dysfunction.Med J Aust.2020;212(7):329-34. doi:10.5694/mja2.50522
Kraus MB, Wie CS, Gorlin AW, Wisenbaugh ES, Rosenfeld DM.Painful ejaculation with cyclobenzaprine: a case report and literature review.Sex Med.2015;3:343–345. doi:10.1002/sm2.93
Chiles KA.Musings on male dysorgasmia.J Sex Med. 2017;14(4):489-490. doi:10.1016/j.jsxm.2017.01.019
National Institute of Diabetes and Digestive and Kidney Diseases.Symptoms & causes of urinary retention.
Ayad BM, Van der Horst G, S Du Plessis S.Revisiting the relationship between the ejaculatory abstinence period and semen characteristics.Int J Fertil Steril. 2018;11(4). doi:10.22074/ijfs.2018.5192
Modgil V, Rai S, Ralph D, et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol.2016;13:13-20. doi:10.1038/nrurol.2015.276
Zhang J, Liang CZ, Shang X, Li H.Chronic prostatitis/chronic pelvic pain syndrome: a disease or symptom? Current perspectives on diagnosis, treatment, and prognosis.Am J Mens Health.2020 Jan-Feb;14(1):1557988320903200. doi:10.1177/1557988320903200
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