Painful ejaculation is a symptom that can impact both sexual and mental well-being. Painful ejaculation not only involves pain in the penis, but also in the scrotum, perineum, and perianal region. While there are multiple causes for painful ejaculation, the symptom is one of the most important urological concerns in men, with nearly 10% of men experiencing this symptom at least once in their lives. Apart from a marked impact on sex life, painful ejaculation also impacts self-esteem, mental health, and relationships negatively. 

Painful ejaculation includes painful sensations during sex and leading up to ejaculation, during ejaculation, and also pain post ejaculation. While STDs are among the possibilities that can lead to painful ejaculation, the symptom is linked with a broad set of underlying causes which makes it necessary to visit a qualified medical professional to get diagnosed accurately. Since the penile and perineal region is also linked to the urinary system, considerations are often multi-disciplinary. Read on as we discuss what can cause painful ejaculation, the factors behind them, and treatment modalities.

Painful Ejaculation Causes & Their Symptoms

Some of the most important causes of painful ejaculation include: 

1. Prostatitis and Other Prostate Issues

• Prostatitis, or the inflammation of the prostate gland, can result in painful ejaculation, alongside frequent and painful urination. 
• The prostate is located between the urinary bladder and the penile region. 
• The most common cause of prostatitis involves infection by bacteria, which can either be a standalone prostate infection or due to an extensive urinary tract infection involving the prostate gland. 
• Other rare disorders such as benign prostate hyperplasia - a non-cancerous enlargement of the prostate gland - also result in painful ejaculation and difficulty in urinating, coupled with pain. 
• More serious forms of prostate enlargement due to prostate cancer too can cause painful ejaculation and urinary issues. 
• Pelvic pain, painful urination, erectile dysfunction, and a sensation to urinate frequently are coupled with painful ejaculation when the cause is either prostatitis or other prostate issues. 

2. Sexually Transmitted Infections

• Several bacterial and protozoal sexually transmitted infections can manifest symptoms such as painful ejaculation. 
• If you’re wondering what can cause painful ejaculation, STIs are among the most common causes.
• So what STD causes painful ejaculation? Bacterial infections such as gonorrhea, syphilis, and chlamydia are known to cause painful ejaculation as a symptom. 
• Burning after ejaculation is another significant symptom coupled with pain when you’re dealing with an STI. 
• Protozoal STIs such as trichomoniasis also cause burning after ejaculation, in case you’ve had questions like ‘Why does it burn when I ejaculate?’. 
• Alongside painful ejaculation, people infected with STIs can also encounter painful urination; yellow, green, or white discharge from the urethra; sores and blisters in and around the penis, and pelvic pain. 

3. Cysts & Calculi

• The development of cysts and calculi (stones) in the ejaculatory duct is not uncommon. 
• Cysts and calculi can obstruct the duct, leading to intense pain during ejaculation. 
• The blockage of the duct leads to increased pressure in the area. 
• Sometimes, the cysts and calculi can also impinge on a nearby nerve, leading to increased and sometimes chronic pain in the penile region. 
• Cysts and calculi in the ejaculatory duct can also cause infertility. 
• Painful ejaculation coupled with burning, perineal pain, and discomfort is common in cases of cysts and calculi in the ejaculatory duct. 

4. Surgical Complications

• Complications arising from surgery in the pelvic and groin region can lead to symptoms such as painful ejaculation. 
• Postoperative complications are not uncommon, especially in surgeries like partial or complete prostatectomy. The surgery is performed in cases of prostate cancer. However, complications in the postoperative phase include painful ejaculation & penile pain, alongside erectile dysfunction. 
• The removal of an inguinal hernia can also lead to complications such as painful ejaculation in the postoperative phase. Potential causes include nerve damage during the procedure, leading to painful ejaculation. 
• The blockage of the ejaculatory ducts following these surgeries is also not uncommon - another cause of painful ejaculation. 
• Erectile dysfunction and pelvic pain are also known complications alongside painful ejaculation following surgery in the region. 

5. Radiotherapy

• Radiation therapy in the pelvic region can cause complications that involve painful ejaculation. 
• Radiotherapy is one of the modalities doctors use to manage prostate cancer in some cases. 
• However, the side effects of the procedures can sometimes cause damage to the surrounding structures, leading to complications such as painful ejaculation in some patients. 
• Burning sensations, pelvic pain, and painful urination are observed along with painful ejaculation in complications arising from radiation therapy for managing prostate cancer. 

6. Cystitis

• While cystitis is an infection that’s more common in women, it can also occur in men, leading to symptoms like painful ejaculation. 
• Cystitis is an infection of the urinary bladder that primarily results in impaired and painful urination, however, the referred pain in the pelvic area can also cause painful ejaculation in men. 
• Inflammation of the bladder can also lead to lower abdominal pain, fever, malaise, and severe pelvic discomfort. 
• Alongside painful urination and ejaculation, symptoms include cloudy & turbid urine, foul-smelling urine, blood in the urine, and a frequent urge to urinate. 

7. Orchitis

• Orchitis is the infection and subsequent inflammation of the testicles. 
• The testicles become enlarged and are painful, causing generalized groin and pelvic pain. 
• Common causes of orchitis involve bacterial and viral infections. These also include sexually transmitted infections. 
• Due to the similarity of symptoms with a serious injury called testicular torsion, immediate medical attention might be required in case you notice swelling and pain in your testicles. 
• The infection might sometimes also involve the epididymis - a tubular organ that transports sperm cells and stores them in the testes. 
• Based on the cause of orchitis, the treatment modality becomes variable, ranging from antibiotic therapy to even surgery. 
• Symptoms of orchitis apart from painful testicles & painful ejaculation include nausea, vomiting, lower abdominal & pelvic pain, fever, malaise, and painful urination.

8. Side Effects from Medications 

• Medications used to treat depression and other mental health problems can sometimes lead to side effects such as painful ejaculation and overall sexual dysfunction. 
• Painful ejaculation, loss of sex drive, and erectile dysfunction are some of the most commonly reported side effects relevant to the urinary and sexual organs due to antidepressants. 
• Individuals on a regular prescription of SSRIs, monoamine oxidase inhibitors, and tri & tetracyclic antidepressants can experience these side effects, depending on both the dosage and individual bodily idiosyncrasies. 
• Painful ejaculation and erectile dysfunction are most commonly reported as side effects upon regular consumption of these medications. 

9. Pudendal Neuropathy

• Injury or damage to the pudendal nerve can cause pelvic and perineal pain. 
• Sometimes an injury to this nerve also manifests as pain during ejaculation.
• Pudendal neuropathy can occur due to several reasons. Some of these include injury during surgical procedures, multiple sclerosis, and even diabetic neuropathy affecting the nerve. 
• The injury also results in burning pain and a burning sensation either during or after ejaculation. 
• The condition can also lead to pelvic pain, pain during urination and defecation, and discomfort, apart from painful ejaculation. 

10. Urethral Stricture

• Urethral stricture is a condition that entails the blockage of the urethra due to scar tissue. 
• Scar tissue can develop either due to injury or because of persistent irritation and inflammation. 
• Stricture results in painful urination and ejaculation since blockages in the urethra also affect the ejection of semen in the penis. 
• Scarring can also occur due to surgical procedures involving the penis and urethra, a history of sexually transmitted infections, and multiple catheters. 
• The blockage from stricture can either be partial or total, leading to pressure and pain during orgasms and ejaculation. 

11. Psychological Issues

• Apart from physical factors leading to painful ejaculation, several psychological and mental health concerns too can lead to these symptoms. 
• Psychological issues such as stress, anxiety, and depression can lead to symptoms such as low libido, erectile dysfunction, and even painful ejaculation in some cases.
• Your doctor will investigate any underlying mental issues in case physical reasons for painful ejaculation are absent. 
• Serious mental health concerns such as post-traumatic stress disorder (PTSD), and a history of major depressive disorder can also cause impediments to sexual drive and health, one of them being painful ejaculation among other physical symptoms. 

Diagnosis

• Your doctor will first begin by conducting a detailed physical examination, which will be supplemented by the recording of a comprehensive medical, surgical, and family history. 
• In addition to the examination, your doctor might recommend imaging investigations such as ultrasound, X-ray, CT scans, and in some cases an MRI. 
• For prostate examinations, the doctor might suggest a digital rectal examination to assess prostate health. 
• Alongside these investigations, your doctor might even suggest an STD panel and a blood examination. 
• A complete urine examination and urine culture might also be done to rule out diseases such as UTIs and cystitis. 
• Your doctor might conduct further testing following the preliminary tests to arrive at a definitive diagnosis for the cause of your painful ejaculation.

Make sure to visit our website for a detailed look at the preliminary and advanced tests we provide to help you zero in on the cause of your painful ejaculation and related symptoms. Our patient testing process is designed to make your experience at our patient service centers seamless and pain-free.

Treatment & Outlook

• The treatment for painful ejaculation is tied to the causative illness. Resolution of the causative illness leads to eventual relief from painful ejaculation and its related symptoms. 
• In case it is caused due to infections, the doctor will prescribe antibiotics or antimicrobials depending on the pathogen behind the infection. 
• For serious illnesses such as prostate cancer or prostate enlargement, doctors might take both a medical and surgical approach to resolve the issue. 
• For painful ejaculation arising from psychosomatic causes and mental illness, the treatment approach involves addressing the underlying mental health condition to bring about overall improvement in physical and sexual health. 
• Painful ejaculation and its related symptoms can sometimes indicate an emergency depending on the intensity of the pain, be sure to visit the ER in case you experience intense pain during or after ejaculation, or are faced with symptoms like pelvic and perineal discomfort.