Painful ejaculation can be caused by conditions such as cystitis, urethritis, prostatitis, or sexually transmitted infections (STIs) like trichomoniasis or chlamydia.
Pain during ejaculation may occur in the glans of the penis, testicles, perineum, pelvic region, or abdomen. It can also be accompanied by other symptoms, such as penile discharge, genital itching, and pain or burning while urinating.
In the case of painful ejaculation, it is important to see a urologist or primary care provider for an evaluation in order to determine a cause and start the appropriate treatment. Depending on the cause, treatment may include antibiotics, anti-inflammatory medications, or, in some cases, surgery.
Possible causes
The most common causes of painful ejaculation are:
1. Cystitis
Cystitis is an infection and inflammation of the bladder that can cause pain during ejaculation, frequent urination, pain during sex, and low-grade fever.
This type of infection is usually caused by Escherichia coli (E. coli), a bacterium that naturally lives in the gut and urinary tract but can multiply and spread to the bladder.
What to do: The doctor may recommend the use of urinary antiseptics such as Cystex, and antibiotics like ciprofloxacin or amoxicillin. Treatment for cystitis can also be complemented with home remedies such as dandelion tea or hibiscus tea.
Also recommended: Top 8 UTI Symptoms in Men (plus How It’s Diagnosed and Treated) tuasaude.com/en/urinary-tract-infection-in-men2. Urethritis
Urethritis is an inflammation or infection of the urethra, the tube that carries urine from the bladder to the outside of the body. Although it affects part of the urinary tract, urethritis is not considered a typical urinary tract infection (UTI), as it is most often caused by sexually transmitted infections (STIs) such as Neisseria gonorrhoeae or Chlamydia trachomatis.
This condition can cause symptoms such as pain during ejaculation, yellowish-green, white, or bloody discharge, genital itching, and pain or burning while urinating.
What to do: Treatment depends on the underlying cause and typically involves antibiotics such as azithromycin, doxycycline, or ceftriaxone, as prescribed by a doctor. It is important that sexual partners are also treated to prevent reinfection.
3. Prostatitis
Painful ejaculation is one of the symptoms of prostatitis, an inflammation of the prostate that can cause the gland to enlarge. Other symptoms may include pain when urinating, fever, and dark urine.
What to do: The urologist may prescribe antibiotics in tablet form or, in more severe cases, intravenous antibiotics administered in a hospital setting. Pain relievers, anti-inflammatory drugs, or alpha-blockers may also be recommended to help relieve symptoms.
4. Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) occurs when the prostate becomes enlarged, leading to symptoms such as frequent urination, painful ejaculation, and difficulty emptying the bladder completely.
What to do: Treatment usually involves medications such as tamsulosin, finasteride, or tadalafil, which help relax the bladder and prostate muscles, reduce prostate size, and ease symptoms.
If symptoms do not improve with medication, surgery to remove part of the prostate (transurethral resection or laparoscopic surgery) may be recommended.
Also recommended: Enlarged Prostate: Symptoms (with Online Checker) & Treatment tuasaude.com/en/enlarged-prostate5. Sexually transmitted infections
Sexually transmitted infections (STIs), such as chlamydia and trichomoniasis, can cause pain during ejaculation or urination, as well as foul-smelling discharge, genital itching, and pelvic or abdominal pain.
What to do: Treatment for chlamydia usually includes antibiotics like azithromycin or doxycycline. For trichomoniasis, the doctor may prescribe metronidazole or tinidazole. Both partners should be treated at the same time to prevent reinfection.
6. Prostate cancer
Painful ejaculation can also be one of the symptoms of prostate cancer. This condition is a malignant tumor that can cause difficulty urinating, a constant sensation of a full bladder, and pain when urinating.
What to do: The doctor may recommend surgery to remove the prostate, followed by radiation therapy to complement treatment. Chemotherapy may also be indicated in more advanced stages of prostate cancer.
7. Side effects of medications
Certain antidepressants, such as desipramine, clomipramine, protriptyline, amoxapine, fluoxetine, and venlafaxine, can cause pain during ejaculation as a side effect.
In addition, some muscle relaxants, such as cyclobenzaprine, may also lead to this symptom.
What to do: It is important to consult to the prescribing provider to determine whether the dosage needs to be adjusted or if it is possible to switch to another medication.
8. Surgeries
Vasectomy is a surgical procedure that can occasionally cause painful ejaculation, typically affecting the scrotum.
Similarly, inguinal hernia repair, especially when performed with polypropylene mesh, may lead to nerve or duct injury that results in chronic pain during ejaculation.
What to do: In cases of post-vasectomy pain, a doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, or neurotropic agents. If medication does not provide relief, surgical options such as vasectomy reversal, epididymectomy, or microsurgical denervation of the spermatic cord may be considered.
For pain following inguinal hernia surgery, the doctor may recommend surgery to remove the mesh or perform a procedure to release the spermatic cord.
9. Epididymitis
Painful ejaculation can also occur due to epididymitis, an inflammation of the epididymis, a small duct that connects the vas deferens to the testicle and stores sperm.
Epididymitis can also cause swelling of the scrotum and pain in the genital area, especially when walking or moving.
What to do: A urologist may prescribe anti-inflammatory and pain-relief medications such as ibuprofen or acetaminophen, along with antibiotics like doxycycline, ciprofloxacin, or ceftriaxone.
Resting, avoiding heavy lifting, and applying ice packs to the area can help reduce symptoms.
10. Ejaculatory duct obstruction
Ejaculatory duct obstruction is a rare condition that can be caused by congenital malformations, stones, fibrosis following prostatitis or seminal vesiculitis, or scarring after prostate surgery.
This condition can cause symptoms such as pain during ejaculation, reduced or absent ejaculation, infertility, blood in the semen, and pelvic pain.
What to do: Treatment may involve surgery to remove the obstructed ducts or a procedure called seminal vesiculoscopy, which is used to remove stones from the seminal vesicles.