What does it feel like?
Pain during ejaculation is also known as dysejaculation, odynorgasmia, post orgasmic pain, dysorgasmia or orgasmalgia. This can range from mild discomfort to severe pain and can occur during or after ejaculation. The usual sites of pain are the penis (along the shaft or at the tip), scrotum, perineal or perianal area.
The pain can last anywhere from a few minutes up to 24 hours. Dysejaculation can be associated with other sexual dysfunctions. It can significantly impair a person’s quality of life and sex life through reduction of the individual’s self-esteem and sexual desire.
Several studies demonstrated its prevalence between 1–10% in the general population, but this may be underreported due as the discomfort may be transient and mild for some people.The prevalence may increase to 30–75% among men who suffer from chronic prostatitis or chronic pelvic pain syndrome. It is also seen in other conditions mentioned below.
There are a variety of conditions that can result in painful ejaculations, but it can also be an idiopathic problem with no identifiable cause. Sexually transmitted infections, calculi or stones in the seminal vesicles, damage to the pelvic nerves, inflammation of prostate, prostate cancer, benign prostatic hyperplasia, prostate surgery, pelvic radiation, a previous history of hernia repair or rectal intercourse and certain medications such as antidepressants have all been associated with dysorgamia.
Psychological issues may also be the cause of painful ejaculations, especially if the patient does not experience this problem during masturbation. Other rarer causes include heavy metal or mercury toxicity or ciguatera toxin fish poisoning.
Just with all types of sexual problems, the doctor will start with a thorough medical and sexual history. A history regarding sexually transmitted diseases, relationship issues, psychological or psychiatric issues and drug intake will be taken. The doctor will also be keen to assess any urinary symptoms, prostatic diseases, familial prostate cancer, previous surgical procedures (e.g., hernia repair or prostatectomy) and previous history of radiotherapy.
Your doctor may do a prostate exam to look for any pain, swelling or nodules which may indicate a prostate pathology. A neurological and musculoskeletal examination may detect a nervous system pathology.
Investigations your doctor might do include a urine or semen culture looking for any infections, especially with sexually transmitted infections. Blood tests for prostate specific antigen (PSA) levels may be raised if it is a prostate issue. Ultrasound scans may also be ordered. No obvious pathology is detected in a significant number of patients.
Treatment of painful ejaculation should be directed at managing the underlying cause if there is one.
If an infection is detected, antibiotics will be given. Urological procedures may be done for prostate growth or cancers. If drugs are a suspected cause, changing the medications or stopping it can be considered. Your doctor may prescribe medical treatment such as muscle relaxants, α-blockers, anti-inflammatory agents, certain types of antidepressants and neuropathic pain medications to alleviate the symptoms. Psychotherapy or relationship counselling should be conducted for patients with an underlying psychological issue. Behavioural therapies and pelvic floor exercises have also shown to be helpful. Extracorporeal shockwave therapy (ESWT) can be done for pelvic pain and dysorgasmia which can also alleviate the pain.
If you do experience pain during ejaculation, it is important to seek medical attention and treatment to rule out serious causes and before this issue impairs your sexual function and quality of life.
Next read: Dysuria (Painful Urination)