Painful ejaculation, formally termed dysorgasmia or orgasmalgia, is discomfort or a burning sensation during or immediately following orgasm. This pain can manifest in the penis, scrotum, perineum, or lower abdomen, ranging from mild aching to severe agony. While it is a relatively common symptom, experiencing this pain can significantly impact a person’s quality of life and sexual function. The causes for this discomfort are varied, spanning from treatable infections and physical blockages to more complex chronic pain conditions.
Infections and Inflammation of the Reproductive Tract
The most frequent causes of painful ejaculation involve infectious or inflammatory processes within the glands and ducts responsible for producing and transporting semen. The prostate gland, which contributes a significant volume of seminal fluid, is a common site of inflammation, known as prostatitis. Prostatitis can be bacterial, caused by an active infection, or non-bacterial, where inflammation is present without a clear infectious agent.
When the prostate is inflamed, the powerful muscular contractions of the pelvic floor and the prostate itself during ejaculation compress the swollen tissue, resulting in pain. Symptoms of prostatitis often include a frequent or urgent need to urinate, a burning sensation during urination, or general pelvic discomfort. In chronic cases, the pain may be subtle and persistent.
Another common inflammatory condition is epididymitis, which is the inflammation of the epididymis, the coiled tube that stores and transports sperm. This condition is typically caused by a bacterial infection, often from a sexually transmitted infection (STI) or a urinary tract infection (UTI). The inflammation and swelling cause acute, severe scrotal pain that is aggravated by the muscular contractions during ejaculation.
Urethritis, or inflammation of the urethra, also frequently causes a painful or burning sensation during the passage of semen. Irritation of the urethra, often due to STIs like Chlamydia or Gonorrhea, creates discomfort during ejaculation. Since these conditions are often treatable with antibiotics, identifying the specific source of inflammation is a necessary first step in resolving the pain.
Physical Causes and Structural Irritation
Physical obstructions or structural changes in the reproductive tract can create pressure that causes pain during ejaculation. Urethral strictures, which are areas of dense scar tissue that narrow the urethra, impede the flow of semen, causing painful pressure during expulsion. These strictures can develop from prior trauma, injury, or long-term inflammation.
Obstructions can also occur in the ejaculatory ducts or seminal vesicles, the glands that store and produce seminal fluid. The presence of stones (calculi) or cysts can block the normal pathway of the ejaculate. As the muscles contract to force the fluid out, the blockage causes an increase in pressure that translates into localized pain. Seminal vesicle stones are sometimes associated with blood in the semen.
Past surgical procedures in the pelvic area may also lead to structural irritation or scarring that results in dysorgasmia. Examples include radical prostatectomy for prostate cancer or inguinal hernia repair. The physical disruption or scar tissue creates mechanical irritation when the sexual organs are in use.
Chronic Pelvic Pain and Neurological Factors
Painful ejaculation is linked to Chronic Pelvic Pain Syndrome (CPPS), characterized by persistent pelvic discomfort lasting three months or more without an identifiable bacterial infection. This syndrome is complex and often involves nervous system dysfunction and muscle tension. The pain is thought to arise from nerve sensitization, where the pelvic nerves become hypersensitive, signaling pain even with minor triggers like the muscular contractions of ejaculation.
The pelvic floor muscles, which are heavily involved in the expulsive phase of ejaculation, can become chronically tight or spastic in CPPS. This muscular tension can compress nerves, such as the pudendal nerve, leading to pudendal neuropathy. This manifests as persistent pelvic pain and is often aggravated by sitting or ejaculation.
Diagnosing dysorgasmia related to CPPS or neurological factors often occurs after infectious and structural causes have been ruled out. Psychological stress can also play a role, as it is known to increase inflammation and muscle tension in the pelvic region, contributing to the cycle of chronic pain. This type of pain requires a comprehensive, multidisciplinary approach that addresses both the physical and neurological components of the syndrome.
Determining When to See a Doctor
While an occasional, brief episode of discomfort may resolve spontaneously, persistent or worsening painful ejaculation warrants a medical evaluation. Consult a physician, such as a urologist, if the pain lasts longer than a few days or significantly interferes with sexual activity. Certain accompanying symptoms signal the need for more urgent attention, including the presence of blood in the semen (hematospermia) or difficulty urinating.
A fever, chills, or severe lower abdominal pain alongside the dysorgasmia could indicate an acute infection that requires prompt treatment. The diagnostic process typically begins with a detailed medical history and a physical examination, which may include a digital rectal exam to check the prostate. Common tests include a urinalysis and semen analysis to check for signs of infection or inflammation.
To identify the root cause, a doctor may order specialized tests like a urine culture, STI screening, or an ultrasound of the prostate and seminal vesicles to look for cysts, stones, or blockages. The goal of the evaluation is to accurately identify the underlying medical condition since self-diagnosis can be misleading and delay the appropriate treatment.