Pain With Ejaculation Has a Number of Causes

When something "hurts so good," it's usually a positive experience, something you'd want to do again. A particularly intense orgasm would qualify. But what if that same activity suddenly just hurts?

If you regularly experience pain with what should be an act of pleasure, don't chalk it up to something out of "Fifty Shades." Instead, see a doctor to uncover the issue.

Once you've identified when and where the pain is occurring, you can work more effectively with a doctor to help determine the cause of the pain.

Someone could have pain with ejaculation for a variety of reasons, and, as is the case with many aspects of the reproductive system, timing means a lot. Here's more on what you need to know if it hurts when you ejaculate.

Timing is everything

The first thing you want to do if it hurts when you ejaculate is to identify when and where the pain is occurring, according to Mohit Khera, M.D., MBA, MPH, a professor of urology at Baylor College of Medicine who specializes in male and female sexual dysfunction and male infertility.

Khera noted a difference between pain that occurs during ejaculation and pain that occurs immediately afterward. While pain that happens in the moment warrants a closer evaluation by a doctor, pain after climaxing might be less worrisome.

He explained pain after ejaculation could happen as a natural result of an orgasm—scientifically speaking, an involuntary contraction and release of muscles—and lead to discomfort in the penis or testicles, or in the perineum as a result of spasms of the perineal muscles. The perineum is the area between the genitals and the anus.

"The muscles can spasm quite vigorously, which can cause some discomfort, as well," Khera said.

Once you've identified when and where the pain is occurring, you can work more effectively with a doctor to help determine the cause of the pain. There are a few possible explanations behind pain that accompanies ejaculation.

Infection

One of the primary causes of pain with ejaculation is an infection, according to Khera. A urinary tract infection (UTI) or a seminal fluid infection could be the culprit.

Blood in your semen may be another sign an infection is present. A doctor can take a culture of your urine or seminal fluid to check for the presence of bacteria.

A prostate problem

Khera noted that along with inflammation caused by an infection, inflammation of the prostate, known as prostatitis, could also be the uncomfortable-climax offender.

Adam Ramin, M.D., a urologist and the medical director of Urology Cancer Specialists in Los Angeles, added that an ejaculatory duct cyst—similar to a kidney stone but much rarer—in the prostate or prostate pathway could also lead to painful ejaculation.

Procedures such as surgery or biopsy that involve the prostate could result in painful ejaculation, thanks to both injury and inflammation of the area.

The testes

Ramin said if the pain is radiating from the testicles during ejaculation, it's most likely due to a testicular infection or, in some cases, epididymal cysts, which are also known as spermatoceles. A spermatocele is a benign cyst that occurs in the epididymis, the coiled tube behind each testicle.

When such a cyst is present, the sperm is not fully released and some of it gets stuck in the cyst, causing the cyst wall to expand, according to Ramin. As you probably guessed, this situation is pretty painful. However, this type of pain is very specific to the testicles and will not occur in the penis, the urethra or the area around the prostate.

Ramin also noted that while testicular cancer is very rare—only about 1 in every 270 men will receive such a diagnosis—it can be a cause of ejaculatory pain, so this possibility should be checked out. Additionally, it's helpful for men to self-examine their testes to check for any possible lumps that could be further indication of a problem.

Obstruction

One of the clues that ejaculatory pain could be from an obstruction or a blockage is any change to the urinary stream. For instance, if you're having difficulty stopping or starting urination, it could be indicative of an obstruction.

Pain could result from a narrowing or a blockage of the ejaculatory ducts, which are the tubes that come out into the prostate and carry the seminal fluid, Khera said. If these tubes are narrow, ejaculation can be painful.

Ramin added that some people may have a very specific type of obstruction called a urethral stricture, which is scar tissue inside the urethra. The scar tissue can block the flow of urine or semen out of the urethra, leading to pain during ejaculation that will be felt within the urethra.

When to call a doctor

Both Ramin and Khera noted that one-time pain following ejaculation may not be anything to worry about. If you experience pain, they said taking a warm bath and treating the pain with a nonsteroidal anti-inflammatory, such as Motrin, could help.

However, you should seek medical attention right away if you notice any of the following symptoms:

• Blood in the semen along with the pain
• Burning with urination
• Severe or worsening pain
• Pain that doesn't go away
• Discharge from the penis
• Swollen testicles

"It's important to get checked out because we want to make sure that there's nothing deep-seated that needs either surgical intervention or additional treatments," Ramin said.