A painful ejaculation is a pain felt during or at the end of ejaculation. Ejaculation occurs in two stages: the emission phase and the expulsion phase. During the emission phase, secretions accumulate in the urethra near the prostate. This is followed by the expulsion phase, which is characterized by a mechanical movement with a succession of perfectly coordinated contractions that ensure the evacuation of the semen to the outside. It is these contractions that can cause pain during ejaculation. Symptoms, causes, treatments, Les Cliniques Marois gives you all the information you need about painful ejaculation.

The symptoms of painful ejaculation

Pain during ejaculation may occur during the semen expulsion phase or after ejaculation. The patient may feel a burning sensation or electric shocks in the genitals or lower abdomen. It can also be similar to ejaculation without pleasure or sexual orgasm.
The duration of ejaculation pain can vary from one individual to another. It can be punctual for some men, or last several minutes or even hours for others.

What causes painful ejaculation?

Painful ejaculation is usually associated with prostatitis. It can also have neurological, musculoskeletal, psychosomatic, infectious or inflammatory causes.

  • Local infections

    Several local infections can cause painful ejaculation. It can be a type II prostatitis or a sexually transmitted infection.

  • Type II prostatitis

    Type II prostatitis

    Prostatitis is characterized by inflammation of the prostate. Chronic prostatitis or type II prostatitis may be bacterial in origin and is more often related to persistent urinary tract infections or prostate pathology. It can be caused by a type I prostatitis that has been poorly treated or that has settled silently. Acute prostatitis or type I prostatitis is when it is bacterial in origin. It is usually a sexually transmitted infection. It can cause fever, abdominal pain and burning of the bladder.

    These symptoms may go unnoticed in some people. In the absence of treatment, in case of delay in treatment or discontinuation of care due to rapid improvement, this can lead to an alteration of the patient's general condition, and thus to type II prostatitis.

    Type II prostatitis can thus manifest itself by the following symptoms:

    • an unpleasant feeling of heaviness in the lower abdomen,
    • pain,
    • a burning or simply a discomfort at the time of urinating,
    • painful ejaculation.

    Chronic prostatitis can also be of non-bacterial origin. This form is referred to as chronic pelvic pain syndrome. The causes of this form of prostatitis are often difficult to identify exactly. They may be infectious or related to inflammatory phenomena. Chronic non-bacterial prostatitis can manifest itself by urinary or genital pain which can be associated with possible sexual or urinary disorders.

  • Sexually transmitted infections (STIs)

    Painful ejaculation can also be a manifestation of a sexually transmitted infection. Although not the most common cause, male genital tract infections such as trichomoniasis can cause painful ejaculation. This sexually transmitted infection may not present symptoms in men. In some cases, the patient may feel a burning sensation after sex or while urinating.

  • Local inflammation

    Pain with ejaculation can also be caused by a local inflammation such as epididymitis. This is an inflammation and infection of the epididymis. The epididymis is the duct where sperm is stored and matured before it migrates to the prostate. This condition manifests itself in two forms: acute epididymitis which is the most common form and chronic epididymitis which is multifactorial.

    This condition may manifest itself as scrotal discomfort and pain. This pain evolves rapidly within 48 to 72 hours and may be accompanied by fever (in one third of cases). Depending on the trajectory of the spermatic cord, the pain may radiate to the abdomen. Epididymitis can also manifest itself by symptoms such as pain on ejaculation and palpation, swelling of a testicle or penis, urethral discharge...

    Most epididymitis is due to retrograde infections. The organisms responsible for epididymitis can be sexually transmitted bacteria such as Neisseria gonorrhoeae, Chlamydia trachomati. Bacteria from urogenital infections (Escherichia coli) may also be responsible for this condition. Other infectious agents of viral or bacterial origin such as Mycobacterium tuberculosis or Salmonella can also be the cause of epididymitis.

  • Neurological causes

    Painful ejaculation in a man can have neurological causes such as pudendal neuralgia. Also known as Alcock's canal syndrome, pudendal neuralgia is a neurological condition that causes intense and chronic pain in the breech area. These pains are more pronounced when the individual is in a sitting position and subside when at rest. In men, they are often located in the testicles, penis and anus.

    These painful sensations are similar to an electric shock, numbness, burning or pinching. They can be unbearable and have repercussions on the individual's professional, social and sexual life. The pain experienced may be associated with pelvic hypersensitivity which involves sexual, urinary and anorectal disorders.

    Pudental nerve compression can occur in a person for no apparent reason. It can also be caused by certain factors such as repeated practice of certain activities such as cycling or horseback riding, a fall that causes compression of the nerve or a hematoma, or surgery in an area that the nerve passes through.

  • Musculoskeletal and psychosomatic causes

    Ejaculation pain can be caused by trigger points in the perineal muscles. Trigger points are located in all muscles that can be actively contracted in the body. These painful muscle tension points are one of the most common causes of chronic pain. They can develop as a result of stretching, compressing or overloading muscles.

    Consisting of ligaments and muscles, the contraction of the perineum helps maintain an erection and plays a major role in the ejaculation process. The appearance of these trigger points in the perineal musculature can cause pain in this part of the body. This can lead to pain during ejaculation.

    In some cases, the cause of painful ejaculation may be completely unknown to everyone. Furthermore, if the patient does not feel any pain during masturbation for example, but only during sexual intercourse, it may be psychological. Stress, trauma, anxiety, depression are also factors that can impact the quality of ejaculation during sex. The best thing to do at this time is to consult a therapist (sexologist) who will help you to see things more clearly.

La prostatite de type II

The different possible treatments

Although antibiotics are often recommended to eradicate various infections, they should not be taken without the advice of a specialist. This can lead to other complications such as resistance to certain molecules or the inability to accurately identify the origin of the condition. Furthermore, since ejaculation pain can have several origins, it is essential to determine the source of the problem before prescribing an appropriate treatment.

La stimulation nerveuse électrique transcutanée

  • Transcutaneous electrical nerve stimulation (TENS)

    Transcutaneous electrical nerve stimulation (TENS) is a therapeutic technique that consists of relieving pain by means of a low-intensity electrical current. This current is transmitted through electrodes that are placed on the skin. It is a non-pharmacological method validated in the management of chronic pain.

    This type of treatment is usually performed by professionals on the recommendation of the physician or urologist. The duration and number of sessions may vary depending on the objectives, the patient's physical condition and the various electrical stimulation modalities. This therapy is a non-drug solution that can be used to treat, for example, chronic epididymitis, a possible cause of painful ejaculation. Transcutaneous electrical nerve stimulation (TENS) is offered at Les Cliniques Marois.

  • Analgesics for pain relief

    Analgesics are medications prescribed to treat chronic or acute pain. Depending on the source and severity of the pain, they may be administered transdermally, intramuscularly, venously, subcutaneously or orally. In cases of painful ejaculation, these types of medications may be used to eliminate the pain. In general, pain medications are prescribed in addition to specific treatment to eliminate the source of the ejaculation disorder. While pain medications are effective in removing pain, they are not indicated to treat the cause of painful ejaculation.

    Even though there are many painkillers available in pharmacies without a prescription, it is important to consult a doctor before self-medicating. Painful ejaculation is not harmless and painkillers are not treatments for infections for example. It is therefore essential to consult a urologist as a matter of urgency for a complete treatment of the problem. The latter will also be able to prescribe the type of analgesic (level 1, 2, or 3 analgesic) that best corresponds to the intensity of the pain you feel.

    Cold is also a natural pain reliever. If the pain is very severe, you may use ice for temporary relief.

  • Antibiotics to treat the causes of painful ejaculation

    Antibiotic treatment is an effective way to treat painful ejaculation if it is caused by an infection. It is essential to perform clinical examinations to detect and diagnose STIs and local infections. The urologist can therefore take a local sample or urine analysis for a urinary and sperm bacteriological assessment. Blood tests and ultrasound of the urinary tract may also be necessary in some cases.

    In the case of chronic prostatitis, treatment is often individualized. The patient may be treated with antibiotics, anti-inflammatory drugs, herbal medicine, alpha blockers, acupuncture or prostate massage.

    In case of epididymitis with a bacterial origin, the best solution is an antibiotic therapy which is adapted to the antibiogram. This treatment can be done at home if the symptoms are not very important. Otherwise, hospitalization is essential.

    If the infectious lesion results in an abscess, surgery such as orchiectomy, vasovasostomy, epididymectomy, and microsurgical denervation of the spermatic cord (performed by an experienced surgeon), may be required.

    In cases of appropriate antibiotic therapy, the symptoms will improve within 48 hours. If they persist or worsen, it is necessary to consult the urologist urgently for further treatment. The urologist can modify the treatment or look for another cause of the condition in order to eradicate it.

  • Anti-inflammatory drugs

    Before considering treatment with anti-inflammatory drugs, the presence of inflammation must first be confirmed. Clinical signs are the first clues that should raise a red flag. Once in the clinic, the specialist may order urine tests and other tests for a more complete diagnosis.

    In cases of chronic epididymitis, for example, non-steroidal anti-inflammatory drugs (NSAIDs) may be required for three months. Depending on the results, the urologist may consider more aggressive treatment.

  • Therapeutic solutions

    Heat treatment, tissue mobilizations and stretching are effective solutions if the muscles are tense. They help relax the muscles of the perineum and the entire body. For example, you can practice relaxation activities such as yoga. Psychotherapy and biofeedback techniques in perineal rehabilitation are also very helpful in relieving chronic pain.

    If it is a pudendal nerve neuralgia, neural mobilizations can be considered.

    To properly manage ejaculation pain, it is essential to first determine the cause of the problem. It can be caused by a local infection, local inflammation, neurological, musculoskeletal or psychosomatic problems. In all of these cases, it is ideal to consult a urologist who specializes in genital pain management. For better management of your pain, consult one of our qualified and competent specialists. The Cliniques Marois, which specializes in urology and sexual health, offers its competent and experienced staff for all your sexual problems.