Painful ejaculation can vary from mild discomfort to severe pain during or after ejaculation. Ejaculation occurs in 2 stages: the emission phase and the expulsion phase. During the emission phase, fluids accumulate in the urethra near the prostate. This is followed by the expulsion phase, marked by mechanical movements and coordinated contractions to expel semen. It’s these contractions that can cause pain during ejaculation. Cliniques Marois will provide you with all the information you need to know about the symptoms, causes and treatments for painful ejaculation.

Symptoms of painful ejaculation

Pain during ejaculation can occur during the expulsion phase or after ejaculation. Patients may experience sensations, such as a burning feeling or electric shocks in the genitals or lower abdomen. It can also resemble ejaculation without pleasure or sexual orgasm.

The duration of ejaculation pain can vary from one individual to another. It can be short-lived 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 be caused by neurological, musculoskeletal, psychosomatic, infectious or inflammatory issues.

  • Local infections

    Painful ejaculation can be caused by a local infection, such as type 2 prostatitis or a sexually transmitted infection (STI).

  • Type 2 prostatitis

    Prostatitis is characterized by inflammation of the prostate. Chronic prostatitis, also called type 2 prostatitis, may be bacterial in origin and is often associated with recurrent urinary tract infections or prostate issues. It can be caused by a type 1 prostatitis that has been poorly treated or that has settled silently. Acute prostatitis or type 1 prostatitis is bacterial in origin. It’s usually caused by a sexually transmitted infection. It can cause fever, abdominal pain and a burning sensation in the bladder.

    These symptoms may go unnoticed in some people. If left untreated, inadequately treated or if treatment is discontinued prematurely due to rapid improvement, it can adversely affect the patient’s general condition and lead to type 2 prostatitis.

    Type 2 prostatitis has the following symptoms:

    • An unpleasant feeling of heaviness in the lower abdomen
    • Pain
    • A burning sensation or uncomfortable feeling when urinating
    • Painful ejaculation

    Chronic prostatitis can also be non-bacterial in origin. This form is referred to as chronic pelvic pain syndrome. Pinpointing the cause of this type of prostatitis is difficult, as it can stem from an infection or inflammation. Chronic non-bacterial prostatitis can lead to urinary or genital pain, which may be linked to potential sexual or urinary disorders.

  • Sexually transmitted infections (STIs)

    Painful ejaculation can also be caused by a sexually transmitted infection. Although not the most common cause, male genital tract infections, such as trichomoniasis, can cause painful ejaculation. Men may not exhibit any symptoms of this sexually transmitted infection. In some cases, the patient may feel a burning sensation after sex or while urinating.

  • Local inflammation

    Painful ejaculation can also be caused by inflammation and infection in the epididymis, the duct where sperm is stored and matured before it migrates to the prostate. This condition manifests itself in 2 forms: acute epididymitis, the most common form, and chronic epididymitis which is multifactorial.

    This condition may manifest itself as scrotal discomfort and pain. The pain escalates rapidly within 48 to 72 hours and may be accompanied by fever (in 1/3 of cases). Depending on the trajectory of the spermatic cord, the pain may radiate to the abdomen. Epididymitis can also cause symptoms such as pain during ejaculation and palpation, swelling of the testicles or penis and urethral discharge.

    Most cases of epididymitis are attributed to retrograde infections. The organisms responsible for epididymitis can include sexually transmitted bacteria such as Neisseria gonorrhoeae and Chlamydia trachomati. Bacteria from urogenital infections, such as Escherichia coli may also contribute to this condition. Other infectious agents, both viral and bacterial, such as Mycobacterium tuberculosis or Salmonella can also cause epididymitis.

  • Neurological causes

    Painful ejaculation can have neurological causes such as pudendal neuralgia, also known as Alcock’s canal syndrome. Pudendal neuralgia is a neurological condition that leads to intense and chronic pain in the pelvic area. The pain is more pronounced when sitting and  at rest. In men, the pain often radiates to the testicles, penis and anus.

    These painful sensations can manifest as an electric shock, numbness, burning or pinching. The pain can be excruciating and impact the individual’s professional, social and sexual life. The pain experienced may also be accompanied by pelvic hypersensitivity, leading to sexual, urinary and anorectal disorders.

    Pudendal nerve compression can develop without any obvious cause. It can also be caused by certain factors such repeatedly engaging in activities like cycling or horseback riding. It can also be caused by a fall that compresses the nerve or a hematoma. Surgery in an area where the nerve passes though can also contribute to its occurrence.

  • Musculoskeletal and psychosomatic causes

    Ejaculation pain can be caused by trigger points in the perineal muscles. Trigger points are found 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 often develop because of stretching, compressing or overloading the muscles.

    Consisting of ligaments and muscles, the perineum contracts to help maintain an erection and plays a major role in the ejaculation process. The emergence of 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 root cause of painful ejaculation may remain unidentified. Furthermore, if the patient doesn’t feel any pain during masturbation for example, but only during sexual intercourse, psychological factors may be at play. Stress, trauma, anxiety and depression can also impact the quality of ejaculation during sex. The best thing to do is to consult a therapist (sexologist).

La prostatite de type II

Possible treatments

While antibiotics are commonly prescribed to treat various infections, they shouldn’t be taken without the guidance of a specialist. Doing so can lead to other complications such as resistance to certain medications or difficulty in accurately identifying the underlying cause of the condition. Furthermore, given the diverse origins of ejaculation pain, it’s 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 used to relieve pain with a low-intensity electrical current. This current is transmitted through electrodes that are placed on the skin. It’s a non-pharmacological treatment used to manage chronic pain.

    This type of treatment is usually performed by a professional on the recommendation of a physician or urologist. The duration and frequency of sessions may be based on the goal, the patient’s physical condition and the specific electrical stimulation techniques used. This drug-free approach can effectively treat chronic epididymitis, a possible cause of painful ejaculation. Transcutaneous electrical nerve stimulation (TENS) is offered at 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, intravenously, subcutaneously or orally. In cases of painful ejaculation, these  medications may be used to relieve discomfort. 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 managing pain, they don’t address the root cause of painful ejaculation.

    Although many painkillers are available over the counter at pharmacies, it’s important to consult a doctor before self-medicating. Painful ejaculation isn’t a benign condition, and painkillers alone can’t treat an infection. It’s essential to consult a urologist as soon as possible to treat the issue. The urologist 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 caused by an infection. It’s essential to have a clinical examination to detect and diagnose STIs and local infections. The urologist can take a local sample or urine analysis for a urinary and sperm bacteriological assessment. In some cases, blood tests and ultrasound examinations of the urinary tract may also be necessary.

    Treatment for chronic prostatitis is often individualized. The patient may be treated with antibiotics, anti-inflammatory drugs, herbal medicine, alpha blockers, acupuncture or prostate massage.

    For bacterial epididymitis, antibiotic therapy tailored to the antibiogram is the best solution. This treatment can be  done at home if the symptoms are mild. Hospitalization may be needed in severe cases.

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

    With appropriate antibiotic therapy, symptoms typically improve within 48 hours. If symptoms persist or worsen, you must immediately consult a urologist for further treatment. The urologist can modify your treatment regimen or explore alternative causes of the condition.

  • Anti-inflammatory drugs

    Before initiating treatment with anti-inflammatory drugs, it’s crucial to confirm the presence of inflammation. Clinical signs are the first clues and should raise a red flag. After an in-clinic examination, the specialist may order urine tests and additional diagnostics for a  complete diagnosis.

    For conditions like chronic epididymitis, non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for 3 months. Depending on the results, the urologist may consider more aggressive treatment.

  • Therapeutic solutions

    Heat treatment, tissue mobilizations and stretching are effective methods for treating muscle tension. These techniques help relax the perineal muscles 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 the patient has pudendal nerve neuralgia, neural mobilization techniques may be considered.

    To effectively manage ejaculation pain, it’s essential to first determine the underlying cause of the issue. It can be caused by a local infection, local inflammation, neurological, musculoskeletal or psychosomatic problems. In any case, you must consult a urologist that specializes in genital pain management. For comprehensive pain management, consult one of our qualified and competent specialists. Cliniques Marois specializes in urology and sexual health, and our competent and experienced staff can help you with all your sexual problems.