Painful Ejaculation (dysorgasmia/orgasmalgia) – what are the causes?

Painful Ejaculation, also called dysorgasmia or orgasmalgia refers to the pain in the penis or scrotum or in the perineum area during ejaculation. Occasional pain is common and most often you need not worry about it. But if the pain is persistent and hindering your sex life, you need to see a good sexologist in your city to figure out the root cause and get it treated.

Common conditions that can cause painful ejaculation

1. Problems with the prostate gland including
   1. Prostatitis – infection of the prostate gland (which may cause inflammation of the prostate)
   2. Enlarged prostate or Benign Prostatic Hyperplasia
   3. Prostate cancer
2. Presence of Cysts or Stones
3. Antidepressants
4. Surgical errors
5. Pudendal neuropathy
6. Sexually Transmitted Infections
7. Radiation therapy

Problems with prostate gland:

1. Prostatitis – an infection to the prostate that could be due to Urinary Tract Infection or a Sexually Transmitted Infection can cause the prostate to swell. As the prostate swells, the urethra that passes through the prostate gets compressed. As a result, problem with urination, pain during urination, incomplete emptying of bladder might be seen as symptoms. The inflammation of prostate can also cause pain during ejaculation.
2. Enlarged Prostate (BPH) – Benign Prostatic Hyperplasia is enlargement of prostate due to the growth of non cancerous cells inside the prostate. Similar to prostatitis, this too causes problems with urination and pain during ejaculation.
3. Prostate Cancer – Unlike BPH, prostate cancer is caused due to the growth of cancerous cells inside the prostate gland. However, the initial symptoms can be the same along with few other symptoms such as blood in urine or blood with semen and pain during ejaculation. If left untreated or unattended, the cancer can spread to nearby tissues and organs.

Presence of cysts or stones

The presence of cysts or stones in the urethra can also result in painful ejaculation (and urination). Not ejaculating properly can also lead to infertility.

Antidepressants

Certain antidepressants can cause erectile dysfunction and painful ejaculation. Types of antidepressant drugs that can cause pain during ejaculation include:

1. SSRIs (Selective Serotonin Reuptake Inhibitors)
2. Serotonin and Norepinephrine reuptake inhibitors
3. Tricyclics and tetracyclics
4. Monoamine oxidase inhibitors

Surgical errors

Surgeries in the pelvis region such as repair of inguinal hernia or removal of prostate (radical prostatectomy to remove prostate cancer and to prevent it from metastasizing) for any reason carry a risk of injury to the nerves or tissues in the surrounding regions. This can lead to erectile dysfunction or painful ejaculation.

Pudendal Neuropathy

Damage to nerve(s) in the pelvis region is called pudendal neuropathy. This can cause genital pain and/or rectal pain. Medical conditions such as multiple sclerosis, diabetes can cause damage to nerves in the pelvis region.

Sexually Transmitted Infections

STIs or STDs such as Chlamydia, Gonorrhoea or Trichomoniasis can cause painful urination or burning sensation during urination and pain during ejaculation.

Radiation Therapy

Radiation therapy (such as that done to cure cancer) in any of the pelvis region can cause temporary erectile dysfunction and pain during ejaculation. Once the radiation therapy is stopped and after recovery, erection problems and painful ejaculation condition may go away.

Diagnosis of painful ejaculation

When you present yourself to a good sexologist with painful ejaculation problem, you will be asked a set of questions including:

1. How long has it been hurting?
2. Did you recently have unprotected sex with an unfamiliar person?
3. If you also have problem urinating
4. If you have pain in your pelvis region
5. The medicines you are taking and your current medical conditions (if any)
6. If you have diabetes etc.

Also, urine test may be done to detect the presence of bacteria and a small amount of tissue may be taken out from prostate to look for the presence of cancer cells (if the imaging tests indicate any such possibility).

Treatment for painful ejaculation

Once the cause of painful ejaculation is determined, the treatment will be provided accordingly. If it is due to the infection of prostate, antibiotics may be given along with pain control medicines. Inflammation of prostate may be treated with surgery. Prostate cancer will be treated with chemotherapy, radiation therapies etc as your doctor determines necessary.

Injury to the nerves during surgery may recover with time, if not, medicines or another surgery may be advised. Side effects of radiation therapy may subside as you recover.  If the problem is due to antidepressants, you may be put on different medication that may not cause the side effect.