Painful Ejaculation

Painful ejaculation is fortunately not common. However, is at a very unpleasant problem. For better understanding, we need to know some basic facts about the mechanism of ejaculation. Ejaculation is caused by a contraction of pelvic muscles and expulsion of sperm from epididymis through sperm duct to prostate, where reproductive system connects to urethra. Through urethra spermatic fluid is expulsed from penis.


Urinary tract infections

Inflammation of urethra (urethritis) can cause pain and a burning sensations when urinating and during ejaculation. Elevated temperature is often present as well as bacteria and leukocytes in urine analysis. Blood in urine is also usually observed. Some sexually transmitted diseases like gonorrhea have similar symptoms.


This is a very painful condition caused by either classical infections, or some sexually transmitted diseases (gonorrhea, chlamydia). Acute inflammation is usually followed by high temperatures and if man is even capable of ejaculation, then it is very painful.

Prostate cancer

Cancer tissue can grow into the urethra that passes through prostatic tissue. Narrowing of urethra by tumor mass can cause problems with urination and ejaculation leading to unpleasant sensations during both of them. Other symptoms may include blood in urine and frequent urination at night.


It means infectious affection of epididymis, a small organ located above each of both testicles. The causes are similar to the inflammation of prostate. It is also a painful condition, but this time it is associated with swelling and redness of the scrotum that is very painful when touched.


Inability to ejaculate and sometimes painful ejaculations have been reported when taking some antidepressants. Sexual dysfunctions in men are relatively common problem even by discontinuation of taking these drugs, or by changing a subgroup to another.

Psychological problems

Troubles with erection and ejaculation tend to be primarily psychological. Before stating this diagnose, we must however exclude above mentioned causes.

Diagnostic approach

Examination by an urologist is the basis. In addition to physical examination and medical history, urine tests shall be done. Prostatic tissue can be examined indirectly by digital rectal exam or by using imaging techniques such as abdominal ultrasound. Further approach depends on our suspicion. If no clear organic cause is found, is advisable to consider an examination by sexologist.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources