Painful ejaculation: possible causes, when to see a GP and what helps

Painful ejaculation means discomfort or pain at the time of, or just after, ejaculation. It can be felt in the penis, the testicles, the area behind the scrotum or the lower abdomen. Because the prostate and the nearby structures are involved in ejaculation, inflammation or irritation there can make the sensation painful.

The UK sources used for this page, from the NHS, NI Direct and NICE CKS, place painful ejaculation mainly within prostatitis and chronic pelvic pain. That does not mean prostatitis is the only cause, and a GP will consider others. It does mean that the symptom is recognised and that effective assessment and treatment pathways exist.

The NHS describes prostatitis as inflammation of the prostate, a small gland found below the bladder in men. It says the symptoms may include pain when peeing, difficulty peeing or straining, needing to pee more often than usual, pain in your penis, scrotum, testicles or bottom, pain when you ejaculate and a high temperature. Prostatitis is usually caused by an infection, such as a urinary tract infection, while the cause of long-term (chronic) prostatitis is not always known.

NI Direct describes two main types: acute prostatitis, which is severe and develops suddenly, and chronic prostatitis, where symptoms come and go over several months. Acute prostatitis is rare, is always caused by an infection and requires immediate treatment. Chronic prostatitis is the most common type and is not usually caused by an infection. It lists sexual problems, such as erectile dysfunction, pain when ejaculating or pelvic pain after sex, among the features of chronic prostatitis, which may have been present for at least three months.

NICE CKS adds that in chronic prostatitis about 10% of men have chronic bacterial prostatitis and about 90% have chronic prostatitis or chronic pelvic pain syndrome, where there is no proven bacterial infection.

NICE CKS says a diagnosis of chronic prostatitis should be based on the history and on excluding other conditions that could cause the symptoms. It lists urinary tract infection, urethritis, epididymo-orchitis, epididymitis, benign prostatic hypertrophy, cancer of the prostate, bladder or colon, urethral stricture, and an obstructing stone or foreign body in the urinary tract.

This list is for clinicians, but it explains why a GP asks about urinary symptoms, discharge, fever and sexual history, and why a urine test and examination are usual. A symptom of pain with ejaculation, taken on its own, does not tell you which of these is responsible.

NI Direct says to see your GP immediately if you develop sudden and severe symptoms of prostatitis, because acute prostatitis needs to be assessed and treated quickly to prevent serious problems such as being unable to pass urine. It lists not being able to pee, which leads to a build-up of urine in the bladder known as acute urinary retention, as needing urgent medical attention.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you are unable to pee, or you have been taking antibiotics for prostatitis for 48 hours and your symptoms have not got better or have got worse. It says to go to A&E or call 999 if you suddenly feel confused, have slurred speech or are not making sense, have blue, grey, pale or blotchy skin, lips or tongue, have a rash that does not fade when you roll a glass over it, or have severe difficulty breathing, because these may mean a serious infection or sepsis.

NI Direct says your GP will ask about the problems you are having and examine your tummy. You may also have a digital rectal examination, where a doctor inserts a gloved finger into the bottom to feel the prostate, and you may experience some discomfort if the prostate is swollen or tender. Your urine will usually be tested for signs of infection, and you may be referred to a specialist for further tests.

The NHS says to try not to be embarrassed, because the doctor will be used to talking about these symptoms. It also says that if you have had symptoms for 3 months or longer (chronic prostatitis) you may be referred to a specialist called a urologist.

The NHS says prostatitis is treated with antibiotics, and that you will usually feel better within 2 weeks after starting, although it may take several weeks for all symptoms to get better. For chronic prostatitis it lists antibiotics and other medicines to help with symptoms, cognitive behavioural therapy or counselling, physiotherapy and alternative therapies such as acupuncture if available in your area.

NICE CKS describes primary care options for chronic pelvic pain syndrome as including pain relief with paracetamol or an NSAID, a stool softener if defecation is painful and a 4 to 6 week trial of an alpha-blocker if there are significant urinary symptoms, with referral to a urologist where the diagnosis is uncertain or symptoms are severe. NI Direct adds that a pain clinic referral may be considered if symptoms are severe and not responding to treatment.

Most men gradually recover with treatment, though NI Direct says this can take months or years and some find their symptoms return. The NHS suggests drinking plenty of fluids, taking paracetamol or ibuprofen for pain and finishing the whole course of any antibiotics.