Dear Dr G,

I am a 36-year-old man who is happily married and have had no extra-marital affairs.

My wife and I have enjoyed an amazing sex life since we got married five years ago and have sex regularly, almost every other day.

During the movement control order, we even had sex twice a day while working from home.

Six months ago, I began having pain upon ejaculating, perhaps after intercourse that was more intense than usual.

My wife and I were shocked. The pain was intense, but thankfully there was no bleeding.

We were hoping the pain would go away after a week of abstinence but the problem recurred over a few months.

The pain is now intermittent and although it is not as intense as it was at first, there is still discomfort.

It has dampened our enthusiasm for sex, and we are not so keen on intimacy until the condition improves.

I am really hoping to put Dr G on the spot on the issue of my painful climax.

Why am I having pain upon ejaculation?

Is it because we had too much sex? Are there such things as too much sex or excessively vigorous intercourse?

I read on the Internet that bleeding in ejaculation may be associated with cancer. Is pain while ejaculating also associated with the disease?

I can’t understand why this is happening. Will this problem ever go away?

Painful Peter

Painful ejaculation is called dysorgasmia or orgasmalgia. The condition may be experienced during or after orgasm, sometimes persisting for several hours.

Both men and women can experience orgasmic pain. The term is sometimes used interchangeably with painful ejaculation when experienced by a man, but ejaculatory pain is only a sub-type of male dysorgasmia as men can also experience pain without ejaculating.

The phenomenon is poorly understood and under-researched. In fact, the prevalence of this condition is largely unknown.

Painful ejaculation may present on occasions as intense pain upon climax, or mild discomfort after ejaculation. The pain can involve the penis, scrotum and perineal area, and impact the sex lives of many men.

Painful ejaculation can occur in any age of sexually mature adults, and is probably one of the most terrifying experiences for a man during sex.

Most dysorgasmia is idiopathic as no specific cause is determined in 90% of the cases. Although most painful ejaculations have little or no medical significance, this may trigger alarm bells in most men and their partners.

Dysorgasmia is generally self-limiting and requires no investigation. However, persistent pain (more than 10 ejaculations or beyond two months), especially if accompanied by bleeding, may warrant more extensive diagnosis.

Persistent pain from ejaculation is usually caused by inflammation in the prostate or seminal vesicles, and the common cause of such inflammation is prostatitis.

This inflammation of the prostate constitutes around 40% of all causes of dysorgasmia. Most infections are “innocent” in nature, although sexually-transmitted infections or STIs may need to be ruled out in promiscuous men.

Typical STIs are chlamydia, gonorrhea, mycoplasma and ureaplasma.

Occlusion of the spermatic ducts can also be a cause of painful ejaculation. Traumatic injuries or post-infection scarring can result in the narrowing of the spermatic delivery system.

Some surgeries such as inguinal hernia repairs or radical prostatectomy can also result in occlusion of the spermatic ducts. This can result in pressurised ejaculation that causes pain upon climax.

This scarring of the sperm delivery system is also associated with male- factor infertility. An analysis of the semen may reveal azoospermia, or the absence of sperm.

The rupture of erectile tissue or injury to the suspensory ligaments of the penis during vigorous sexual intercourse is another common reason for pain upon ejaculation.

This is particularly prevalent in men having intense sex after a long period of abstinence. The vast majority of such cases are associated with minor bruising and self-limiting, that is, they resolve without treatment.

Medications such as non-steroidal anti-inflammatory drugs and prostate shrinking remedies may help relieve the symptoms.

Lastly, certain types of medicines such as antidepressants can result in sexual dysfunction including painful ejaculation. Medications that could result in dysorgasmia include selective serotonin reuptake inhibitors, tricyclic antidepressants and monoamine oxidase inhibitors.

Pain is generally associated with danger and warning, usually indicating something alarming is happening.

However, in the complexity of sexual health, this is a general rule with some exceptions, especially applicable to younger men with dysorgamia.

The American writer and professor of literature Joseph Campbell once wrote: “Find a place inside where there’s joy, and the joy will burn out the pain.”

Having been put on the spot, Dr G’s response is: “When pain burns out the joy during climax, seek medical attention to rule out serious causes and you will soon find the place with painless joy.”

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