Dear Dr G,
I hope you can help me as my problems are not solved despite seeing many doctors.
My name is Dave and I am 32 years old. I am still a bachelor and have a regular sexual partner. We have been together for the last two years.
Initially, our sex life was simply brilliant. Sadly, in the last six months, things have changed a great deal.
I started experiencing pain during climax and the discomfort lingers on for a while after ejaculation.
The intensity of the pain has not worsen, but it has not eased, and I am worried that this will put me off sex!
I've gone to many doctors and they all said it is all in my mind. I even went through several scans and was told they are all normal.
I hope to put Dr G on the spot to find out what are the reasons men get pain during ejaculation? Can this be due to underlying serious medical conditions?
Can this be due to too much sexual indulgence in the past? Can something be done to relieve pain? Will it ever go away?
Please help me, as I am feeling helpless and desperate.
Painful climax is a medical condition known as orgasmalgia or dysorgasmia.
This is a sexual dysfunction that is well documented affecting both men and women.
In men, the pain occurs following sexual climax, accompanied with or without ejaculations.
The true prevalence of the condition in both genders is largely unknown, but believed to be under reported, as the discomfort is usually transient and mild in nature.
For men affected by orgasmalgia, the pain following ejaculation is typically described as a burning sensation that is felt in the shaft of the penis, lower abdomen or the perineum (The region between the anus and the scrotum).
In some men, the pain is also felt in the testis and scrotum. Although most men describe it as short-lived and mild, it can range from aching sensation to intense spasm, and may even linger on for days.
In men facing recurring problems, painful ejaculation can definitely affect sex. The causes of painful ejaculation may not be identified so easily, or even identifiable at all.
However, the key for solving the problem is to investigate for the etiology and ensuring nothing serious is missed.
The most common cause of painful ejaculation perhaps is infections that affect the prostate or urethra.
Prostatitis, or the inflammation of the prostate, commonly haunts men below the age of 50. Apart from causing discomfort following ejaculation, other symptoms may include frequent and burning sensation with urination.
Although infection is mainly due to dehydration, however, previous sexual mischief that results in sexually transmitted infections, such as chlamydia and trichomoniasis, are not uncommon.
The other cause of dysorgasmia is the damage of the pelvic nerve leading to genital and pelvic pain, also known as pudendal neuropathy. The damage of the pelvic nerve is common among men with multiple sclerosis and diabetes.
Most men affected by such neuropathy may face increasing intensity of pain with time! Prostate cancer is also a condition closely associated with painful ejaculation.
Although mainly asymptomatic, some men presented with prostate cancer initially encounter frequent urination, blood in the semen and painful ejaculation.
In men with increase risks of cancer, it is crucial to have the prostate examined to exclude malignancy.
In vast majority, the causes of painful ejaculations may not be identified and the pain is often thought to be psychological.
As such pain can be emotionally-based, the guilt of sexual pleasure may enhance pain that starts mild in nature. To date, there is no documented association between frequency of sex and worsening pain on ejaculation.
In fact, most men are encouraged to ejaculate more frequently, as they can learn to cope with the pain. It is often said: "There is a fine line between pleasure and pain. They are two sides of the same coin, one not existing without another."
Dr G agrees that sexual behaviour is one of the most complex human behaviours. Sexual encounter may be experienced with pleasure and pride, at the same time, disgust and guilt.
Perhaps it is the latter that tends to exacerbate any guilt perceived as pain, for men facing non-serious causes of painful ejaculation.
Under such circumstances, the use of behavioural therapy or medications such as alpha-blockers, muscle relaxants and anti-inflammatories may be helpful.
Joseph Campbell, an American authors best known for his work on comparative mythology, once said: "Find a place inside where there is joy, and the joy will burn out the pain."
When Dr G is put on the spot in dealing with men with no serious pelvic pathology, but still face the paradox of pain after climactic pleasure, his response is simply: "There is plenty of joy in climactic sex - it will overpower the pain of ejaculation!"
> The views expressed are entirely the writer’s own.
Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at firstname.lastname@example.org