Ejaculatory pain

Specialty: Nephrology and urology.

• odynorgasmia
• painful ejaculation
• painful male dysorgasmia

Why it occurs

• Chronic bacterial or non-bacterial prostatitis (muscle contraction during climax generates pressure on an inflamed prostate)
• Seminal vesiculitis (infection or inflammation of the seminal vesicles that alters the composition and emission of semen)
• Obstruction of the ejaculatory ducts (due to Müllerian duct cysts, calcifications or duct stones that prevent the free passage of semen, causing painful spasm)
• Adverse effect of psychotropic drugs (selective serotonin reuptake inhibitors such as paroxetine, or antipsychotics that alter sympathetic ductal motility)
• Urethral or bladder neck stenosis (the forced passage of ejaculate through a narrow duct generates acute burning pain)

Initial workup

Spermoculture to rule out bacterial infections or other STDs in the semen; high-resolution transrectal ultrasound to assess the status of the seminal vesicles, prostate and rule out obstructive cysts; urine culture obtained after an orgasm; Pelvic MRI if there is suspicion of complex obstructive malformation.

Standard management

• Levofloxacin — 500 mg daily orally for 21 to 28 days if an infectious bacterial cause of the prostatic or seminal vesicles is confirmed
• Ibuprofen — 400 mg every 8 hours orally for 10 days to reduce inflammation and ductal edema
• Tamsulosin (0.4 mg daily orally to relax the smooth fibers of the ejaculatory ducts and prostate, reducing ejaculatory spasm).