When a male ejaculates, his muscles suddenly contract and send semen from the testicles to the urethra, where it is eliminated from the body through the opening of the penis.

Any condition that causes inflammation or an infection of the structures that contribute to ejaculation or in the surrounding area may result in painful ejaculation. The discomfort usually presents itself as penile pain, a perineal ache, or pain in the testicular or glans areas.

The incidence of painful ejaculation is more common among men older than 50, and certain estimates put the figure of men experiencing this condition as high as 6 percent of the population.

Epididymitis
Epididymitis is inflammation of your epididymis. The epididymis is a long curled tube inside your scrotum. It stores and carries sperm from your testicles to your penis. Acute epididymitis lasts for 6 weeks or less and becomes chronic if it lasts longer than 3 months.

Orchitis
Orchitis is the inflammation of one or both of the testicles. The condition usually occurs as a result of inflammation of the epididymitis, a tube that connect each testicle to another structure called the vas deferens. Epididymitis also commonly occurs as a result of a bacterial or viral infection. Treatment for orchitis consists of a combination of antibiotics, anti-inflammatory medications, pain medications, and bed rest.

Prostatitis
Prostatitis is a disease of the prostate gland, characterized by pain and various urinary symptoms. There are different types of prostatitis: bacterial, chronic, and asymptomatic. Bacterial prostatitis occurs as a result of bacteria that travel into the prostate from the urethra.

Treatment for Painful Ejaculation
To prevent complications and transmission of sexually transmitted infections, presumptive therapy is indicated at the time of the visit before all laboratory test results are available. Selection of presumptive therapy is based on risk for chlamydia and gonorrhea and/or enteric organisms. The goals of treatment of acute epididymitis are 1) microbiologic cure of infection, 2) improvement of signs and symptoms, 3) prevention of transmission of chlamydia and gonorrhea to others, and 4) a decrease in potential chlamydia/gonorrhea epididymitis complications (e.g., infertility and chronic pain).

Although most men with acute epididymitis can be treated on an outpatient basis, referral to a specialist and hospitalization should be considered when severe pain or fever suggests other diagnoses (e.g., torsion, testicular infarction, abscess, and necrotizing fasciitis) or when men are unable to comply with an antimicrobial regimen. Because high fever is uncommon and indicates a complicated infection, hospitalization for further evaluation is recommended.