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During ejaculation, semen is rapidly ejected from the testicles into the urethra and then eliminated from the body in jets. On its long way, the male urethra passes through the tissue of the prostate and this is the most important narrowing of the urethra. Any obstacle between the testicles and the external environment can cause painful ejaculation. Here are some of the most common causes of pain during or after ejaculation

Orchitis, Epididymitis, And Epididymo-orchitis

Semen is partly created in the testicles and the joining organ called the epididymis. Any inflammation caused by an infection of the testes and epididymis can cause painful ejaculation. This is accompanied with other symptoms, such as pain in the scrotal area, especially during movements or sexual activity. The appearance of pus and blood in semen is common in these cases, especially if bacterial infections are present. This condition can be accompanied by a high body temperature, general feeling of weakness, and other systemic symptoms. The diagnosis is easily made by a urologist, based on a physical examination and laboratory testing. The treatment includes use of antibiotics to which bacterial agents are sensitive.

Prostatitis

Prostatitis is an inflammation of the prostate, which is a small gland located in the male pelvis. It is responsible for the production of some components of semen, and the urethra passes right through its tissue. Therefore, prostate inflammation can obstruct passing semen, which produces painful ejaculation and painful urination. The infection can be viral, bacterial, or of unknown cause when all the tests are negative. Bacterial prostatitis can be successfully treated with antibiotics. Sperm culture and urine culture are recommended to determine which antibiotic will have the best possible effects.

Urethritis

Urethritis is an inflammation of the urethra. It is often bacterial and can be categorized among sexually transmitted diseases. Urethritis causes similar symptoms as prostatitis, including painful urination and ejaculation, bloody urine, and burning sensations while ejaculating and urinating. If it becomes severe enough, it can completely obstruct the flow of urine, which requires cystocentesis (placing a needle in the urinary bladder in order to evacuate urine). Bacterial urethritis is also treated with antibiotics and uroantiseptics.

Medications

Some medications can cause painful urination. It has been noted that some types of antidepressants produce these symptoms. The mechanism is still not completely revealed, so the only option to remove these symptoms is to lover the doses of antidepressants.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is very common issue in older men. It includes an overproduction of prostate tissue, which puts pressure on the urethra and causes painful and frequent urination, along with painful ejaculation. Many treatment options are available, including medications and surgery to control this progressive condition.

Prostatic Cancer   

Prostatic cancer is the most severe cause of painful ejaculation. Besides that symptom, painful urination, blood in the burine and semen, and pelvic pain are usually present. However, this condition is most commonly present in elderly men. There is a valuable laboratory finding that can indicate the presence of prostatic cancer. It is called prostate specific antigen (PSA), and its normal range is between 0 and 4. A grey zone exists between 4 and 11, and all above that is consedered a high risk of prostate cancer. This cancer is highly metastatic and it usually already has metastases at the time of diagnosis. Treatment is primarily surgical, including the removal of the prostate and the surrounding structures. Radiation therapy and chemotherapy are also applied.

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