Differential Diagnosis for Painful Ejaculation

Single Most Likely Diagnosis

• Prostatitis: This is the most common cause of painful ejaculation, as inflammation of the prostate gland can lead to pain during ejaculation. The pain is often described as a sharp or burning sensation.

Other Likely Diagnoses

• Epididymitis: Inflammation of the epididymis, which stores sperm, can cause pain during ejaculation due to the proximity of the epididymis to the prostate and the shared nerves.
• Urethritis: Inflammation of the urethra can cause pain during urination and ejaculation, especially if the urethritis is caused by a sexually transmitted infection.
• Seminal Vesiculitis: Inflammation of the seminal vesicles, which produce a significant portion of the ejaculate, can cause painful ejaculation.
• Benign Prostatic Hyperplasia (BPH): Enlargement of the prostate gland can cause urinary symptoms and may also lead to painful ejaculation due to the increased pressure on surrounding nerves and structures.

Do Not Miss Diagnoses

• Testicular Cancer: Although rare, testicular cancer can cause pain during ejaculation, among other symptoms. Early detection is crucial for effective treatment.
• Prostate Cancer: Similar to testicular cancer, prostate cancer is a serious condition that may cause painful ejaculation, among other urinary symptoms. Early detection significantly improves treatment outcomes.
• Sexually Transmitted Infections (STIs): Certain STIs, such as gonorrhea or chlamydia, can cause painful ejaculation. Identifying and treating these infections is crucial to prevent long-term complications and transmission to others.

Rare Diagnoses

• Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to pain during ejaculation.
• Spermatocele: A cystic structure filled with sperm that arises from the head of the epididymis can cause discomfort or pain during ejaculation.
• Ejaculatory Duct Obstruction: Blockage of the ejaculatory ducts can cause painful ejaculation, infertility, and other symptoms related to the obstruction of semen flow.
• Neurological Disorders: Certain neurological conditions, such as multiple sclerosis or peripheral neuropathy, can affect the nerves involved in ejaculation, leading to painful sensations.