Differential Diagnosis for Painful Ejaculation

• Single most likely diagnosis
  • Prostatitis: This is often considered the most common cause of painful ejaculation in men. The pain is usually due to inflammation of the prostate gland, which can be caused by bacterial or non-bacterial factors. The symptoms can include pain during ejaculation, frequent urination, and pelvic pain.
• Other Likely diagnoses
  • Epididymitis: Inflammation of the epididymis, which stores sperm behind each testicle, can cause painful ejaculation. This condition is often caused by bacterial infections and can be accompanied by symptoms like testicular pain and swelling.
  • Seminal vesiculitis: Inflammation of the seminal vesicles, which produce a significant portion of the fluid in semen, can lead to painful ejaculation. This condition can be caused by bacterial infections and may present with symptoms like pelvic pain and difficulty urinating.
  • Urethritis: Inflammation of the urethra, often due to infection, can cause pain during ejaculation, along with symptoms like burning during urination and discharge.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Testicular cancer: Although rare, testicular cancer can cause painful ejaculation among other symptoms like testicular swelling and hardness. Early detection is crucial for effective treatment.
  • Prostate cancer: Advanced prostate cancer can cause painful ejaculation, along with other symptoms like difficulty urinating and pelvic pain. Given the potential severity of prostate cancer, it's essential to consider it in the differential diagnosis.
• Rare diagnoses
  • Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to painful ejaculation. This condition is less common but can be serious if not properly treated.
  • Interstitial cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain, which can be associated with painful ejaculation in some cases. It's a rare but possible cause that should be considered if other diagnoses are ruled out.
  • Spondyloarthritis: Certain types of arthritis, like ankylosing spondylitis, can cause inflammation in various parts of the body, including the genital area, potentially leading to painful ejaculation. This is a less common cause but should be considered in patients with a history of arthritis.