Chronic Epididymitis: This condition is characterized by inflammation of the epididymis, which can cause pain during ejaculation, tenderness above the testicles where the cord meets the testicle, and pelvic pain. The chronic nature of the symptoms (four years) supports this diagnosis.

Prostatitis: Chronic prostatitis can cause painful ejaculation, pelvic pain, and discomfort in the genital area. The symptoms can be persistent and may worsen over time.
Epididymal Cyst or Spermatocele: These are benign cysts that can cause discomfort, pain during ejaculation, and tenderness in the epididymal area.
Varicocele: A varicocele is an enlargement of the veins within the scrotum, which can cause pain, discomfort, and tenderness, especially during ejaculation.

Testicular Cancer: Although testicular cancer is rare, it is crucial to rule out this diagnosis, especially if there is a palpable mass or significant testicular asymmetry. Painful ejaculation and pelvic pain can be associated with testicular cancer, especially if the cancer has spread to the epididymis or other pelvic structures.
Urethral Stricture or Obstruction: A urethral stricture can cause painful urination, ejaculation, and pelvic pain due to obstruction of the urethra.

Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections, can lead to pain, swelling, and tenderness.
Henoch-Schönlein Purpura (HSP): A rare condition that can cause testicular pain, swelling, and tenderness, along with other systemic symptoms like purpura and joint pain.
Sperm Granuloma: A rare condition where a granuloma forms at the site of a previous vasectomy or other surgical intervention, causing pain and discomfort during ejaculation.