Painful Orgasm (Dysorgasmia)

Dysorgasmia (dis-awr-GAZ-mee-uh) is a type of sexual dysfunction that causes pain during or after an orgasm. Dysorgasmia isn’t uncommon. It can affect anyone during any type of orgasm, including:

• Anal orgasms
• Clitoral orgasms
• Penile orgasms
• Vaginal orgasms

Painful orgasms can occur as a result of sexual intercourse or masturbation.

Your sexual health is important to your overall quality of life. Reach out to a healthcare provider if you experience orgasm pain.

Symptoms of dysorgasmia

Dysorgasmia may cause mild or intense pain during or after an orgasm. It may feel uncomfortable, burning or sharp. It may last only a moment, or it may last up to an hour. You may feel the pain in your:

• Abdomen
• Genitals
• Pelvis

Pain may only affect one specific area, or it may affect a larger region.

Causes

There are many different causes of dysorgasmia. Healthcare providers generally classify them as:

• Emotional
• Physical
• Psychological

A combination of two or more different factors can also cause painful orgasms.

Emotional causes

Emotional factors include:

• Anxiety
• Depression
• Stress

You may experience these feelings for many reasons, like worrying about your sexual performance, relationship issues with your partner(s) or even general stressors in your life like work or school.

Physical causes

Physical causes typically differ depending on whether you’re female or male.

Common causes of pain with female orgasm include:

• Cysts that grow on or in your ovaries
• Growths in or on your uterus
• An infection in your uterus, fallopian tubes or ovaries (pelvic inflammatory disease)
• Tissue that’s similar to your uterus lining grows in other places (endometriosis)
• Neurologic issues, including nerve damage or inflammation around your pelvis
• Inability to completely relax or coordinate your pelvic floor muscles (pelvic floor dysfunction)

Common causes of pain with male orgasm include:

• Blockage in your ejaculatory duct (ejaculatory duct obstruction)
• Inflammation of your prostate gland (prostatitis)
• Pelvic floor dysfunction
• Prostate cancer
• Neurologic issues, including nerve damage or inflammation around your pelvis
• Sexually transmitted infections (STIs), including chlamydia, gonorrhea and trichomoniasis
• Complications after surgery, like a hernia repair or prostate removal

Painful orgasms can also be a side effect of some antidepressant medications. These include tricyclic antidepressants (such as clomipramine), selective serotonin reuptake inhibitors (such as fluoxetine) and monoamine oxidase (MAO) inhibitors.

Anyone can experience anal orgasms. Common causes of painful anal orgasms include:

• Cramping in your pelvic floor muscles around your anus (proctalgia fugax)
• Pinched nerve that affects the inferior rectal nerve branch of the pudendal nerve
• Inflammation of the prostate or seminal vesicles

Psychological causes

Psychological factors include:

• Low self-esteem
• Past emotional abuse
• Past sexual abuse or assault
• Shame, especially due to cultural, religious or societal beliefs

Complications

Your sexual health is an important factor in your overall quality of life. Not being able to orgasm without experiencing pain can affect your self-esteem and feelings of self-worth. This may lead to mental health conditions like anxiety, depression and stress.

Dysorgasmia can also create a lack of intimacy with your partner(s). One or both of you may feel disconnected, frustrated or lonely.

If an STI causes dysorgasmia, complications may include damage to your uterus, ectopic pregnancy, and female or male infertility.

How doctors diagnose dysorgasmia

Healthcare providers will review your medical and sexual history, ask questions about your symptoms and conduct a physical exam. A physical exam may also include examinations of your:

• Anus (butthole), rectum and prostate (digital rectal exam)
• Cervix, fallopian tubes, ovaries, vagina and uterus (pelvic exam)

Providers may also recommend more tests. These may include:

• Imaging tests (CT scan, MRI, X-ray, ultrasound) to help diagnose the cause of painful orgasms
• Prostate-specific antigen test to confirm prostate cancer
• Pee tests, blood tests or swab tests to check for STIs or other infections

What are the treatments?

Dysorgasmia treatment depends on the underlying cause. Your treatment may include:

• Antibiotics to treat pelvic inflammatory disease or an STI
• Hormonal birth control to treat endometriosis or uterine fibroids
• Pelvic floor therapy (Kegels) and diaphragmatic breathing to help relax your pelvic floor muscles
• Surgery to treat an ejaculatory duct blockage (transurethral resection), endometriosis, uterine fibroids (myomectomy) or prostate cancer
• Alpha-blockers like tamsulosin (Flomax®) to treat an enlarged prostate or ejaculatory duct blockage
• Changing your antidepressant medication
• Other medications, including muscle relaxants, anti-inflammatory medications and/or pain reliever medications
• Counseling or therapy to address stress, anxiety or past trauma

When should I see my healthcare provider?

Reach out to your healthcare provider if you have:

• Intense pain
• Pain that happens every time or almost every time you orgasm
• Pain along with a fever
• Blood in your pee (hematuria) or semen (hematospermia)

You should also schedule an appointment if orgasm pain or discomfort affects your quality of life to the point you avoid sexual activity.

In many cases, your provider may refer you to a:

• Gynecologist
• Urologist
• Physical therapist who specializes in pelvic floor dysfunction (pelvic floor therapist)
• Sex therapist

What can I expect?

Your first step is to talk about your painful orgasm with a trusted healthcare provider. They’ll help diagnose the cause and talk to you about the best treatment options. In many cases, your symptoms may go away pretty quickly with treatment. But depending on how severe it is and the underlying cause, you may need to try different treatments. Your providers will work with you to find the most effective ones.

Can it be prevented?

Although you may not be able to prevent all causes of painful orgasm, you can help prevent some causes by:

• Getting regular STI tests, especially before having sexual intercourse with a new partner
• Limiting your sexual partners
• Practicing safe sex, including using condoms to help prevent STIs and having open communication with your partners about expectations and limits to protect your mental and emotional health
• Scheduling regular checkups with a healthcare provider
• Treating anxiety, depression or stress