Painful Orgasm

What causes painful orgasm in men, and how can it be treated?

Painful orgasm (painful ejaculation) is commonly described as a pain or burning sensation that happens when a man ejaculates. He may feel pain between his anus and genitals or in his testes. He may also feel it in the urethra, the tube that semen passes through. Pain may be mild or severe.

A man may become so frustrated by this pain that he starts to avoid sex. His relationship with his partner may suffer as a result. Many men with painful ejaculation experience depression and anxiety.

Painful orgasm can have a number of causes:

Inflammation and Infections

  • Prostatitis - inflammation of the prostate gland, which is involved with semen production

  • Orchitis - inflammation of one of both testes, the glands that make sperm

  • Urethritis - inflammation of urethra, the tube that semen passes through when a man ejaculates.

  • Sexually-transmitted infections – such as trichomoniasis

Pelvic Conditions and Treatments

  • Prostate cancer

  • Pelvic radiation

  • Lower pelvic surgery– such as radical prostatectomy (removal of the prostate)

  • Nerve damage in the penis– such as from an injury or complications of diabetes.

  • Chronic pain in the pelvis

  • Blockages in the ejaculatory system- from cysts or stones

Some antidepressants, spermicides, and contraceptive creams have also been linked to painful ejaculation.

Sometimes, the cause of painful ejaculation is more difficult to pinpoint. Psychological problems can play a role, especially if a man has pain only with a partner, not when he masturbates.

To treat painful orgasm, a doctor must first determine the cause. Usually this involves a thorough medical exam. Sometimes, samples of urine or semen are analyzed.

Medications may help if there is inflammation of the testicles, prostate or urethra. Men who have sexually-transmitted infections are usually given antibiotics.

If painful ejaculation is a side effect of medication, it may help to lower the dose (with a doctor’s guidance) or change the medication type.

Men who have painful ejaculation due to nerve damage often find that the situation gets better as the nerve heals. This may take up to two years.

Counseling or sex therapy can be helpful if the problem is psychological.

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What is a penile rehabilitation program (PRP)?

What is a penile rehabilitation program (PRP)?

The prostate gland is surrounded by nerves that are critical for a man’s ability to have an erection.

When a man has prostate cancer, he may have a procedure called a prostatectomy, which involves removing the prostate gland. During a prostatectomy, a surgeon tries to preserve the surrounding nerves as much as possible. However, many men still have problems with erections after surgery.

Penile rehabilitation programs (PRPs) are like a form of physical therapy. For example, if a man has knee surgery, he may go to physical therapy and do exercises to strengthen his knee and get it back into good condition. If he doesn’t do his exercises, his knee may get weaker.

PRPs work in a similar way. They can help men recover their erectile function by inducing erections to “exercise” the penis. This process keeps erectile tissue healthy while the remaining nerves heal from surgery. The erections may be induced through oral medication, injections into the penis, penile suppositories, or vacuum devices. Some men are advised to masturbate on a regular basis.

Through penile rehabilitation, it is hoped that the patient will eventually have satisfactory erections on his own or will respond well to oral medications for erectile dysfunction.

It should be noted that some experts do not think penile rehabilitation is a worthwhile strategy.

Penile rehabilitation can take time – sometimes up to four years. With patience and dedication, however, many men are able to again have erections suitable for sex.

What does a penile rehabilitation program (PRP) involve?

Penile rehabilitation programs vary from clinic to clinic and patient to patient, but some of the more common strategies include the following:

Oral medications. Phosphodiesterase type 5 inhibitors, such as Viagra®, Levitra®, and Cialis®, improve blood flow to the penis and help keep erectile tissue healthy.

Penile Injections. The patient is trained to inject medication into his penis to prompt an erection.

Suppositories (MUSE). Pellets of medicine are inserted into the urethra, the tube that allows urine and semen to exit the body.

Vacuum erection devices. A clear plastic cylinder is placed over the penis. The man then uses a pump to draw out the air, creating a vacuum. This leads to an erection.

How successful are penile rehabilitation programs (PRPs)?

Penile rehabilitation programs (PRPs) can help men restore their ability to have erections after prostatectomy (removal of the prostate gland). However, several factors affect the success rate of PRPs:

The man must consider how well he was able to have erections before surgery. Men who had good erectile function beforehand can often recover that good function after penile rehabilitation. Men who had poor function may not be as successful.

The man needs to be compliant with the program, following his doctor’s instructions. Men who stick with the program diligently tend to have greater success than men who are not as dedicated.

Nerve-sparing also plays a role in recovery. The prostate gland is surrounded by nerves that are important for erectile function. Surgeons try to preserve as many nerves as possible, but usually there is some degree of nerve damage. The success of penile rehabilitation may depend on how much nerve damage results from surgery.

Other factors to consider are age, weight, smoking status, and any medical conditions like diabetes. Having additional treatments for prostate cancer, such as radiation and/or hormonal therapy, can also affect the outcome of penile rehabilitation.

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Should men with an enlarged prostate avoid certain medications?

Should men with an enlarged prostate avoid certain medications ?

Men with an enlarged prostate should not take medications that contain antihistamines or decongestants. These agents are often found in over-the-counter cold, sinus, and allergy medications.

To understand why, it helps to review some prostate anatomy. The prostate is a walnut-sized gland that produces seminal fluid. This fluid mixes with sperm to form ejaculate – the semen that is expelled from the penis when a man reaches orgasm.

Running through the prostate is the urethra – the tube from which urine and semen exit the body.

As men get older, it’s common for the prostate gland to grow inward. This results in an enlarged prostate or benign prostatic hyperplasia (BPH). Scientists aren’t sure why this happens. In some cases, the prostate itself does not enlarge, but it undergoes changes which make it more sensitive to chemicals that your body naturally produces.

The prostate may also undergo other changes which may slow down the flow of urine or increase urinary symptoms such as frequency and urgency.

Because of these changes, many men experience trouble emptying the bladder, find that they have to use the bathroom more often (especially at night), or feel a greater urge to urinate.

Antihistamines and decongestants may add to the problem. These drugs can make it harder for the prostate and the bladder to relax, making it even more difficult for urine to flow.

Fortunately, there are other ways to treat colds and allergies. Men with BPH should talk to their doctors about the treatments that are right for them.

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Should men stop taking erectile dysfunction (ED) drugs before having surgery?

Should men stop taking erectile dysfunction (ED) drugs before having surgery?

Yes. The American Association of Nurse Anesthetists recommends that men avoid taking erectile dysfunction (ED) drugs like Viagra and Cialis for a full 24 hours before surgery.

When patients receive anesthesia, they are often given drugs to control high blood pressure that might occur during surgery. Such drugs contain a substance called nitric oxide.

ED drugs also contain nitric oxide, which helps men achieve erections by relaxing muscles and widening arteries so that more blood can flow into the penis and make it firm for intercourse. These medications usually take 24 hours to leave the body.

Combining ED drugs with anesthesia can lessen the effects of the blood pressure drugs. It can also lead to poor circulation to the kidneys, heart failure, and other side effects.

Men should be up front with their doctors about any medications they use, including complementary and alternative medicines, like dietary supplements, ginseng, and ginger. It’s important for anesthesiologists – or any doctor - to know exactly what a patient is taking so that dangerous drug interactions can be avoided.

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Vit D and Erection

Do vitamin D levels have any impact on a man’s erections?

Vitamin D is an important nutrient for our overall health. And some experts believe vitamin D deficiency might interfere with a man’s erections.

Sometimes called the “sunshine vitamin,” vitamin D helps the body process calcium to strengthen bones. It’s also important for nerves, muscles, and the immune system.

The body makes vitamin D when the skin is exposed to sunlight. Vitamin D can also be found in certain foods, such as fish and fortified cereals. Some people also take vitamin D supplements.

In 2016, the journal Atherosclerosis published a study by American researchers examining the relationship between vitamin D deficiency and erectile dysfunction (ED). The research team collected data from 3,390 men between the ages of 20 and 85. The men were considered to have vitamin D deficiency if their levels were below 20 ng/mL. Almost a quarter of the men had ED.

The scientists determined that the prevalence rates of vitamin D deficiency were 36% for men with ED and 29% for men without ED. Men with ED tended to be older, less active, and in poorer health.

It was unclear why vitamin D deficiency was linked to ED in this way. It’s possible that low levels of vitamin D could lead to damage in the blood vessels of the penis. Such damage could lead to atherosclerosis (hardening of the arteries), which would make it more difficult for blood to flow into the penis for an erection.

Another theory involves nitric oxide, an important element for erections. Vitamin D helps the body make this compound, but if a man is deficient, less nitric oxide can be produced.

More research is needed to determine if increasing vitamin D levels would improve erections for men with ED. In the meantime, men with erection problems are encouraged to see their doctor. Many factors can contribute to ED, and a full checkup can determine the cause and, in turn, the appropriate treatment.

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Are there natural ways to boost testosterone?

Are there natural ways to boost testosterone?

Yes. In some cases, men can raise their testosterone levels by changing some lifestyle habits.

Low testosterone can have a variety of causes. Sometimes, there are problems in parts of the body involved with testosterone production, such as the hypothalamus, the pituitary gland, or the testes. Men’s testosterone levels naturally decline as they get older, too.

Symptoms of low testosterone include diminished sex drive, loss of muscle mass, weakness, and moodiness. While testosterone replacement therapy may help, some men find that their symptoms improve by following healthy habits.

Improve sleep hygiene

A man’s body makes testosterone while he’s sleeping. As a result, the less he sleeps, the less testosterone his body will produce. In a 2011 study of younger men, researchers found that after one week of reduced sleep, testosterone levels decreased by 10% to 15%.

For better sleep, men might consider the following tips:

  • Make sleep a priority, with a goal of seven to nine hours of quality sleep each night.

  • Relax and “unplug” at bedtime. Avoid using electronics like televisions, smartphones, and tablets.

  • Cut down on caffeine and alcohol consumption.

  • Exercise regularly.

  • Go to bed and get up at the same time every day.

  • Manage stress, and ask for help if necessary.

  • See a doctor if sleep problems persist

Maintain a healthy weight

Obesity is also related to low testosterone. Normally, some of a man’s testosterone converts to another hormone called estrogen. This process typically happens in fat cells. So being overweight or obese can increase the amount of testosterone converted to estrogen and, in turn, decrease overall testosterone levels.

To keep weight under control, men are advised to:

  • Eat healthy foods like fruits, vegetables, and whole grains. Avoid sugars and processed foods.

  • Watch portion sizes.

  • Exercise regularly and stay active.

  • Discuss any concerns with a doctor, nutritionist, or fitness specialist.

Ask a doctor about your current medications

Testosterone production can be impaired by some medications (such as opiates for pain) and hormones. Changing drugs or doses may help, but this step should always be taken with a doctor’s guidance.

Avoid anabolic steroids and supplements

Anabolic steroids or other performance enhancing drugs can interfere with testosterone production and should be avoided.

Supplements that claim to boost testosterone levels should be avoided as well. While these products are easy to buy online or at a pharmacy, they are not always effective. They may also contain ingredients that can cause harmful interactions with drugs a man is already taking. Sometimes, these ingredients are not listed on the product packaging.

Men should always consult their doctor before taking any type of supplement.

For men with low testosterone symptoms, seeing a doctor is always a good idea. A thorough physical exam may reveal other possible reasons for low testosterone, such as inflammation or infection. A doctor can make recommendations and tailor treatment to the individual.

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Diabetes and Erectile Dysfunction

How does diabetes lead to
erectile dysfunction (ED)?

Erectile dysfunction (ED) is a common problem for diabetic men. In fact, diabetic men are four times more likely to develop ED than those without diabetes. They also tend to develop ED ten to fifteen years earlier and have more severe cases.

Erectile difficulties associated with diabetes are usually caused by neuropathy, atherosclerosis, endothelial dysfunction, venous leak, or low testosterone.

Neuropathy is a nerve disorder. In normal circumstances, when a man is sexually aroused, a message travels through his nervous system to signal the start of an erection. For a man with neuropathy in his penis, this transmission gets disrupted and the penis does not respond in the typical way.

Experts don’t know why neuropathy occurs in diabetics. Some believe that abnormal proteins formed by high blood sugar cause the nerve damage. High blood sugar could also interfere with message transmission.

Atherosclerosis is a hardening, or thickening, of the arteries. When a man has an erection, his penis fills with blood. Arteries are a critical part of this process, as they expand in response to sexual stimulation and allow blood in. Veins constrict to keep the blood in the penis until the man ejaculates. Then, the blood flows back into the body.

Atherosclerosis makes it difficult for blood to enter the penis. Depending on how severe the condition is, the blood flow may be insufficient for an erection firm enough for sex.

Endothelial dysfunction. The endothelium is tissue that lines the blood vessels, including those in the penis. High blood sugar can damage this tissue, making it more difficult for blood to flow in and form an erection. High blood sugar can also interfere with the production of nitric oxide, an important compound for erections. Insufficient nitric oxide may contribute to endothelial dysfunction.

Venous leak occurs when veins are unable to keep enough blood in the penis for a suitable erection. As noted earlier, a firm erection results when blood flows into the penis. Veins normally constrict to keep the blood inside until the man ejaculates. A venous leak prevents blood from staying in the penis. Instead, blood leaks back into the body and the erection fails to stay rigid.

Venous leak is often caused by problems with smooth muscle tissue, which needs to relax for a good erection to occur. Studies have shown that many diabetic men have less smooth muscle content and that this tissue does not always relax properly.

Low testosterone is another common problem for diabetic men. Testosterone is a sex hormone that affects a man’s sex drive. Testosterone deficiency can lead to erectile dysfunction.

Men with diabetes and ED are encouraged to see their doctor. Sometimes, erections improve when men make healthier choices, like exercising more, keeping blood sugar under control, and quitting smoking. There are also several ED treatment options available. A man’s doctor can advise which treatment path is best.

Being committed to a healthy lifestyle can help erections in other ways, too. For example, staying fit can improve a man’s mental health, body image, and self-esteem, resulting in greater sexual self-confidence and possibly better erections.

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What is postcoital dysphoria (“post-sex blues”)?

What is postcoital dysphoria (“post-sex blues”)?

Sometimes, people feel deep sadness or agitation after consensual sex. The medical term for these feelings is postcoital dysphoria (PCD), but some call it the “post-sex blues.”

In some cases, people become tearful or depressed after orgasm. In others, they become argumentative with their partner. These feelings occur even if the sexual encounter has been satisfying and enjoyable.

Not much is known about PCD, but research published in the journal Sexual Medicine in 2015 has revealed how common it is among women.

Researchers from the Queensland University of Technology (QUT) in Australia asked 230 female university students to participate in a survey about their experiences with PCD. The women ranged in age from 18 to 55 with an average age of 26 years.

Forty-six percent of the women said they’d experienced PCD in the past. About 5% said they’d had symptoms over the past month. And about 2% reported having PCD “always” or “most of the time.”

However, PCD was not linked to intimacy in close relationships, the researchers reported.

Experts aren’t sure why PCD happens. It may be that the bonding with a partner during sex is so intense that breaking the bond triggers sadness. Childhood sexual abuse may play a role as well.

The QUT researchers noted that their findings may not apply to other groups, as their participants were heterosexual, mostly Caucasian, and university students.

Additional studies with larger, more diverse groups may provide more clues. It is also uncertain to what extent postcoital dysphoria affects men.

People who are concerned about the post-sex blues are encouraged to talk to their doctor or a sex therapist.

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Soft Drinks & ED

Soft Drinks

Can consuming soft drinks lead to erectile dysfunction (ED)?

It’s possible. Soft drinks, which include sweetened carbonated beverages like soda, are usually high in sugar, refined carbohydrates, and calories. Consuming too much of these ingredients can contribute to the development of metabolic syndrome, which can then lead to erectile dysfunction (ED).

Metabolic syndrome is actually a group of conditions that include obesity, high triglycerides, low HDL (“good”) cholesterol, high blood pressure, and high blood sugar. Many people with metabolic syndrome eventually develop diabetes.

In 2015, research published in the Journal of Sexual Medicine found that men with metabolic syndrome are 2.6 times more likely to have ED compared to healthy men. And in 2010, a study in the British Medical Journal reported that obese men were two and a half times more likely to have ED than men who were not obese.

In addition, men with diabetes are about four times more likely to develop ED compared to non-diabetic men. They are more likely to start having erection problems at earlier ages, too.

There are many ways the components of metabolic syndrome can lead to ED.


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Penile Prosthesis

Penile Prosthesis

When should a man consider a prosthesis?

Usually, a prosthesis is considered a last resort. Men with erectile dysfunction (ED) are encouraged to try all other possible treatments (such as pills, injections, and vacuum devices) before getting an implant. However, some treatments are not suitable for all men. For example, men who take nitrates cannot take certain ED medications.

What types of prostheses are available?

Generally, there are two different types:

Semi-rigid positionable rods have an inner core made of stainless steel or interlocking plastic joints. A man can bend the penis up when he wants an erection and bend it back down when he’s finished with sexual activity.

Inflatable implants use a pump system. When a man wants an erection, he activates a pump placed in the scrotum. This action sends fluid (usually a saline solution) into inflatable cylinders placed in the penis.

Inflatable implants can have 2 or 3 parts. With 2-part implants, the fluid is held in the back part of the inflatable cylinders. With 3-part versions, the fluid is contained in a separate reservoir.

Nowadays, 3-part inflatable implants are the most common.

Both semi-rigid rods and inflatable implants are completely concealed within the body. Nobody can see them.

What are some of the drawbacks of a penile prosthesis? Can the device malfunction?

Infection is one risk. If the implant becomes infected, it will need to be replaced. Sometimes the implant damages surrounding tissue.

It’s possible for an implant to malfunction. This is more common with inflatable devices, which can leak saline fluid into the body. The fluid itself shouldn’t cause problems, but the device should be replaced or repaired.

What is the implant procedure like?

For some men, an implant procedure is same-day surgery. Others need to spend one night in the hospital. Men receive general anesthesia and incisions are made in the penis, lower abdomen, or scrotum. Afterward, many men need to take oral medications for pain. Sexual activity should be avoided for about a month after surgery.

Can the prosthesis wear out?

Yes. Normally, the device will function for about 12 to 15 years. After that, it will probably need replacement, if the patient wishes.

What is the satisfaction rate for penile prostheses?

The satisfaction rate is very high. For men with implants, the rate can reach 85%.  For their partners, it can be as high as 90%.

Will sex still feel the same with a prosthesis?

Most men feel sensation, reach orgasm, and ejaculate just as they did before getting an implant.

What if I don’t like the implant? Can the operation be reversed?

No. The implant replaces the corpora cavernosum, the spongy tissue that typically fills with blood during an erection. So, it’s important that men discuss the pros and cons with their physician before getting an implant. Usually, other treatments for erectile dysfunction (such as oral medications or vacuum devices) are tried before an implant is considered.

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