Rectal Pain After Ejaculation: Causes and Solutions

Experiencing swelling and pain in the anus after masturbation?

Hello Doctor: For the past month or two, I have been experiencing a painful, swollen sensation in my anus about one to two hours after ejaculation, making it impossible to sit comfortably.
I previously visited a urologist twice, who conducted a urinalysis and found nothing significant.
The doctor suggested trying antibiotics, which provided slight pain relief, but I still experience this sensation daily.
I later considered seeing a colorectal surgeon, who diagnosed me with hemorrhoids and performed a ligation procedure, but the pain persists.
Recently, I purchased a rectal medication that has provided some improvement, but after using it for a week, I still occasionally feel this discomfort, especially after ejaculation.
Could you please advise me on which specialty I should consult? The pain seems to be related to the area that tightens and exerts pressure during ejaculation.
Thank you.

Mr. Lin, 30~39 year old female. Ask Date: 2014/03/26

Dr. Liu Jiaju reply Urology

Your issue may be chronic prostatitis or hemorrhoids.
It is recommended to first consult a urologist for a digital rectal examination and semen analysis to rule out chronic prostatitis.
If chronic prostatitis is ruled out and symptoms persist, it is advisable to see a colorectal surgeon for a more detailed examination.

Reply Date: 2014/03/26

More Info

Understanding rectal pain after ejaculation can be a complex issue, as it may stem from various underlying causes. Based on your description, it seems that you have already consulted with urologists and a colorectal surgeon, which is a good start. However, persistent pain after ejaculation warrants further exploration to identify the root cause and appropriate treatment.

Possible Causes of Rectal Pain After Ejaculation
1. Prostatitis: This is an inflammation of the prostate gland, which can lead to pain in the pelvic area, including the rectum. Chronic prostatitis can cause discomfort during and after ejaculation. Symptoms may include pain during urination, difficulty urinating, and pelvic pain.

2. Pelvic Floor Dysfunction: The pelvic floor muscles play a crucial role in sexual function and ejaculation. If these muscles are tense or in spasm, they can cause pain during or after ejaculation. This condition may also be associated with other symptoms such as pain during bowel movements or discomfort while sitting.

3. Hemorrhoids: You mentioned having hemorrhoids and undergoing a minor surgical procedure. While this may provide some relief, hemorrhoids can still cause discomfort, especially during activities that increase abdominal pressure, such as ejaculation.

4. Nerve Irritation or Damage: The nerves that innervate the pelvic region can become irritated or compressed, leading to pain. This could be due to previous injuries, surgeries, or conditions affecting the spine or pelvis.

5. Infections: Although your urine tests were normal, it’s essential to consider that some infections may not be easily detectable. A thorough evaluation for sexually transmitted infections (STIs) or other infections in the pelvic region may be warranted.

6. Psychological Factors: Anxiety or stress related to sexual performance or pain can exacerbate physical symptoms. It's essential to consider the psychological aspect of chronic pain, as it can create a cycle of discomfort and anxiety.

Recommended Steps for Management
1. Consult a Specialist: Since you have already seen urologists and a colorectal surgeon, it may be beneficial to consult a pelvic floor specialist or a pain management specialist. They can provide a comprehensive evaluation and tailor a treatment plan specific to your needs.

2. Physical Therapy: Pelvic floor physical therapy can be highly effective in treating pelvic pain. A physical therapist specializing in pelvic health can help you learn relaxation techniques, exercises to strengthen or relax pelvic floor muscles, and strategies to manage pain.

3. Medication: While antibiotics may have provided some relief, other medications such as anti-inflammatory drugs, muscle relaxants, or nerve pain medications (like gabapentin) may be beneficial. Discuss these options with your healthcare provider.

4. Lifestyle Modifications: Avoiding activities that exacerbate your symptoms, such as prolonged sitting or heavy lifting, may help. Incorporating gentle exercises, such as walking or swimming, can improve overall pelvic health.

5. Alternative Therapies: Some patients find relief through acupuncture, biofeedback, or mindfulness practices. These therapies can help manage pain and reduce anxiety related to sexual function.

6. Follow-Up: Regular follow-up with your healthcare providers is crucial to monitor your symptoms and adjust your treatment plan as necessary. If your symptoms persist or worsen, further diagnostic tests, such as imaging studies or a referral to a pain clinic, may be needed.

Conclusion
Persistent rectal pain after ejaculation can significantly impact your quality of life. It is essential to approach this issue holistically, considering both physical and psychological factors. By consulting with the right specialists and exploring various treatment options, you can work towards finding relief and improving your overall well-being. Don't hesitate to advocate for yourself and seek further evaluations if your symptoms do not improve.

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