Q: My boyfriend and I have been together about a year, we’re the same age, we’ve been friends for a long time — things are great! Only not quite. There is a problem. When we have sex, it’s great for me, but not so much for him. He has sensitivity issues even though we don’t usually use condoms (I have an IUD), and what’s worse, about 50 percent of the time he experiences rather acute pain when he ejaculates(!!). He usually just shrugs it off and says it’s fine, it doesn’t bother him, but REALLY?! I’ve taken some very thorough ganders at his nether regions, and I see nothing that could be causing the pain, so this leads me to believe that this is a) an internal problem, or b) a mental problem that he has created unconsciously. He does have some extreme anxiety and can be very introverted, so I wonder if the latter may be the case. But I’m far from a professional. Have you ever heard of anything like this? I have no idea what to do! I don’t want him to be in pain just because he wants to be manly and please me!
A: Acute pain as a result of a normal body function is certainly nothing to shrug off. What if blood sprayed out of your eyes every time you sneezed? In addition to the ability to entertain friends with a spot-on coast horned lizard impression, you’d have a pretty serious medical problem.
Even if you don’t see anything wrong with his man tackle from the outside, there may well be something going on inside. Common causes of painful ejaculation are prostatitis (a nagging condition that causes pain and other symptoms in the prostate), orchitis (an inflammation in one or both testicles) and urethritis (an inflammation of the urethra, usually caused by a bacterial or viral infection). These conditions can be easily diagnosed and usually treated with antibiotics. Painful ejaculation can also be indicative of an STD, such as chlamydia, which is another easy diagnosis. Interestingly, some antidepressants can also cause the problem, specifically SSRIs, which are frequently prescribed for anxiety disorders. Does your boyfriend take medication for his anxiety? If so, that could be the culprit. In addition to seeing a urologist, he should also speak with his psych doc about alternative treatment options.
While it sounds to me like your boyfriend’s problem is physiological in nature, I tapped an expert in the field of sexual psychology just to be sure. Patricia Aletky, a clinical psychologist in the Twin Cities, is fast becoming my favorite source to aid in answering questions because she is so damn quick to reply. She agrees that the first step for your boyfriend is to see a good urologist. As for the psychological component: Does your boyfriend place too much importance on the actual feat of ejaculating? “Keep in mind that a male can ejaculate without much of a subjective feeling of orgasm,” says Dr. Aletky. “It is possible that high anxiety can cause involuntary muscle contractions which could be painful.”
If your boyfriend has performance anxiety about being able to shoot a load, he could be psyching himself out to the point of pain. “Please keep in mind that any problem can be both ‘mental’ and physical,” Dr. Aletky adds. An existing medical condition exacerbated by the stress of being able to get off and get you off must be a special hell for your man. Make sure he sees a urologist as soon as possible, so you can both enjoy the sex, sans pain.