Why Do My Testicles Hurt When I Ejaculate?

Balls are weird.

Use whatever adjectives you want to describe them: sensitive, vulnerable, goofy, defenseless, squishable. The fact remains, these things are kind of crazy when you think about them.

Now consider that for testicles to produce healthy sperm—it is their main job, after all—they have to basically live outside a man's body. This is so they maintain a temperature that's about 2 degrees cooler than the rest of him. 

They dangle like a bizarre pair of rotund, fleshy earrings from the spermatic cords, which, if twisted, can cause a testicle to begin dying within hours. And of course, we all know what happens if someone gives them a swift kick.

The 'hurts so good' part of sex shouldn't be unplanned testicular pain.

Nature's a wonderful thing but, really, who would deliberately come up with a design like this?

Of course, you associate ejaculating with pleasure, but it may come as a surprise that for some, there can be pain involved. Let's get straight to the question that plagues some men: Why do my testicles hurt when I ejaculate?

An infection could cause pain in your testicles when you ejaculate

Simple explanations are nice when it comes to medicine and sexual health. It's always good when straightforward problems can be answered with straightforward solutions. Sometimes, that's true with testicular pain during ejaculation if it turns out to be an infection. Typically, that means you get a round of antibiotics for a week or two, and you're good to go.

"Infection can certainly be a reason for testicular pain," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "Those can be much easier to treat: they get tested, and if it's positive, you treat them."

Keep in mind, though, that an infection is likely to be pretty noticeable. It might be more acute when you ejaculate, but if you have an infection involving the testicles, it's always going to be with you.

"If someone has an infection, it's going to hurt all the time until it's treated," Pearlman said. "You're not going to have pain only when you ejaculate. The testicle is usually enlarged or they have a red, hot scrotum. An infection is going to be pretty obviously different on a physical exam."

Scar tissue could cause pain in your testicles when you ejaculate

If you've ever learned about Peyronie's disease, you know that scar tissue in the genital region can dramatically affect such sensitive and delicate structures.

A type of scar tissue unrelated to Peyronie's can build up on the inside of the urethra and may cause a man to experience pain when he ejaculates. Imagine a hoarder's apartment with decades' worth of old newspapers piled up along the hallway. If a crowd of people tried to jam through there all at once at a high rate of speed, they're going to get clogged. That's what happens with scar tissue in the urethra.

"Oftentimes, where scar tissue develops in the urethra is in front of the ejaculatory duct, toward the tip of the penis," Pearlman said. "So when the ejaculatory fluid is trying to go in, it's trying to go past this scar tissue and it has trouble doing that. That can cause a high-pressure situation back toward the testicles."

Testicle retraction could cause pain when you ejaculate

In case you missed it earlier, balls are weird.

For instance, they move up and down in response to temperature, exertion, anxiety or sexual stimulus. Sometimes, though, when a man ejaculates, the testicle may pull up so high it retracts up into the body cavity. This movement, combined with the sudden surge of semen coursing through the system at high speeds, can cause discomfort.

"Sometimes, the testicle will retract upward during different types of activity," Pearlman said. "It could be if they're anxious or if someone goes outside when it's cold, it will retract. But sometimes, too, with ejaculation or sexual activity, the testicle can sometimes ride all the way up and into the groin region."

Chronic pelvic pain syndrome

A phenomenon known as "referred pain" often comes up when discussing male sexual health issues. That's because the entire pelvic region is filled with nerves that connect muscles, organs and sexual structures with a variety of functions and conditions that can affect them.

For instance, the pelvic floor muscles—a sling-like apparatus that runs from your pubic bone in the front underneath to the tailbone in the back—are involved in urination, defecation, sexual functioning, ejaculation and helping your core keep you upright.

It's crisscrossed with branches of the pudendal nerve that links the spine and brain to the penis, prostate gland and testicles. When something goes awry down there, the nervous system may register it as pain but not be able to provide an entirely accurate picture of where that pain originates.

The more sensitive something is—we're looking at you, testicles—the more likely we are to "think" that's where the pain originates.

"You have to separate out testicular pain into acute pain and chronic pain. Prostatitis and prostate infections can cause painful ejaculations, for instance. But more often than not, what we see is chronic pelvic pain syndrome (CPPS) being the cause. It's usually a pelvic floor muscle spasm issue," said Neel Parekh, M.D., a men's fertility and sexual health specialist with Cleveland Clinic.

He said it's pretty straightforward.

"When the pelvic muscles are tight, those are the same muscles that contract during ejaculation," Parekh added. "So when you ejaculate, you're contracting an already tight muscle, which causes further pain and discomfort."

Conclusions

Yes, testicles are weird, but they're the only ones we've got, and most of the conditions described mentioned here aren't going to get better on their own. It's also worth noting that infections and CPPS can get worse if they're ignored.

The "hurts so good" part of sex shouldn't be unplanned testicular pain. Don't let your weird buddies suffer unnecessarily. Plan to talk to your doctor as soon as you start to feel pain down there during sex.