About ten years ago I had severe pain during ejaculation. It was treated, but gradually I began to lose the pleasure normally felt during ejaculation. I also sometimes have discomfort when sitting in a chair for a long time.
I have seen several urologists and have received different antibiotics. Some have suggested surgery. Ultrasound shows that my prostate is not enlarged. I am now 50 and otherwise in generally good health.
One urologist suggested prostate massage or milking, but I found this too complicated to perform myself. What could be causing the problem and what treatment should I consider?
Quick Answer: Why Can Pleasure During Ejaculation Decrease?
A gradual loss of orgasmic pleasure after a history of painful ejaculation and pelvic discomfort is not automatically caused by an enlarged prostate. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), pelvic-floor muscle dysfunction, medications, nerve problems, hormonal disorders and psychosexual factors are among the possibilities.
- A normal-sized prostate on ultrasound makes significant prostate enlargement (BPH) a less convincing explanation for this particular symptom pattern.
- Pain during or after ejaculation is a recognized feature of chronic prostatitis/chronic pelvic pain syndrome.
- Discomfort after prolonged sitting can also occur with pelvic-floor, pudendal or other chronic pelvic-pain disorders.
- Repeated antibiotics are unlikely to help indefinitely if testing does not demonstrate a bacterial infection.
- Surgery should not be performed merely because ejaculation feels less pleasurable unless a specific structural problem requiring surgery has been identified.
- I would not recommend self-prostate massage or prostate milking as a routine treatment for this problem.
First, Orgasm and Ejaculation Are Not Exactly the Same Thing
Men often use the words orgasm and ejaculation interchangeably, but they describe related rather than identical processes.
Ejaculation is the physical release of seminal fluid. Orgasm is the pleasurable sensory and neurological experience that normally accompanies sexual climax.
A man can therefore:
- ejaculate normally but experience much less pleasure;
- have orgasm with little or no ejaculation;
- experience delayed orgasm;
- experience painful ejaculation;
- or occasionally be unable to reach orgasm.
The EAU (European Association of Urology) describes anorgasmia as the perceived absence of orgasm. In an acquired problem, a man previously experienced normal orgasm and later developed diminished or absent orgasmic sensation.
What Can Cause Loss of Pleasure During Ejaculation?
There is no single cause, so the evaluation should be broader than repeatedly treating the prostate for infection.
| Possible Cause | Why It May Fit | What Helps Clarify It |
|---|---|---|
| Chronic prostatitis / chronic pelvic pain syndrome | Previous painful ejaculation plus ongoing pelvic discomfort can occur with CP/CPPS. | History, examination, urine testing and exclusion of other disorders. |
| Pelvic-floor muscle dysfunction | Pelvic-floor muscles participate in ejaculation and orgasm. Tender or overactive muscles can cause pain and sexual symptoms. | Pelvic-floor examination by an appropriately trained clinician or physiotherapist. |
| Medication effect | Antidepressants, antipsychotics, opioids and some other medicines can reduce orgasmic sensation or delay orgasm. | Full medication and supplement review. |
| Hormonal or metabolic problem | Testosterone deficiency, thyroid disorders and some metabolic conditions can affect sexual function. | Clinical assessment and selected blood tests when indicated. |
| Nerve or neurological disorder | Orgasm depends on intact sensory and neurological pathways. | Neurological history and examination if symptoms suggest it. |
| Psychosexual factors | Anxiety, chronic pain, fear of painful ejaculation and relationship factors can alter orgasmic response. | Sexual and psychological history when relevant. |
| Structural or inflammatory disorder | Less commonly, seminal vesicle disorders, ejaculatory duct problems or other pelvic pathology can contribute. | Urological examination and targeted imaging only when indicated. |
Could This Be Chronic Prostatitis or Chronic Pelvic Pain Syndrome?
Yes, this is certainly one possibility that I would consider.
When men hear the word “prostatitis,” they often assume that there must be a bacterial infection in the prostate. In reality, the most common form is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and in many cases there is no ongoing bacterial infection that can be identified.
According to the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases), CP/CPPS typically involves pelvic pain or discomfort that persists for three months or longer and may be felt in several areas, including:
- the perineum, which is the area between the scrotum and anus;
- the penis;
- the scrotum;
- the lower abdomen;
- and the lower back.
Some men describe the discomfort as aching, pressure, burning, heaviness or a deep pelvic pain rather than a sharp pain.
Another symptom that is particularly important in this situation is pain during or after ejaculation. This is a recognized feature of chronic prostatitis/chronic pelvic pain syndrome and can sometimes be one of the symptoms that brings a patient to the doctor.
Men with CP/CPPS may also experience urinary symptoms such as:
- frequent urination;
- urgency;
- discomfort while urinating;
- difficulty starting the urine stream;
- or a feeling that the bladder has not completely emptied.
However, these symptoms can overlap with several other urinary and pelvic conditions, so the diagnosis should not be made from one symptom alone.
If an ultrasound reportedly shows that the prostate is not enlarged, I would be cautious about assuming that the symptoms must be caused by BPH.
In that situation, symptoms such as pelvic discomfort, pain around the prostate area, urinary changes and particularly pain associated with ejaculation may fit chronic prostatitis/chronic pelvic pain syndrome better than a typical enlarged-prostate symptom pattern.
That does not confirm the diagnosis, because similar symptoms can also occur with urinary tract infection, pelvic-floor muscle problems, bladder disorders, urethral conditions and other causes.
The important next step is therefore not simply to treat the prostate as enlarged, but to look at the whole symptom pattern and rule out other possible causes.
I usually explain to patients that CP/CPPS can be frustrating because there is not always one simple cause or one single treatment. Management may involve a combination of approaches depending on the symptoms, including pain control, urinary medications in selected patients, pelvic-floor therapy, lifestyle changes and treatment of any contributing bladder or pelvic-floor problems.
The key message is that persistent pelvic pain or pain with ejaculation deserves proper medical assessment, even when imaging shows that the prostate itself is not enlarged.
“Prostatitis” Does Not Always Mean Infection
Chronic pelvic pain may involve the pelvic floor, nerves, pain processing, previous inflammation and other mechanisms. That is why a long series of antibiotic courses may fail when cultures do not show a bacterial cause.
Why Does Discomfort While Sitting Matter?
When a patient tells me that the discomfort becomes worse after sitting for a long time, I consider that an important clue rather than a minor detail.
Prolonged sitting places pressure on the pelvic floor, perineum and surrounding muscles and nerves. If discomfort repeatedly appears or becomes stronger while sitting, it can suggest that the problem may involve more than the prostate itself.
Several conditions can produce this type of pain or pressure, including:
- pelvic-floor muscle overactivity or pelvic-floor myalgia, where the muscles remain too tense or become painful;
- chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS);
- perineal pain, involving the area between the scrotum and anus;
- pudendal nerve irritation, which can sometimes produce burning, aching or pressure that becomes worse while sitting;
- musculoskeletal problems involving the hips, lower back or pelvis;
- and other pelvic conditions that can produce overlapping urinary, sexual and pain symptoms.
This is why I would not automatically assume that pelvic discomfort in a man must be caused by an enlarged prostate.
The Pelvic Floor Can Play an Important Role
The pelvic floor is a group of muscles that supports the bladder and other pelvic structures. These muscles also participate in urination, ejaculation and sexual function.
If the pelvic-floor muscles become chronically tight, tender or poorly coordinated, a man may experience symptoms such as:
- aching or pressure in the pelvis or perineum;
- pain that becomes worse after sitting;
- difficulty starting urination;
- a feeling of incomplete bladder emptying;
- pain during or after ejaculation;
- and discomfort that may spread toward the penis, testicles, lower abdomen or lower back.
The AUA (American Urological Association) guideline on male chronic pelvic pain emphasizes that doctors should consider musculoskeletal and pelvic-floor causes when evaluating persistent pelvic pain.
One particularly useful point is that pelvic-floor myalgia can occur together with painful ejaculation, urinary hesitancy and pelvic pain. That combination can sometimes fit the patient’s history better than simply assuming that all of the symptoms are coming from prostate enlargement.
Why Painful Ejaculation and Sitting Pain Can Occur Together
I often explain to patients that the pelvic floor is not inactive during sexual function. These muscles participate in the sexual response and contract during ejaculation and orgasm.
The EAU (European Association of Urology) also recognizes the role of pelvic-floor muscle function during the excitement and orgasm phases of the sexual response.
If these muscles are already tense or painful, contraction during ejaculation may aggravate the discomfort. The same muscles may also be compressed or placed under additional strain during prolonged sitting.
This can help explain why some men experience a pattern such as pelvic pressure while sitting together with discomfort during or after ejaculation.
What Does This Mean for the Evaluation?
If sitting clearly makes the discomfort worse, I would want the evaluation to look beyond prostate size alone.
Depending on the history and examination, this may include assessing:
- pelvic-floor muscle tenderness and tension;
- the lower back, hips and surrounding muscles;
- urinary symptoms and bladder emptying;
- possible infection when appropriate;
- the location and character of the pain;
- and whether ejaculation, exercise, bowel movements or prolonged sitting make the symptoms better or worse.
For some patients, treatment may eventually include pelvic-floor physical therapy, relaxation techniques, treatment of contributing urinary symptoms, pain management or other targeted approaches, depending on what the examination shows.
The main point I want patients to understand is that pain made worse by sitting is clinically meaningful. It can provide an important clue that pelvic-floor muscles, nerves or other musculoskeletal structures may be contributing to the problem.
When this is combined with symptoms such as pelvic pain, urinary hesitancy or painful ejaculation, it deserves a broader evaluation rather than being attributed automatically to BPH.
Should Repeated Antibiotics Be Used?
Only when there is a reasonable indication for bacterial infection.
Antibiotics are appropriate for acute and chronic bacterial prostatitis.
However, CP/CPPS is often nonbacterial.
If several antibiotic courses have already failed and repeated testing does not demonstrate infection, simply trying more antibiotics is much less likely to solve a chronic pelvic-pain or orgasmic problem.
The evaluation may include urine testing and, depending on symptoms and previous results, additional testing for infection or sexually transmitted infections.
Do Not Treat Every Pelvic Symptom as Infection
Repeated unnecessary antibiotics expose patients to adverse effects and antimicrobial resistance without treating pelvic-floor dysfunction, nerve pain or another nonbacterial cause.
Should You Try Prostate Massage or “Milking” at Home?
I would not recommend self-prostate massage as a routine treatment for this problem.
Prostate massage has historically been suggested for prostatitis, but it is not a standard evidence-based treatment for loss of orgasmic pleasure.
Trying to perform internal massage yourself can also cause:
- pain;
- rectal irritation or injury;
- bleeding;
- and worsening of pelvic symptoms.
It should also not be attempted in situations where acute bacterial prostatitis or another contraindication is suspected.
Our updated guide to self-prostate massage explains why the claimed medical benefits need to be separated from the limited evidence and potential risks.
Pelvic-Floor Physical Therapy Is Different
Pelvic-floor therapy is not the same thing as prostate milking.
For appropriately selected men with pelvic-floor myalgia or chronic pelvic pain, specialist pelvic-floor physical therapy may include assessment, relaxation training, myofascial treatment and biofeedback. Current chronic-pelvic-pain guidance recognizes these approaches as potentially useful.
What About Surgery?
Surgery should only be considered when a specific surgically correctable problem has been identified.
A recommendation for surgery needs an answer to a simple question:
What exactly would the surgeon be correcting?
For example, surgery might sometimes be appropriate for:
- significant urinary obstruction;
- urethral stricture;
- selected ejaculatory-duct disorders;
- stones or another defined structural problem;
- or another clearly demonstrated urological condition.
But surgery is not a generic treatment for reduced orgasmic pleasure, chronic pelvic pain or unexplained painful ejaculation.
Some Prostate Procedures Can Themselves Change Ejaculation
Before agreeing to any prostate or urinary surgery, ask specifically how the proposed procedure may affect ejaculation, orgasm, erections, fertility and urinary function.
What Evaluation Would Be Reasonable?
Because this problem has persisted for many years, I would favor a structured reassessment rather than another empirical treatment.
Depending on the complete history, an appropriate evaluation may include:
- A detailed sexual history — whether orgasm is reduced, absent, delayed or painful and whether ejaculation itself has changed.
- A medication review — particularly antidepressants, antipsychotics, opioids and other drugs that can affect orgasm.
- Urinary and infection history — including previous cultures and response to antibiotics.
- Physical examination — genital, neurological and appropriate prostate examination.
- Pelvic-floor assessment for tenderness, overactivity or myofascial pain.
- Urinalysis and urine culture when infection is suspected.
- STI testing when history or symptoms indicate it.
- Selected blood tests such as testosterone, glucose or thyroid testing when clinically appropriate.
- Further imaging or endoscopic testing only when the history suggests a structural disorder or other urological indication.
At age 50, routine prostate health assessment may also include discussion of PSA testing according to individual risk and shared decision-making, but PSA does not diagnose the cause of reduced orgasmic pleasure.
How Is This Type of Problem Treated?
Treatment depends on what the evaluation actually finds.
| Finding | Possible Management |
|---|---|
| Confirmed bacterial prostatitis | Appropriate culture-directed antimicrobial treatment and urological follow-up. |
| CP/CPPS | Multimodal treatment directed at the individual’s pain, urinary, pelvic-floor and sexual symptoms. |
| Pelvic-floor myalgia | Specialist pelvic-floor physical therapy, myofascial treatment, relaxation strategies and sometimes biofeedback. |
| Medication-associated orgasmic dysfunction | Prescriber-led medication review; do not stop necessary medicines independently. |
| Hormonal disorder | Treat the documented endocrine abnormality rather than empirically taking testosterone. |
| Psychosexual component | Sex therapy or psychological intervention may complement medical treatment. |
| Structural abnormality | Urologist-directed treatment tailored to that specific problem. |
EAU chronic pelvic pain guidance recognizes pelvic-floor muscle therapy as part of treatment for improving quality of life and sexual function, and recommends a multidisciplinary approach when symptoms are complex. :contentReference[oaicite:2]{index=2}
Does Smoking Matter?
Smoking is unlikely to explain this entire symptom history by itself, but quitting is still worthwhile.
Sexual function depends partly on healthy vascular and neurological function, and smoking is an important modifiable cardiovascular risk factor.
If erectile function has also changed, cardiovascular risk factors, diabetes, blood pressure, medications and smoking history deserve review rather than assuming everything comes from the prostate.
When Should You Seek Prompt Medical Care?
Seek prompt assessment if pelvic or ejaculation symptoms occur with:
- fever or chills;
- complete inability to urinate;
- severe or rapidly worsening pelvic pain;
- visible blood in the urine;
- significant testicular swelling or severe testicular pain;
- new weakness, numbness or neurological symptoms;
- or unexplained weight loss or other significant systemic symptoms.
Acute bacterial prostatitis can cause fever, urinary symptoms and severe pain and needs prompt medical treatment.
Dr. Albana’s Answer
Hello,
The first point I would make is that your ultrasound showing a non-enlarged prostate makes BPH a less convincing explanation for the symptoms you describe.
Your history of severe painful ejaculation in the past, followed by reduced pleasure during ejaculation and discomfort during prolonged sitting, makes me think more broadly about chronic pelvic pain, pelvic-floor dysfunction and acquired orgasmic dysfunction.
Chronic prostatitis/chronic pelvic pain syndrome would be one important possibility. This condition can cause pain during or after ejaculation and may occur even when there is no ongoing bacterial infection.
Because you have already received several courses of antibiotics, I would want to know whether bacteria were actually documented in urine or other appropriate testing. If cultures have repeatedly been negative, simply prescribing another antibiotic is unlikely to address pelvic-floor or neurological causes.
I also would not advise you to perform prostate milking yourself. Prostate massage is not an established treatment for loss of orgasmic pleasure, and repeated internal manipulation can cause irritation or injury.
Of particular interest in your case is the discomfort from prolonged sitting. I would ask your urologist—or ideally a clinician experienced in male chronic pelvic pain—to assess the pelvic-floor muscles for tenderness or overactivity. When pelvic-floor dysfunction is present, specialist pelvic-floor physical therapy can be more appropriate than prostate massage.
I would also review every medication you use, sexual desire, erectile function, genital sensation and whether orgasm is diminished with both intercourse and masturbation. Selected testing for testosterone, thyroid function, glucose or other conditions may be appropriate depending on the rest of your history.
If surgery has been recommended, I would ask the urologist exactly what anatomical problem the proposed operation is intended to correct. I would not undergo prostate surgery simply for reduced orgasmic pleasure without a clear diagnosis and a reasonable expectation that the procedure targets the actual cause.
Your symptoms are real and deserve a structured reassessment, but they do not point automatically to an enlarged prostate or to a problem that requires prostate massage.
Most Asked Questions About Reduced Pleasure During Ejaculation
Why can I ejaculate but feel very little pleasure?
Ejaculation and orgasm are related but separate processes. Reduced pleasure may occur with chronic pelvic pain, pelvic-floor dysfunction, medications, hormonal or neurological disorders, or psychosexual factors.
Can chronic prostatitis cause loss of orgasm sensation?
Chronic prostatitis/chronic pelvic pain syndrome is associated with sexual dysfunction and painful ejaculation. Chronic pain can disrupt several phases of the sexual response, although reduced orgasmic pleasure has multiple possible causes.
Why does sitting make my prostate area uncomfortable?
Prolonged sitting discomfort can occur with chronic pelvic pain, pelvic-floor muscle dysfunction, perineal pain, nerve irritation or musculoskeletal problems. It does not prove that the prostate itself is the source.
Do I need antibiotics for chronic prostatitis?
Antibiotics are important for bacterial prostatitis. They do not treat every form of chronic pelvic pain, particularly when no bacterial infection is demonstrated.
Can prostate massage restore ejaculation pleasure?
There is no good evidence that prostate massage reliably restores orgasmic pleasure. Self-prostate massage is not a standard treatment for this symptom.
Can pelvic-floor therapy help painful ejaculation?
It may help appropriately selected men when pelvic-floor muscle tenderness or overactivity contributes to chronic pelvic pain and sexual symptoms.
Can antidepressants reduce orgasmic pleasure?
Yes. Several antidepressants, especially SSRIs, can delay orgasm or reduce orgasmic sensation. Other medicines including antipsychotics and opioids may also affect orgasm.
Does a normal-sized prostate rule out prostatitis?
No. Prostate size and prostatitis are different issues. A man can have chronic prostatitis/chronic pelvic pain syndrome without an enlarged prostate.
Is surgery a treatment for loss of orgasm sensation?
Not by itself. Surgery is appropriate only when a specific structural problem that can reasonably explain the symptoms has been identified.
Related Prostate & Pelvic Health Guides
Medical References
-
American Urological Association.
Diagnosis and Management of Male Chronic Pelvic Pain:
AUA Guideline.
2025.
AUA Male Chronic Pelvic Pain Guideline -
European Association of Urology.
EAU Guidelines on Chronic Pelvic Pain.
2026.
EAU Chronic Pelvic Pain Guideline -
European Association of Urology.
EAU Guidelines on Sexual and Reproductive Health —
Disorders of Ejaculation.
EAU Disorders of Ejaculation -
National Institute of Diabetes and Digestive and Kidney Diseases.
Prostatitis: Inflammation of the Prostate.
NIDDK
Medical information notice: Loss of orgasmic pleasure and painful ejaculation have several possible causes. Repeated antibiotics, prostate massage or surgery should not be used without a diagnosis that supports those treatments. Persistent symptoms should be evaluated by a clinician familiar with male sexual dysfunction and/or chronic pelvic pain.