Why do I have sudden pain during ejaculation for the past three months?

Hi doctor,

I experienced a sudden onset of painful ejaculation that has been ongoing for two to three months, significantly interfering with my sexual life. The maximum pain is on the glans of the penis, which is spamsic in nature, coming wave-like with every contraction before ejaculation and then persisting for the whole duration of ejaculation, disappearing after the act of ejaculation. The speed of ejaculating semen has decreased, and no shooting is detected. Five minutes after ejaculation, a relatively tiny amount of fluid, presumably sperm remnant or prostatic fluid, continues to flow. A similar amount of flow with the exact chronology happens with the urine, which requires me to manually empty my urethra by pressing the prostatic segment of the urethra with the third to fifth finger after micturition. I had occasional dysuria, only once or twice in the past two years, lasting less than an hour, relieving spontaneously. In the past, I had occasional, minimally disturbing mild, intermittent pain in the groin and perineum area, which lasted five years and was relieved spontaneously. Seven years back, I had a single episode of painless hematospermia after the fifth ejaculation within six to seven hours. I underwent a full urological workup including physical, laboratory analysis of urine and sperm, sonography of kidney and bladder, and cystoscopy. The pathological result was microhematuria, which disappeared in follow-ups. Nine years back, I developed sudden and mild symptoms for which I was prescribed Doxycycline 200 mg/day for one week, after which there was a transient regression of symptoms. I have been taking Ciprofloxacin 1000 mg every day for the past ten days. I am directed to continue the medication for four to six weeks, but there are no noticeable changes after ten days. I have also been taking Finasteride 1 mg daily for hair loss for at least five years. Other than that, I have irrelevant urological or oncological medical history. Is there an alternative diagnosis or treatment for my current symptoms? Is there any diagnosis for unclear temporary subcutaneous nodules in the penis shaft? Please help.

Thank you.

Hello doctor,

Thank you for the reply.

It could be chronic prostatitis. I sit for six to eight days while working. Everything was examined and found negative during hematospermia, including sperm and urine. Recently, I have not undergone any tests. Honestly, the cystoscopy I had made me so afraid I did not want to have any tests that involved touching my urethra. That is why I am going purely based on clinical diagnosis this time. I had brief dysuria yesterday after ejaculation, although it only lasted an hour before going away. I had a burning pain in my urethra during ejaculation; is this normal? Do you advise taking oral antibiotics for longer than four weeks if I do not notice any changes after 12 days? Do you recommend NSAIDs? Although I have never taken alpha-blockers, if you suggest Tamsulosin, I can begin taking it.

Thank you.