Pain after sexual intercourse
June 15, 2011 | 10,00 EUR | answered by Dr. med. Ralf Berg
Good day,
when I have sexual intercourse while feeling the urge to urinate, I regularly experience relatively strong, pulling, difficult to localize pains after orgasm, which last for up to 20-30 minutes. This always happens when I consume a certain amount of fluids before intercourse and develop the urge to urinate. The need to go to the toilet doesn't have to be particularly strong, it is enough if the bladder is slightly filled. This is often accompanied by a feeling of needing to have a bowel movement during the pain. I feel that the pain subsides when I gradually empty my bladder completely in the 20-30 minutes after orgasm. I am in my early 20s and have hemorrhoids, but they usually do not cause me any problems. A proteinuria was diagnosed a few years ago. I am aware that I should seek a doctor's advice personally, and I will do so. However, I am still interested in possible differential diagnoses, as I study medicine myself.
Thank you.
Hello
Dear medical student!
Since you are studying medicine yourself, you can see how difficult a differential diagnosis can sometimes be.
First of all: your symptoms are not normal or usual.
1. Difficulty: You have difficulty localizing the pain
suggests visceral pain, so more likely bladder ureter etc instead of prostate, urethra (DD prostatitis urethritis)
2. Main suspected diagnosis: Reflux of semen into the bladder during or after intercourse? (usually urinating during intercourse is not possible as the detrusor vesicae is blocked and the bladder opening is kept closed. According to your description, it could be that this does not work 100% for you, or only with an empty bladder, a closure pressure can be maintained at a sufficient level so that there is no reflux of semen and prostatic secretions into the bladder. (further clarification only possible with a urologist with uroflow US, sphincter
continence measurement etc;)
DD: Reflux only occurs after intercourse because an obstruction in the prostate or penile urethra (stricture/hyperplasia) prevents complete emptying of the semen and then reflux into the bladder occurs.
Additional diagnoses: bladder irritation independent of intercourse (polyps, tumors, ) that only manifest after intercourse.
DD: Re-evaluate proteinuria DG: Glomerulonephritis,
further DD (due to urge to defecate) recto/proctoscopy due to inflammatory bowel diseases (colitis) as "referred pain" after mechanical irritation (unlikely).
Practical tip: never have intercourse with the urge to urinate, empty the bladder completely beforehand.
I hope I could help you further with a presentation of possible pathophysiological causes.
As you know, there is no way around a urological examination of the urinary and possibly seminal ducts and the bladder.
With many greetings and have a nice Sunday
Dr. R. Berg
