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Avatar universal

Ongoing Penis and Urethra Pain

I have been experiencing pain at the tip of my urethra, and on the top of my penis head, for about 2 months now. It feels more like a constant sting rather than a burning, and there is no discharge, or visible symptoms.

When I touch the top of my penis head, it is extremely sensitive, and sometimes the skin looks a little cracked, but other times it looks completely normal. It feels like a chaffing effect, but I only wear breathable cotton boxers, and have not caused any chaffing. There are no lesions or bumps, and while I keep the area clean, I do not use any soaps or irritants directly on it.

I am in a happy monogamous relationship, and have abstained from sex for a very long time (years before these symptoms began). I have completely normal urine flow, and it looks clear/yellow, and has been tested at nauseam.

I went to my doctor multiple times, and went to a urologist. This is what has been done with unsuccessful results:

Urgent Care Facility (Doctor Unavailable)
1) First urine test, to test for UTI- no leukocytes and negative
2) Second urine test, to test for gonorrhea/chlamydia- both negative
3) Diagnosed with bacterial prostatitis and put on 3 weeks of levofloxacin- no help

General Physician (2 Visits)
4) Third urine test, to microscopically test for stones- no blood or any evidence
5) Given oral anti-fungal in case of yeast infection from 3 weeks of antibiotics- test revealed no yeast infection, and oral anti-fungal did nothing

Urologist
6) Fourth urine test- completely normal results
7) Gave me a prostate exam- completely normal results, but told me this could be lingering pain from chronic prostatitis

General Physician
8) Fifth urine test to check for c-reactive protein and any bacteria- both negative
9) Tested for Diabetes- negative

I have noticed the pain is usually isolated to the left side of the meatus. Urine flow is totally normal and painless, but there is a frequent urge to go. If this was a parasite or trich, would a bacteria test not pick it up?

Looking forward to hearing back, and maybe even getting some resolve. Thanks in advance.
6 Responses
207091 tn?1337713093
There is something called Chronic Pelvic Pain Syndrome (CPPS), which used to be called chronic prostatitis. One of the types of this is chronic non-bacterial prostatitis. Prostatitis is a common cause of pain in the tip of your penis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040610/

https://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome

https://en.wikipedia.org/wiki/Chronic_prostatitis/chronic_pelvic_pain_syndrome - yes, this is Wiki, but it's a decent article.

I am not diagnosing you, but a urologist should be able to. Go back to the urologist and ask about it, or find another one. Technically, it's not chronic until it's 6 months, but there may be some treatments you can do now to maybe prevent it from lasting that long, or ease it.

Go in with info on it, if you think that's what you might have after reading about it.

I'm sorry you're having such a hard time getting a diagnosis. :(

6 Comments
Thank you for the response! I am starting to think this could be CPPS. A few other things I noticed are that after I finish urinating, there is a some Post Micturition Dribble which I believe to also be related to CPPS. I have also noticed that in general, my libido is way down, and it is near impossible for me to get/maintain an erection now. My testosterone level was checked during one of the many blood tests they ran, and it was normal- but I know from my past, that this lack of any sexual arousal is not normal for me.

I should also note that when I went to the urologist, he confirmed I didn't have bacterial prostatitis as there was no inflammation/discharge during the prostate exam. I did take levofloxacin before that visit though as they thought that it was bacterial and wanted to be safe (while I was waiting 2 weeks for a urologist apt). When it all started, my semen was yellowish- it looked like there was some kind of infection. A few months later, when I was able to get an erection and masturbate, my semen was back to normal white- but as I stated, it is very hard for me to get an erection now. I am just never aroused.

It has truly been an awful experience considering I am only 28; It is not the first time I went through something like this (lack of diagnosis). When I was 25, I was diagnosed with appendagitis, which took 6 doctor/specialist visits, and I was not diagnosed until I finally went to the ER. It is very rare, and I was told there was nothing I could do to avoid/help it. I hate feeling like only 3 years later, I am in a similar situation with another unknown issue without a way of avoiding/helping it.

I'm sorry that you are going through this again, and sorrier still to tell you that it probably won't be the last time this medical limbo (what you are going through right now trying to get a diagnosis) happens to you. It IS very frustrating.

What kind of testosterone testing did they do? Do you have your lab results?

There are other tests to consider as well - https://www.webmd.com/a-to-z-guides/testosterone-test#2

Something else to consider is your thyroid - https://www.issm.info/sexual-health-qa/can-thyroid-problems-contribute-to-erectile-dysfunction-ed/ Your thyroid probably wouldn't be causing all these issues, but it could be a contributing factor.

This is a list of thyroid tests you should ask for - https://www.thyroid.org/thyroid-function-tests/ You can start with the blood tests and consider the rest if the blood work is abnormal. Insist on all the tests, though. Docs often want to do just one or two, and that doesn't really help. You could test fine on the tsh, and still have an autoimmune issue, which would show on a different test.

Hang in there. I know it's frustrating.

They did testosterone free and total and both were within range:

TESTOSTERONE, SERUM 650 ng/dL
FREE TESTOSTERONE(DIRECT) 17.3 pg/mL


By the way- yesterday, my semen was now yellow again and there was a lot of dysuria. Today the symptoms are starting to subside, but the pain persists.

Not much I can do at this point other than see another urologist, and frankly with all the visits I have had, that is not of much interest to me. If 6 months approach, and this is still an issue, then I will see another urologist. Thanks for your assistance.
I get it, really. It gets very frustrating. If anything changes, let us know. Take care.
Do you think alpha blockers would help at all? Are they something that need to be taken on a schedule or are they taken as needed? What exactly do they do?
They can help BPH, another prostate condition, but get a definitive diagnosis before taking those. They can have fairly serious side effects, and you should only take them if needed.

https://www.uptodate.com/contents/benign-prostatic-hyperplasia-bph-beyond-the-basics
Avatar universal
Still experiencing pain, but I really don't think it's CPPS. The pain is isolated now to the tip and left side of the mestus. It is so strange because it comes and goes every 2-3 days. I noticed my urine smells, but it looks completely normal. The doctors are stumped still and it is so annoying and painful. Sometimes it is sensitive to touch (ie rubbing in soft briefs even), but other times it is completely normal. It is killing my every day mental life.
Avatar universal
I should add that I tried doing pelvic floor exercises, and it made it worse. I also notice that if I clench my but (as part of the exercise), I can feel the pain radiate up to the left of the meatus which is so strange. It's like a hemorrhoid pain, but in my penis. I wonder if it could be related to my blood vessels or even arthritis.
2 Comments
Okay, so I had a really long post and somehow it disappeared, but I wonder if you have an anal fissure. A male friend of mine had one years ago, and he had the same pain radiating. It's not a symptom commonly associated with it, but he also had tingling and some other things that I can't recall now.

He'd had some rectal exams that missed it, too. Have you had an ultrasound or any other imaging of the area?
I was diagnosed with an anal fissure back when I was in college (2012). I was given a custom compound cream and it appeared to heal (albeit very slowly). I don't feel any pain there anymore, but do you think this could be related, and if so what can I do?
Avatar universal
I think it is important to add that I am HIV-1 positive and have been for about 3 years. I have been on ART medication and am/have remained undetectable since treatment right after diagnosis. I started by taking Tivicay and Descovy, and then when Biktarvy came out, I was switched to the single pill regiment. There was no complication with the switch and this seems to be unrelated to the medication, but given my technically suppressed immune system, I thought it was important to add.
Avatar universal
I have another question- How can I tell the difference between post Micturition Dribble, and a clear discharge? I noticed after I urinate, every time there is a bead that looks clear on the end of my meatus. I can shake it off but there are always a few more. It does not persist, but happens every time I urinate. Could this be just a dribble, or could it be discharge? I can attach a photo if need be.
3 Comments
A clear discharge is one that is there when you haven't just urinated. It sounds like it's just dribble. A discharge would appear regularly, and would probably be visible on your underwear.

Thanks for letting me know about your HIV status, and your medication. I didn't find any possible side effects for Biktarvy that could possibly be causing this. What's your viral load?

This is a decent article that may help somewhat -https://www.sciencedirect.com/science/article/pii/S2090506812001121

It discusses the possibilities of anogenital issues in HIV+ patients. Section 4 is probably most relevant, as it describes the potential issues. Anal fissures are mentioned.

I think you should talk to your doctor about the possibility of this, and get a rectal exam (I'm sorry), and at least rule any of these possibilities out. Your symptoms don't totally fit, but it's a start.

Are you abstaining from sex because of your HIV status? It's really none of my business, but if that's your only reason, there are things you can do to help prevent transmission. If your viral load is undectable, you can't transmit. Your partner can take PrEP. If there are other reasons, that's fine and obviously, your choice, but I wanted to make sure you knew there were options. I won't push, but if you want more info on any of that, let me know.



Hi- My viral load is <20 copies, so it is considered undetectable. I am just not really that sexual of a person. I received HIV-1 from a partner I had in college who found out he had it from a previous partner, so it was a very difficult burden to shoulder- but I am living a normal life save this issue. Luckily my current partner has consistently tested negative, probably because of our lack of penetrative sex.

I talked to my urologist again today, and he recommended that I have a urethral swab done to test for anything that might not have been a part of the standard urine tests. He said that sometimes even if the urine sample comes back clean, bacteria can be found on the swab test. He said if that comes back all clean that I should have imaging done to determine the possibility of a stone, but honestly I know there is no stone. I have had kidney stones in the past, and there is no pain like that, and no blood in my urine- I honestly think he just wanted me to come in and pay for another pointless visit.

This is ruining my life.
I should also note that last year I had an anal pap smear done as part of my routine testing, and it was completely normal. That is part of why I really don't think the fissure has anything to do with this.
Avatar universal
I am going back to the urologist for imaging next week and they said if they don't see anything I will likely have to have a cystoscopy. Stay tuned.
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