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

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.
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Avatar universal
Yo, sooo I am part of another forum that has the same issue. Unfortunately none of us have found a cure. It usually gets triggered when I receive aggressive oral, last anywhere from a few weeks to months. I get pea size lump on the left side of meatus, sometimes the right swells up. It burns when I pee and ejaculate, also noticed that my sphincter burns a bit too. No stds, tried every antibiotic, every anti fungal, have seen urologist and had a camera shoved up there, prostate and bladder are healthy, seen dermatologists. Tried switching my diet, the last attempt is going to do a full body cleanse and fasting, as well as trying to talk to a world renown urologist hopefully at end of month. The closest thing that I have found in symptoms is a paraurethral duct infection but that is usually caused by a gonorea. Got an ultrasound and still nothing comes up. Best of luck will post more about my upcoming visit with urologist. Keep me updated. Also, do you vape at all? Second any injury to penis or scrotum or anus? Also one idea I had reading about your flombosis is I remember when I was young I would start and stop my pee a lot, I wonder if that has to do with anything?
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Avatar universal
Hey just wanted to check in. How’s it going?
I feel like we may be in the same boat.
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Avatar universal
How old are you?
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Without  a cystoscopy it is difficult to tell. You are young, i'm assuming you are not obese, and you don't have any other comorbidity, so you might want to try, if the only finding is an overactive bladder and a non relaxed sphincter, is to stop and start the flow of urine when you are voiding, start with one or two starts and stops and if that exacerbates your symptoms stop, otherwise increase the frequency of starts and stops when you are voiding it should improve the tonus of the sphincter , but you must do a cystoscopy to rule out structural problems. And ask for a second opinion.
I am not obese- 165lbs and 5'11". My urologist insisted that doing a cystoscopy would cause additional issues as it would aggravate the sphincter and bladder wall. That was why we did not schedule one. What kind of structural problems are you thinking?

Also- I should not that I stay hydrated and drink about a half gallon of water every day. When I urinate it is always saturated with air bubbles. Everyone has told me (PCP, Uro etc) that this is completely normal, but I remember before this started happening, that never was the case for my urine.

Right now I am experiencing pain underneath my testicles- it feels like my urethra is enlarged and swollen. This comes and goes, and this was how everything started about 5 months ago- a swollen urethra that I thought was my prostate- when the uro did a prostate exam, everything was normal and there was no discharge or swelling which was when/how he ruled out prostatitis.

I am not sure stopping and starting would be possible. As it is, it takes a little bit to get going, and often comes out under pressure. If I were to stop the flow I'd be worried it would back up and not start again. Sometimes only a little comes out- and other times it is completely normal.

The weirdest part about all this is the inconsistency of the symptoms and how they present.

I gave up alcohol, caffeine (coffee mainly), spicy foods, and citrus. But it has made no difference. I also feel zero effect when taking asprin, or tylenol, or advil. I would have thought that at least one of them would help with the inflammation I feel, but they never help at all.
You need a cystoscopy , and a PSA, if sometimes is normal and sometimes is not,  but you are saying that the flow is constricted, then that could be the prostate, you see it doesn't always swell on the outside sometimes it does on the inside, that can be a 1 possible explanation of what you are experiencing, and the diverted pain in the tip of the penis.My advice, find a better urologist, do psa, do prostate ultrasound, an a cystoscopy, then everything will be know. And if there is no findings , then microbacterial tests, on the prostate fluid, coupled with a urethral swabs.
Thank you for the insight.
207091 tn?1337709493
I'm going to get this moved to Urology, but I'll still check there. I'm hoping others may have some help, too.
Helpful - 0
Thank you- can you please post the link as well; This forum is a bit confusing to use for me.
Never mind- I see it was moved. Thank you.
Avatar universal
So, I wanted to give an update. I went to the urologist and was diagnosed with dysfunctional voiding. He did x-rays and found no stones, and then did an ultrasound on my bladder. He said that given my symptoms of frequent urination, dribbling, urgency, and the fact that my bladder did not fully empty (per the ultrasound) that this was the diagnosis.

He also said that it was leading to the penis pain as my sphincter was not fully relaxing during urination, leading to high pressure urination and then the pain. He said that there was no way he would do a cystoscopy becauseit would lead to further irritation of the bladder wall and would not help in this case.

I am on vesicare 5mg and have been for a few weeks. While my frequency has declined, and my dribbling has stopped, unfortunately I am still experiencing pain and high pressure urination. I got in touch with the nurse at the urologist's office, and she talked to the urologist and said I needed an aplha blocker in addition to help relax the bladder wall.

Unfortunately, the first night I took the alpha blocker (flomax .4mg), I had severe side effects- chest pain, swelling around the eyes, horrible stomach pains, nausea. It was so bad that I could not sleep at all. So I called and they told me to stop taking the alpha blocker.

The pain I get consistently almost feels like a blood flow issue. As if there is pressure in the shaft- it just feels uncomfortable all the time, and I honestly don't believe I have been diagnosed properly once again. If I take asprin, I noticed the pain tends to decrease. That's why I am now curious if it could be thrombosis. I read a study that said men can often be misdiagnosed with both prostatitis, and then DV, and that thombrosis should not be ruled out as a result.

I am slotted to go back for a check up in April, but this is still ongoing. It has been nearly five months, and still no relief. Although I am hopeful that we are getting closer.

Just to recap- I was initially misdiagnosed with prostatits and put on levofloxacin. Then I was diagnosed with DV. Along the way we ruled out UTI, STIs, stones, diabetes, yeast infection, and any inflammatory or bacterial causes.
Helpful - 0
So did you have the cystoscopy? Have you had an ultrasound? Any imaging at all? An ultrasound could find blood flow issues.

I'm so sorry you are still dealing with this, and that you had such a reaction to the flomax.
The did an x-ray, and then they did an ultrasound. X-ray showed nothing (he said he looked for any stones), and the ultrasound concluded that my bladder was not fully emptying as there was greater than 25ml remaining.

I was going to the bathroom about twice an hour when this began, and now I am only going every 2-4 hours. So there is some relief there. However, it often burns when I urinate and the flow is very constricted. It also smells strong, but my urine looks normal and has been tested 7-8 times already and always comes out clean.

It also hurts after I masturbate every time. It feels fine during, but within 30 minutes it hurts very badly and lasts for a few days. I am able to get an maintain an erection again however. But I have been trying hard to not masturbate as it irritates the issue.
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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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.
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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 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.
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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.
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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
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.
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207091 tn?1337709493
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://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. :(

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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:


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.

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