mysterious irritation of urethra

[Antonioni]

Male 27.  In good overall health.  Meds: Propecia – now once every other day.  Been on it for four years.  Stopped taking it every day about three months ago.

Symptoms: near constant need to pee.  Irritation of urethra and glans after peeing.  Pain if I urinate too soon after ejaculating.  Irritation is worst in middle of night.  symptoms since last may.

No discharge, no leakage.  No pain during sex, but irritation after.  Longer-lasting irritation if I have sex a few times in a short span.

2 doctor visits.  GP took a urinalysis and blood tests - nothing abnormal.  Told me not to think about it.  Urologist also took urinalysis and did prostate exam - nothing abnormal.  Gave me 2 weeks doxycycline "just in case".  Visually examined my genitalia and, after doing so, decided not to test for stds

Questions:

Could this have anything to do with the Propecia?  For a while I took it every other day, then stopped altogether for three weeks, and now am back to every other day.  Could prolonged use of it have messed up my prostate?  Should I go back to taking it every day?

I want to go back to the urologist.  I thought the one that I visited was a competent and nice guy – but didn’t seem willing to consider more unlikely possibilities.  Should I go to see the same doc or a different one?  He is at one local teaching hospital, but there is another teaching hospital nearby as well.

I like coffee, wine, beer, the occasional cigarette, spicy food, etc.  Have cut down on most of these things.  Do I have to stop them altogether?  How much does diet have to do with it?  

biggest problem in my current condition is trouble sleeping.  during the day, I can go hours without peeing or really thinking about it (although the weird feeling of irritation never quite goes away).  I have begun smoking marijuana when I really have trouble sleeping, which is quite helpful.  Could I be making this worse by doing so?  What would you recommend on the sleep front?

[miserygalore]

A related discussion, toconcernedmom1971 was started.

[Kevin Pho, MD]

I am not aware of the symptoms being associated with Propecia.

I agree with the antibiotic treatment, as infection is a leading possibility.  Examining the prostate can be considered, with a prostatic massage.  Any prostatic fluid can be sent off for analysis and culture.  A transrectal ultrasound can be done to exclude an abscess.

A cystoscopy can be considered as well to exclude anatomical abnormalities.

Regarding the insomnia, you can consider a referral to a counselor.  Guided imagery, cognitive therapy, or medications can all be discussed.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[ConcernedMom1971]

I am a 36 year-old female with very similar symptoms.  However, I am not taking any meds.  My problem started about 6 weeks ago and I thought I had just a pretty bad bladder infection.  I felt like I had to go constantly.  When I did sit down to go, the pressure built up to the point I felt like my vagina was actually going to explode.  It was extremely painful.  My symptoms began to subside for a day or 2 then came back fiercely.  My doctor prescribe a 7 day course of Nitrofour - an antibiotic for UTI's.  It seemed to be clearing, though it never went completely away. 2 days after I stopped the antibiotics (I took the complete course), it all came back again almost as fiercely as before.  I drank 2 bottles of pure cranberry juice in 2 days time (a treatment reccommended by a doctor) and began taking cranberry supplements and acidophilus from the health food store.  The urgent need to pee has passed, but there is still lingering pain after I finishing going.  Is there some infection we're missing?