I've been seeing a urologist for this but want another opinion. I'm an otherwise healthy circumcised male age 26.
This started after masturbating ~4 months ago (I am not otherwise sexually active). I thought I overdid it since my glans was very sensitive the day afterwards, but a few days later the pain had worsened enough that I went to the ER. The ER doctor said things looked normal and did an STD swab that came back negative. I was given an injected dose of an antibiotic and a 10-day round of doxycycline, during which the pain slightly improved.
My urologist also said things looked normal. Pressing on my perineum didn't cause additional pain, so he said this wasn't prostate-related (no digital rectal exam.) His guess was inflammation rather than a trauma/structural injury from masturbation. He prescribed topical betamethasone propionate cream (which had no positive effect) as well as 400mg of ibuprofen every six hours. At the end of a week on ibuprofen, things felt better, but worsened after I stopped taking it. A uroflow test to check for urethral stricture showed normal volume/stream pressure. Multiple urine tests came back clean.
The next guess was genital dysaesthesia, for which I've been taking 50mg Elavil daily for ~1 month, but the pain hasn't improved. My glans is still sensitive when clothing rubs on it and I feel a continuous aching/burning sensation with no contact. It shows minor redness that comes and goes. There is no pain during urination, but sometimes there is as I stop. I've never seen any odd discharge or bleeding. My urologist doubts this is an infection since the pain has been stable over a long period of time. I have avoided cystoscopy so far as it could damage my smaller-than-average meatus and possibly make the existing irritation worse.
I can't tell if this is a skin problem or a urological problem, or both, or something else entirely?
First of all, prostatitis which has not been ruled out in your case till now should be ruled out. It is an inflammation of the prostate gland. The typical symptoms of prostatitis are fever, pelvic, testicle, or rectal pain, frequent and painful urination and ejaculation and incomplete emptying of bladder.
You will need ultrasound, X-ray, and computerized tomography (CT) along with prostatic fluid examination and prostate specific antigen to rule it out.
Secondly, for your symptoms urethritis should also be ruled out. Urethritis is inflammation of the urethra and it is caused by infection by bacteria that enter the urethra from the skin around the urethra's opening. These bacteria may be present in the stools like E.coli or due to Chlamydia and gonorrhea. Feeling the frequent or urgent need to urinate and pain during urination are frequent symptoms. You need to get a swab culture of the urethral opening done to completely rule it out.
It looks more likely a urological problem rather than a skin problem. Hence you should get these tests done. If need arises a cystoscopy may also be done to find out the cause.
Another possibility which should be ruled out is uncontrolled diabetes which can cause such burning sensation and pain on touching. Hence get your blood sugar levels also done.
Hope that this information helps and hope that you will get better soon.
hi friend, I've had the same symptoms that you have described for 1 year and 4 months already, I've seen urologists and also one neurologist, I've done similar tests as you but in the end nobody can know what kind of penile trauma/injury I might have. The neurologist told me that I can keep spending money on doing all kinds of tests but I won't really find a way to heal this injury, all I can do is just wait and see if it heals with time or just learn to live with it. I'm glad I'm not the only one having this problem all I can say is that you're not alone, wish you the best and please let me know if you ever find the way to cure the injury.
*Avoid masturbating or any similar sexual activity because it will get worse and the burning sensation will increase for a couple of days.
Since writing my original post I've seen two other urologists, and the consensus seems to be the same as what you've heard: more tests are likely not worthwhile and I should give the problem more time to resolve itself. One of the urologists said he has seen problems like this in the past and that the problem taking a year or more to disappear on its own isn't uncommon.
My pain hasn't fully vanished but seems to be very slowly improving over time. For now I am staying on the Elavil (amitriptyline) and taking ibuprofen as needed.
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