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?