Chronic Urethral Pain and Foreign Body Sensation: Prostatitis

Chronic pain at the urethral opening and a sensation of a foreign body at the base?

Hello Doctor: I have been suffering from Chlamydia and Trichomoniasis since December 2014 (at that time, the pain at the urethral opening was so severe that I couldn't sleep).
After treatment with doxycycline and metronidazole, I was initially diagnosed with Trichomoniasis and took medication for three weeks.
However, the pain at the urethral opening persisted, so I went to another clinic for further examination and was found to have Chlamydia.
I underwent another three weeks of treatment, which led to some improvement, but I still frequently experience sharp pain at the urethral opening and a feeling of discomfort at the base during urination.

In June 2015, the doctor, seeing that I was still unwell, performed a cystoscopy and reported that everything looked normal except for some whiteness in the prostate, which the hospital doctor said was a normal finding.
Since then, I have not fully recovered and resorted to traditional Chinese medicine.
However, after taking it for four to five months, I still did not fully recover, although there was some improvement (it felt like the condition was suppressed, but without medication, it would relapse after two to three weeks).
Later, other doctors suggested that I might have prostatitis.

I would like to ask the doctor:
1.
How can I confirm whether it is prostatitis? The doctors at the hospital did not perform any tests and simply diagnosed me.
I have also had PSA and urine flow rate tests, both of which were normal, with only slight post-void dribbling, which the doctors said was normal.

2.
I read online that a prostate fluid analysis can be done, but no doctor has suggested this test to me.
Should I proactively ask my doctor if I can have this test done?
P.S.
I have been troubled for a long time.
I have undergone many tests, urine analyses, and other examinations, but doctors keep saying everything is normal.
Some doctors suggest it may be psychological (however, in April 2016, I had an inner ear infection and took corticosteroids for two weeks, during which I experienced no pain while urinating).
I consulted a hospital doctor at that time, and he mentioned that corticosteroids are a miracle drug in the U.S.
but have significant side effects and are not suitable for long-term use.
He suggested I see an immunologist to check if it is related to white blood cells, but my tests were normal, with only an ESR of 18 in one hour indicating inflammation.
The immunologist then referred me back to urology.

Mr. Pan, 20~29 year old female. Ask Date: 2016/07/05

Dr. Li Xinyi reply Urology

To confirm whether it is prostatitis, a prostatic fluid examination can be considered as one of the methods.
Most physicians will diagnose prostatitis based on symptoms, as even if the prostatic fluid examination is normal, it does not rule out the possibility of prostatitis.
In your case, it is possible that the urethritis has not been fully treated.
It is recommended to continue seeing a urologist for further evaluation and to discuss with the physician.
The key point is that the treatment process should involve both you and your sexual partner.

Reply Date: 2016/07/05

More Info

Chronic urethral pain and the sensation of a foreign body can be distressing symptoms that significantly impact quality of life. Based on your history, it appears that you have been dealing with a complex interplay of infections and potential prostatitis for several years. Let’s address your questions and concerns regarding the diagnosis and management of prostatitis.

1. How to Confirm Prostatitis: Prostatitis can be challenging to diagnose, especially in its chronic forms. The diagnosis typically involves a combination of clinical evaluation, symptom assessment, and laboratory tests. While PSA (Prostate-Specific Antigen) levels and urine flow studies can provide some information, they are not definitive for diagnosing prostatitis. A thorough history and physical examination, including a digital rectal exam (DRE), are essential. In some cases, a prostate massage may be performed to obtain prostatic secretions for analysis, which can help identify inflammation or infection. If your physician has not suggested this, it is reasonable to ask about it, especially if your symptoms persist.

2. Prostate Secretions Testing: The examination of prostatic secretions can provide valuable insights into the presence of inflammation or infection. If you suspect prostatitis, you should indeed advocate for this test. It may not be routinely performed unless there is a strong clinical suspicion, so bringing it up with your healthcare provider is important.

3. Chronic Pain and Psychological Factors: Chronic pain syndromes, including chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), can sometimes have psychological components. Stress and anxiety can exacerbate symptoms, leading to a cycle of discomfort. However, this does not mean that your symptoms are "all in your head." It is crucial to address both the physical and psychological aspects of your condition. Cognitive-behavioral therapy (CBT) or other forms of psychological support may be beneficial alongside medical treatment.

4. Treatment Options: Treatment for chronic prostatitis can vary widely depending on the underlying cause. Antibiotics are often the first line of treatment, especially if a bacterial infection is suspected. However, in cases of chronic non-bacterial prostatitis, other treatments may be necessary, including anti-inflammatory medications, alpha-blockers (to help with urinary symptoms), and pelvic floor physical therapy. Some patients find relief with lifestyle modifications, such as dietary changes, increased hydration, and stress management techniques.

5. Role of Corticosteroids: You mentioned that corticosteroids provided relief during a previous treatment. While corticosteroids can reduce inflammation, they are not typically a long-term solution due to potential side effects. If inflammation is a significant component of your symptoms, discussing this with your healthcare provider may lead to alternative anti-inflammatory treatments that are safer for long-term use.

6. Follow-Up and Specialist Consultation: Given the chronic nature of your symptoms and the multiple consultations you have had, it may be beneficial to seek a second opinion from a urologist who specializes in chronic pelvic pain or prostatitis. They may offer different perspectives on treatment options or additional diagnostic tests that could provide clarity.

In conclusion, chronic urethral pain and the sensation of a foreign body can stem from various causes, including prostatitis, pelvic floor dysfunction, or even psychological factors. A comprehensive approach that includes both medical and psychological support, along with appropriate diagnostic testing, is essential for effective management. Don’t hesitate to advocate for your health and seek further evaluations if your symptoms persist.

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