Redness and Swelling at the Urethral Opening: Causes and Treatments

Redness and swelling of the glans and urethral opening?

Hello, doctor! Recently, I noticed some redness and swelling at the urethral opening, more pronounced on the left side and slightly on the right side.
There is no pain or itching.
I visited two urologists, and both blood and urine tests came back normal (no inflammation or infection in the urethra, and blood tests ruled out syphilis).
The first hospital suggested it might be due to heat and humidity and prescribed Meikang ointment to apply before bed.
The second doctor prescribed a three-day course of antibiotics and advised against using the ointment, mentioning that my foreskin is longer and I might consider a circumcision...
but it seems that the health insurance does not cover that, so I didn't pursue it further.
Is this considered inflammation of the foreskin or inflammation of the glans and urethral opening?

Niming, 40~49 year old female. Ask Date: 2018/03/14

Dr. Li Xinyi reply Urology

It sounds more like inflammation of the urethral opening, which could be related to contact dermatitis or allergic reactions, and may also be associated with heat and humidity.
It is important to identify potential allergic triggers, such as friction, laundry detergent allergies, or if it has always been this way.
The asymmetry you mentioned may be normal, but you have only recently noticed it.
Recommendations include: avoid wearing tight pants (maintain a loose and cool environment), avoid prolonged sitting, and refrain from straining during urination or defecation.
It is advised to clean only with water, minimize exposure of the glans to chemical substances, use a hairdryer to dry off after bathing, and ensure to wipe dry and maintain cleanliness after urination.

Reply Date: 2018/03/14

More Info

The redness and swelling at the urethral opening that you are experiencing can be attributed to several potential causes, and understanding these can help guide appropriate treatment. Given that you have already consulted two urologists and undergone blood and urine tests that returned normal results, it is essential to consider both infectious and non-infectious factors that could be contributing to your symptoms.

Possible Causes
1. Irritation or Inflammation: The redness and swelling could be due to irritation from moisture, friction, or contact with irritants such as soaps, lotions, or even urine itself. This is particularly relevant if you have been in a warm, humid environment, as the first urologist suggested.
2. Balanitis: This condition refers to inflammation of the glans (the head of the penis) and can occur in conjunction with posthitis (inflammation of the foreskin). Symptoms may include redness, swelling, and discomfort, although you mentioned that you are not experiencing pain or itching. Balanitis can be caused by poor hygiene, infections (bacterial or fungal), or skin conditions.

3. Allergic Reactions: Allergies to certain materials (like latex in condoms) or personal care products can lead to localized swelling and redness.

4. Infections: While your tests have ruled out common infections, it is still possible to have a localized infection that may not have been detected. Conditions such as yeast infections or sexually transmitted infections (STIs) can sometimes present with mild symptoms.

5. Phimosis: If you have a longer foreskin, it may not retract properly, leading to irritation and inflammation. This could be a reason why the second urologist suggested considering circumcision, especially if the condition is recurrent.

Treatment Options
1. Topical Treatments: The first urologist prescribed a topical ointment (Mei Kang ointment) to apply before bed. This could help soothe the area and reduce inflammation. It is essential to follow the instructions provided by your healthcare provider regarding the use of any topical medication.

2. Antibiotics: The second urologist prescribed a short course of antibiotics. While you may not have an active infection, antibiotics can sometimes help if there is a low-grade infection or if the redness is due to a bacterial imbalance.

3. Hygiene Practices: Maintaining good hygiene is crucial. Ensure that the area is clean and dry, and avoid using harsh soaps or products that could irritate the skin.

4. Avoid Irritants: If you suspect that certain products or materials may be causing irritation, try to eliminate them from your routine.

5. Consider Circumcision: If you continue to experience issues and have phimosis, circumcision may be a long-term solution. While it may not be covered by insurance, discussing the potential benefits and risks with a urologist could help you make an informed decision.

When to Seek Further Help
If your symptoms persist or worsen despite treatment, or if you develop new symptoms such as pain, discharge, or fever, it is essential to return to a healthcare provider for further evaluation. Persistent symptoms may require additional testing or a referral to a specialist for a more in-depth examination.

In summary, while the redness and swelling at the urethral opening can be concerning, there are various potential causes, and treatment can vary based on the underlying issue. It is crucial to continue monitoring your symptoms and maintain open communication with your healthcare providers to ensure appropriate management.

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