Urological Issues: Painful Urination and Ejaculation Symptoms

Penile issues, urination, ejaculation?

Hello Doctor: Recently, I visited a hospital due to abnormal urination and penile pain.
I underwent urine and blood tests.
The results showed that my hydration levels were insufficient, but no other abnormalities were found.
The doctor prescribed me "Alfuzosin." However, after taking the medication, while my urination feels smoother and stronger, the other lower urinary tract symptoms persist, and the penile pain has not improved.
During my hospital visit, due to limited consultation time and concerns about embarrassment, I worried that I might not clearly describe my symptoms in a short time.
Therefore, I hope to ask here for clarification on what conditions I might have and whether they could affect my future sexual function.

I am 170 cm tall, weigh 67 kg, currently unmarried, and have a habit of masturbation, averaging ejaculation every two days, with multiple erections lasting slightly over an hour.
I tend to sit for long periods and previously drank less than 2000 cc of water daily.
Two months ago, I began experiencing significant symptoms after ejaculation, along with abnormal lower urinary tract symptoms (urination).
My symptoms mainly manifest as lower urinary tract symptoms and pain during ejaculation, which influence each other:
1.
Frequent urination: about 10 times a day, with 3-4 instances having noticeably smaller volumes.
2.
Difficulty initiating urination; sometimes I need to stand in front of the toilet for 2-4 seconds before I can start.
3.
Incomplete voiding; even after urination, urine may drip from the tip of the penis for 2-5 minutes.
4.
A constant sensation of urine flowing from the bladder into the penis, leading to frequent urges to urinate and affecting penile erections, particularly noticeable during masturbation.
5.
In the morning (approximately 6 hours after falling asleep), I wake up due to penile swelling and urine retention, but the volume is not significant.
6.
There seems to be an injury near the tip of the urethra, causing a sharp pain at the moment of urination.
Additionally, due to difficulty urinating, the penis sometimes experiences pain as it tries to expel residual urine (this symptom likely appeared after the pain during ejaculation).
Pain caused by ejaculation:
1.
A sharp pain at the tip of the glans or urethra during ejaculation (could this be due to strong ejaculation causing injury to the penis?).
2.
After ejaculation, the penis can feel distended and painful for up to 12 hours due to urine retention; if ejaculation occurs at night, I experience multiple episodes of pain while sleeping.
3.
A brief sharp pain near the tip of the glans during the erection process (this symptom existed earlier but was not particularly noted due to its low frequency).
Note: The tip of the glans, especially near the areas where I experienced sharp pain, appears dark blue-black.
Here are my questions for the doctor:
1.
What related conditions might I have, or which parts of the urinary system could be affected? (Knowing the names of the conditions would help me communicate with other doctors more easily, as I imagine they may not have much time to listen to my symptoms in detail.)
2.
What tests do you recommend I undergo?
3.
Could the above symptoms potentially have a permanent impact on my sexual function?
Thank you, Doctor, for your assistance!

Nìmíng, 20~29 year old female. Ask Date: 2018/09/28

Dr. Sun Hongshun reply Urology

Hello, you have observed very carefully.
Regarding your urinary issues, I recommend keeping a voiding diary to track your daily fluid intake, urine output, and frequency.
Additionally, you may consider undergoing urodynamic testing at a hospital.
The sharp pain you described at the tip of the glans or urethra cannot rule out the possibility of balanoposthitis or urethritis.
As for the bluish-black discoloration at the tip of the glans, it could be due to impaired blood flow to the penis or an infection.
I suggest you seek medical attention as soon as possible.

Reply Date: 2018/09/28

More Info

Based on the symptoms and concerns you've described, it seems you are experiencing a complex interplay of urological issues that could be related to several underlying conditions. Let's break down your symptoms and address your questions systematically.

Potential Conditions
1. Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This condition is characterized by pelvic pain and urinary symptoms without evidence of urinary tract infection. Your symptoms of painful urination, frequent urination, and pain during ejaculation could align with this diagnosis.
2. Urethritis: Inflammation of the urethra can cause pain during urination and ejaculation. This could be due to infections (bacterial or sexually transmitted) or irritation.

3. Bladder Dysfunction: Given your symptoms of urgency, frequency, and difficulty initiating urination, there may be an issue with bladder function, possibly related to overactive bladder or bladder outlet obstruction.

4. Penile or Urethral Injury: The pain you describe, especially near the glans (tip of the penis), could indicate trauma or irritation, possibly exacerbated by sexual activity or insufficient lubrication during masturbation.

Recommended Tests
To clarify your diagnosis, the following tests could be beneficial:
1. Urinalysis and Urine Culture: To rule out urinary tract infections or other abnormalities.

2. Urodynamic Studies: These tests assess how well your bladder and urethra are functioning and can help diagnose issues like bladder overactivity or obstruction.

3. Transrectal Ultrasound or MRI: These imaging studies can provide a view of the prostate and surrounding structures to identify any abnormalities.

4. Cystoscopy: A procedure that allows direct visualization of the bladder and urethra, which can help identify any structural issues or inflammation.

Impact on Sexual Function
Regarding your concern about the potential for permanent effects on sexual function, it largely depends on the underlying cause of your symptoms. Chronic conditions like prostatitis can lead to persistent discomfort, but they do not necessarily result in permanent damage to sexual function. However, if there is significant structural damage or ongoing inflammation, it could affect erectile function or ejaculation.

Recommendations
1. Follow-Up with a Urologist: Given the complexity of your symptoms, it would be prudent to consult a urologist who specializes in male pelvic pain or sexual health. They can provide a more thorough evaluation and tailored treatment plan.

2. Hydration and Lifestyle Changes: Increasing your fluid intake and reducing irritants (like caffeine and alcohol) may help alleviate some urinary symptoms.

3. Pelvic Floor Physical Therapy: If muscle tension or pelvic floor dysfunction is contributing to your symptoms, physical therapy may provide relief.

4. Open Communication: When you see a doctor, consider writing down your symptoms and concerns beforehand. This can help ensure you cover all points during your appointment, especially if time is limited.

5. Mental Health Support: Given the emotional toll chronic pain can take, consider speaking with a mental health professional if you're feeling overwhelmed or anxious about your symptoms.

In summary, while your symptoms are concerning, they are not uncommon and can often be managed effectively with the right medical care. Seeking a specialist's opinion and undergoing appropriate tests will be crucial in determining the best course of action for your health.

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