Unexplained Urological Discomfort: Symptoms and Insights

I'm not sure where the problem lies?

Hello, Doctor.
Recently, I've been experiencing discomfort in my lower region, which has severely affected my sleep.
I consulted a urologist, but the doctor couldn't identify a specific cause.
Here are my symptoms:
1.
Initially, I found myself frequently needing to urinate before bed, but often when I lay back down, I felt the urge to go again, and I couldn't produce much urine.
2.
I have a history of excessive sexual activity, about 2-3 times a day, and one day while showering, I suddenly experienced cramps in my penis, leading to significant discomfort in the perineal area.
3.
I have a history of urinary stones; the last occurrence was three years ago, and I was able to pass them successfully.
4.
Since last week, the situation has worsened.
I have a burning sensation near my testicles, and I feel itching and soreness at the base of my penis where it connects to the scrotum, as well as in the perineum near the anus.
This has led me to frequently want to press and massage that area, and due to the itching, I feel the urge to urinate often.
My testicles also feel slightly sore while sleeping.
5.
There is no pain during urination, but I experience a slight stabbing sensation during an erection, which feels uncomfortable.
6.
Based on my description, the doctor currently does not know the cause.
The physician only prescribed medication for frequent urination and bacterial infection.
I would like to know if this could be prostatitis or if there might be a stone lodged somewhere.
7.
I have had a urine test, and the doctor said it was normal.
Thank you for your response, Doctor.

Peng, 20~29 year old female. Ask Date: 2021/06/01

Dr. Li Xinyi reply Urology

Yes, the most likely condition is prostatitis, although stones are also a possibility.
If it is prostatitis, in addition to obtaining medication from a urologist for a period of time, it is also advisable to practice some abstinence to allow it to rest; otherwise, recovery may be difficult.
It is recommended to discuss the detailed situation further with a urologist.

Reply Date: 2021/06/01

More Info

Understanding unexplained urological discomfort can be quite challenging, especially when symptoms are persistent and affect your quality of life, such as sleep. Based on the symptoms you've described, it seems like you are experiencing a combination of urinary urgency, discomfort in the genital area, and possibly some psychosomatic responses to your discomfort. Let's break down your symptoms and explore potential causes and insights.

1. Frequent Urination and Urgency: The sensation of needing to urinate frequently, especially at night, can be indicative of several conditions. This could be related to bladder irritation, which might stem from a urinary tract infection (UTI), prostatitis (inflammation of the prostate), or even overactive bladder syndrome. Given that your urine tests came back normal, a UTI may be less likely, but it’s still worth considering other factors that could irritate the bladder.

2. Discomfort Following Sexual Activity: The cramping sensation you experienced during showering could be related to muscle spasms in the pelvic region, which can occur after excessive sexual activity. This can lead to temporary discomfort in the perineum and genital area. The pelvic floor muscles can become tense or fatigued, leading to discomfort that may persist for some time.

3. History of Urinary Stones: Your past experience with urinary stones is relevant. While you mentioned that you passed a stone three years ago, it's possible that small stones or fragments could still be present, leading to intermittent discomfort. However, since you have had normal urine tests, this seems less likely.

4. Burning Sensation and Itching: The burning sensation around the testicles and the perineum, along with itching, could suggest a few things. It might be related to a skin condition, such as a fungal infection or irritation from hygiene products. Alternatively, it could be a sign of prostatitis, which can cause discomfort in the pelvic region and is often accompanied by urinary symptoms.

5. Pain During Erection: The slight pain you experience during an erection could be due to several factors, including inflammation of the prostate or surrounding tissues. This could also be related to pelvic floor tension or muscle spasms.

6. Prostatitis Consideration: Given your symptoms, prostatitis is indeed a possibility. This condition can present with a variety of symptoms, including pelvic pain, urinary urgency, and discomfort during sexual activity. It can be acute or chronic, and sometimes the cause is not easily identifiable.
7. Further Evaluation: Since your doctor has prescribed antibiotics for potential bacterial infection, it’s essential to follow up if your symptoms persist. If the antibiotics do not help, further evaluation may be necessary. This could include imaging studies like an ultrasound or CT scan to rule out any anatomical issues or stones that might not have been detected in your urine tests.

In conclusion, your symptoms could be related to several potential issues, including prostatitis, pelvic floor dysfunction, or even skin irritation. It’s crucial to maintain open communication with your healthcare provider and possibly seek a referral to a urologist specializing in chronic pelvic pain if your symptoms do not improve. Keeping a symptom diary, noting when symptoms worsen or improve, can also provide valuable information for your healthcare team. Remember, while it can be frustrating to deal with unexplained discomfort, many conditions are manageable with the right approach and treatment.

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