Frequent Urination and Penile Discomfort: A Urology Perspective

Frequent urination and penile discomfort?

Hello Doctor: I apologize for the lengthy message.
I started masturbating around the age of 19, with a frequency of once a day, occasionally twice.
In January, between the 2nd and the 15th, there were several nights when I masturbated more frequently (about 2 to 4 ejaculations between 10 PM and 3 AM), and each time I experienced prolonged erections lasting nearly 30 minutes, without any occurrence of hematospermia.
After that, whenever I lay down, I would feel a slight urge to urinate, but it did not significantly affect my daily routine.
During this time, I maintained a frequency of once a day for masturbation, and I did not experience any discomfort during ejaculation.
Around February 5, I began to experience nocturia, and on the night of February 7, I had symptoms of nocturia and painful urination.
I visited the doctor on February 8, and the diagnosis was urethritis, with a urine culture performed.
I was prescribed a 7-day course of Uracare 10mg/tab, Urogen (Pyridium) 50mg/tab, and Cephanmycin 500mg/cap.
By the third day, I began to experience symptoms of increased urinary frequency.
After completing the medication, the issue of frequent urination did not show significant improvement, and I often felt a sense of bladder fullness (similar to the feeling of needing to urinate), along with a sensation of incomplete urination.
During a follow-up visit on February 15, I did not inquire about the results of the urine culture, and the doctor did not mention it either.
After describing my symptoms to the doctor, he informed me that the bacteria had not been completely eradicated, so he prescribed another 5-day course of Curam FC 1000mg/tab.
After finishing this medication, my symptoms did not improve.
At this point, I would feel an urgent need to urinate within about 30 minutes after drinking a glass of water, and I constantly felt a sensation of incomplete urination.
During a follow-up visit, tests for urine sediment, post-void residual volume, and PSA levels in the blood were all normal, and the doctor stated that no issues could be identified, suggesting that I might be experiencing urinary system fatigue and to return the following week.
Subsequently, I began to experience pain in my right testicle, so I sought treatment from a traditional Chinese medicine practitioner, and after taking the herbal medicine, the testicular pain alleviated.
During the day, I mostly did not experience symptoms, although occasionally I would feel bladder fullness and incomplete urination.
However, after 6 PM, the sensations of bladder fullness and incomplete urination would return, especially after taking a hot shower.
I then underwent renal ultrasound and urinary tract X-rays, both of which showed no issues.
Therefore, the doctor prescribed a 14-day course of Terodine F.C 2mg/tab, and I was to return for a follow-up after completing it.
During this period, I masturbated once and noticed pain during ejaculation, followed by a significant sensation of engorgement in the penis (which lasted about 6 hours before subsiding), and the resolution of penile engorgement was much slower than before.
I have not yet taken the Terodine F.C 2mg/tab, as I am concerned about potential interactions with the herbal medicine.
I would like to ask if the feeling of incomplete urination I experienced as a child after nocturnal emissions, which would subside after about an hour, could be related to the symptoms mentioned above.
Is it possible that there is an issue with the seminal vesicles? Are there any additional appropriate tests I should undergo? What lifestyle changes should I be aware of moving forward?

Mr. Wu, 20~29 year old female. Ask Date: 2022/03/07

Dr. Li Xinyi reply Urology

It is generally considered normal for young males to experience pelvic pain after ejaculation, including discomfort in the penis or perineum.
However, if symptoms resembling prostatitis occur and are difficult to treat, it is often a consequence of misuse, which includes excessive frequency or duration of activity, application of unknown substances, or injuries caused by the use of tools leading to infection.
Treatment can be challenging in such cases.
The key is to maintain a healthy lifestyle, including both physical and mental health, and to adhere to treatment, as this can improve inflammation of the pelvis and prostate.

Reply Date: 2022/03/07

More Info

Frequent urination and penile discomfort can be distressing symptoms that significantly impact daily life. Based on your detailed description, it seems you have been experiencing a range of urinary and sexual health issues, including increased frequency of urination, a sensation of incomplete bladder emptying, and discomfort during ejaculation. These symptoms can be interconnected and may stem from various underlying causes.

Firstly, the frequent urination you are experiencing could be attributed to several factors, including urinary tract infections (UTIs), bladder irritation, or even overactive bladder syndrome. Your initial diagnosis of urethritis and the subsequent treatment with antibiotics suggest that an infection may have been a contributing factor. However, the persistence of symptoms after antibiotic treatment raises the possibility of other underlying issues, such as bladder dysfunction or pelvic floor dysfunction.

The sensation of a full bladder or the feeling of incomplete urination can be indicative of bladder overactivity or irritation. This could be exacerbated by factors such as anxiety, dietary irritants (like caffeine or alcohol), or even the frequency of masturbation, which you mentioned has increased recently. The discomfort you experience during ejaculation could also be related to pelvic floor muscle tension or inflammation in the surrounding tissues, including the prostate or seminal vesicles.

Given your history of nocturnal emissions and the associated feelings of incomplete bladder emptying, it is plausible that there may be some connection to the pelvic floor muscles and their function. Pelvic floor dysfunction can lead to a range of symptoms, including pain, discomfort, and urinary issues. It might be beneficial to explore pelvic floor physical therapy, which can help in relaxing and strengthening the pelvic muscles, potentially alleviating some of your symptoms.

Regarding the tests you have undergone, it seems you have already had a thorough evaluation, including urine tests, imaging studies, and PSA levels. If your symptoms persist, you might consider discussing further evaluations with your healthcare provider, such as a urodynamic study, which assesses how well the bladder and urethra are functioning. This can provide valuable insights into bladder pressure, capacity, and the coordination of bladder and sphincter function.

As for lifestyle modifications, consider the following recommendations:
1. Hydration: Ensure you are drinking enough water throughout the day, but try to limit fluid intake in the evening to reduce nighttime urination.

2. Diet: Identify and avoid potential dietary irritants that may exacerbate bladder symptoms, such as caffeine, alcohol, spicy foods, and artificial sweeteners.

3. Pelvic Floor Exercises: Engage in pelvic floor exercises (Kegel exercises) to strengthen the pelvic muscles, which may help with urinary control and discomfort.

4. Stress Management: Since stress and anxiety can exacerbate urinary symptoms, consider incorporating relaxation techniques such as mindfulness, yoga, or meditation into your routine.

5. Follow-up Care: Regular follow-ups with your urologist or primary care physician are essential to monitor your symptoms and adjust treatment as necessary.

In conclusion, while your symptoms may seem complex, they are not uncommon, and with appropriate management and lifestyle adjustments, there is a good chance for improvement. It is crucial to maintain open communication with your healthcare provider and advocate for further evaluations if your symptoms do not resolve. Your well-being is paramount, and addressing these issues holistically can lead to a better quality of life.

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