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Urology/Uncomfortable glans and prostate area.

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QUESTION: Three years ago I had a trauma to the genitals when I had a circumcision which developed complications, including infection (which was treated) and severe swelling.  I continued having nocturnal erections during the time my penis and perineum were still very swollen, and I believe this may have caused some damage.  

For two years following the circumcision I had symptoms of discomfort and tingling sensations in my penis, testis, perineum, anus and prostate which, to be frank, was torture.  My glans became uncomfortably sensitive to touch which troubled me when it brushed against my underwear - no matter what kind I wore. The skin on my penis was also uncomfortable.  Although I could still have an erection there was no pleasurable sensation in my penis so I struggled to have even a weak orgasm.  

Over the past year things have started becoming more numb - which is actually a relief given the symptoms I had before.  My glans is now numb if I squeeze it, although the skin on the glans is still painfully sensitive to touch.  I have noticed that the skin of the glans often has a light sticky coating on it, but there is not any discharge from the urethra.  The prostate area is still uncomfortable though and there is a tingling/buzzing coming from that area.  I have found a way of relieving this problem slightly by massaging the prostate internally; however, when I do this I notice that there is a discharge on my finger that definitely has the consistency and smell of semen.

I have had a urine test, my prostate has been examined and an MRI of the pelvis has been done, but they can not detect a problem.  I have been treated with antibiotics and Tamsulosin but there has been little improvement.  This is having a very negative impact on my life and so I would be grateful if you had any thoughts about what could be causing this, further investigations that could be carried out, or treatments I could discuss with my doctor.  I am grateful for your time.

ANSWER: Donald:

I do not see how any complication from a circumcision would cause all of these problems.  We expect the glans to be somewhat senstive, but the surgery is nowhere near the area involved in orgasm nor should it cause any prostate issues.  Likewise, there should be any perineal swelling after a circumcision as this area is far from the end of the penis.

The fluid you are expressing by "massaging the prostate internally" is obviously prostatic fluid secretions and not semen which cannot be produced in this manner.  The fact that this helps suggests that your underlying problem is actually prostatitis.

A more definitive test for prostatitis would be a 2-glass or the 4 glass urine test.  Talk to your physician about this or get another opinion from a different urologist.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply, I appreciate your time.  I shall speak to my Doctor about this test.

I understand that this problem seems unrelated to a circumcision, however, all I can say is that I never had any urological problems before this - all this began straight after the circumcision.

Regarding the fluid, perhaps I didn't explain it properly.  The prostatic fluid (I stand corrected that it is not called semen) which comes out when I massage the prostate actually comes out via the rectum, not the penis.  It this normal?  I have had a sigmoidoscopy in the last few months because I have had loose stools for about a year, however they did not detect any problem with the rectum - or at least nothing obvious.  This fluid does not come out during the day, but only when I make myself more comfortable by massaging this area.

Thank you again for your time.

ANSWER: Donald:

Fluid coming from the rectum is not likely to be prostatic fluid.

---------- FOLLOW-UP ----------

QUESTION: Hi, thanks for your reply.

I have now located the site of the discomfort to being approximately 10cm into the rectum, on the same side of but above the prostate.  This may sound strange but I did this very carefully using a curved "sex toy".  By doing this I was able to locate an area which seems hard and quite painful even to the lightest pressure.  Fluid did come out when I did this.

It is more uncomfortable with a full bladder; urination relieves the symptoms slightly.

The symptoms are exacerbated by my glans rubbing against my underwear.

I have to be honest, I don't know what to do now and I am in a bit of a mess.  Living a normal life day-to-day is a real challenge.  I have seen a urologist and had an MRI scan which, they say, didn't show anything - is it possible that something didn't show up on an MRI scan?  I have also had a sigmoidoscopy and they say this didn't uncover anything either.

In terms of what to do next, would a trans-rectal ultrasound be appropriate or something else?  Or another type of scan?

Again, I thank you very much for your time and any pointers you might be able to offer.

Answer
Donald:

MRI scans don't pick up everything; no scan does.

Your symptoms are most compatible with a diagnosis of prostatitis so that is what I would treat you for.  I don't see where more scans are going to help. The most definitive test for prostatitis is the 2 glass or 4 glass urine test mentioned earlier.  If your current physicians can't solve your problem, then you may need a second opinion from a tertiary medical center urology department.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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