QUESTION: I am a 54 year old male.have pain on ejaculation.when i take a shower it hurt,s after when i pee.i have some tiny bumps on shaft of penis,hard to see unless skin is stretched.went to urologist showed bumps ,i asked if it was hpv ,he said no.did prostate exam,said it was fine.gave me cipro.i think hes wrong,worried i may have hpv in urethra.on day 3 of cipro.been with same gal for over a year.she has no symptoms.
ANSWER: Mac, as you might imagine, for this type of problem it is not possible for me to make an exact diagnosis or give recommendations over the internet because of the inability to take a more complete history and do a physical examination. However, I shall try to help you.
The common causes of such lesions are sebaceous cysts, infected hair follicles, skin tags & genital warts (HPV or condylomata accuminata).
Sebaceous cysts are a special type of sweat gland that are prominent in the genital region. Not infrequently, the duct that drains their secretions to the skin surface can become blocked. If this happens, the fluid builds up and they begin to swell. Sebaceous cysts are very common and generally of no consequence. The material in the cysts is a thick white substance that resembles toothpaste (in color & consistency but not in odor). If large and unsightly, they are sometimes excised for cosmetic reasons. On occasion, these glands may becomes infected. The most common cause of infection is trying to squeeze the mass and, therefore, this should not be done. In fact, squeezing an inflamed mass may spread infection to other parts of the body which can be very serious. If infected, they become red, more swollen and tender. In this case, you should see a physician for possible incision and drainage. This is a minor procedure that usually can be done in a few minutes the office. If the infections are recurrent, the sebaceous gland should be excised once the site is completely healed to prevent further recurrences.
With an infected hair follicle, you should note a hair centrally surrounded by and area of redness (inflammation). These also should NOT be squeezed.
With either an infected sebaceuos cyst or hair follicle, the application of warm wet compresses (a warm wet wash cloth covered with a heating pad) or warm bath 3-4 times a day for several days may help with resolution of the inflammation. If not, medical consultation is recommended.
Skin tags are very common but of unknown cause. They occur with aging and are more common in women than men. They are non-cancerous and do not requite treatment but they can be removed for cosmetic reasons. It is important to be certain, however, that such skin tags are not really genital warts. The latter generally have an irregular or somewhat cauliflower surface but it is often difficult for a layman to differentiate the two conditions. If unsure, they should be checked by a urologist as genital warts (HPV or human papilloma virus) are viral and, therefore, contagious via contact. In addition, a few strains of this virus may predispose a woman to cancer of the cervix. Regardless of the true etiology of your lesions, you should not "mess" with them. Doing so, could them to become infected or to spread to other areas.
As the diagnosis of your condition requires a physical examination, I strongly recommend that you see a urologist in consultation. If you were not satisfied with the evaluation by your urologist, seek a second opinion. However, the diagnosis of warts by a urologist is generally easy and quite routine. This is the only way that a correct diagnosis be made and proper treatment recommended. Based on your description, however, I doubt you have HPV.
As for your other problem, pain with ejaculation and discomfort after urination most characteristically occur from an inflammation of the prostate gland, so called prostatitis. This is a disorder that I have commented on extensively on this web site. In case you have not read it before, to follow is a "macro" I have written on this problem that will explain the various types of prostatitis and their treatment to you.
Symptoms that might occur with prostatitis include frequency of urination, slowing of the urinary stream, burning with voiding or ejaculation, burning in the penile tip unrelated to voiding, urethral discharge, sexual dysfunction (such as difficulty with erection), aching in the penis, testicles, and discomfort in the lower abdomen, low back, groin, rectum or perineum (the area between the scrotum and rectum – between the “wind and the rain”) and constipation. The passage of blood at the initiation or termination of urination or in the semen can also be noted. During sexual arousal the prostate gland & seminal vesicles manufacture fluid that account for the majority of the semen. The seminal vesicles are paired structures located behind the prostate gland that are also sensitive to sexual excitement. Sperm from the testicles (which account for only 1-2 % of the semen) travel up a series of tubes (epididymis and vas deferens) on each side to join the seminal vesicles forming the paired ejaculatory ducts. These structures empty into the prostatic portion of the urethra. At the time of ejaculation, fluid is discharged from the prostate gland and ejaculatory ducts into the urethra (urinary canal) forming the semen. The average semen volume is 2-6 cc. With the inception of ejaculation, the bladder neck closes and the semen is forced forward out the urethra by contraction of the pelvic muscles.
It is not uncommon for inflammation and/or infection to spread in a retrograde manner into the vas and epididymis. Even without such spread, prostatic discomfort is often referred into the testicle. Too frequent or too infrequent ejaculation, sexual arousal without ejaculation, withdraw at the time of ejaculation, aggressive bike or horse back riding, and excessive spicy foods, alcohol, and caffeine in the diet can predispose you to this. Sitting for long periods of time, especially in an automotive vehicle, can put undo pressure on the prostate and aggravate the condition. For the latter, it is best not to sit more than 2-3 hours at a time. Stop the vehicle periodically, take a short walk and go to the bathroom to urinate. A thick pad or piece of sponge rubber on your seat will also help to cushion the prostate. One should avoid any of the above that apply. Eliminating all of these factors that apply to you are just as important, if not more so, than taking medication! Ejaculation beyond the tolerance of the prostate to fill and empty may also cause discomfort. Likewise if one does so infrequently, fluid still builds up from thoughts, dreams, fantasies, etc. and has to be released periodically to decompress the gland and relieve the symptoms. For most men, ejaculation in moderation, perhaps 1-2 times a week, is reasonable. A daily warm bath for 10-15 minutes 1-2 times daily also lessens the discomfort. Attention to sexual activity and warm bathes should be utilized regardless of the type of prostatitis and whether or not medications are prescribed.
There are several types of prostatitis. Sometimes prostatitis can be due to an infection of the gland with bacteria. Typically, pus cells and bacteria are found in the prostatic fluid. The infection usually requires an initial 4 week course of an appropriate antibiotic (the commonest prescribed are the fluoroquinolones, but tetracyclines, sulfas and other agents can also work).
Abacterial prostatitis has several varieties. In one, the prostatic fluid demonstrates pus cells but no bacteria. In the other, there are neither pus cells nor bacteria in the fluid, just the symptoms. In all types of prostatitis, the urinalysis generally is normal unless the infection spreads into the bladder. Abacterial prostatitis is an elusive entity that has been called by a variety of names including nonbacterial prostatitis, prostadynia, pelvic congestion syndrome and most recently pelvic myoneuropathy. The latter name was coined by Dr. David Wise of Stanford. He believes that this may represent up to 95% of all cases of prostatitis. This variant may be an expression of interstitial cystitis and possibly is due to autoimmune or neurogenic factors. Dr. Wise suggests that the primary cause of the symptoms involves pelvic muscle spasm, nerve trigger points and some degree of anxiety (either the cause or result of the symptoms). His therapy involves the use of anti-depressents (we have used Elavil for years in refractory patients), relaxation techniques, trigger point physiotherapy, and biofeedback. Some others recommend Yoga & meditation as being useful. Although he may well prove to be correct, I generally recommend an initial course of antibacterial therapy for patients who clinically have symptomatic prostatitis of any variety. The majority of patients (even those with nonbacterial prostatitis) seem to respond favorably. It has been know for decades that many patients with the abacterial variety of prostatitis do well with antibiotics but the reason has been vague. Some theorized that they may harbor bacteria in the tissues of the prostate that are not being picked up in cultures (possibly walled off loci of infection). For more information on Dr. Wise's studies check out:
In my experience, symptoms usually responds to the general measures mentioned in the initial paragraph. Medications that sometimes help include the over-the-counter natural supplement saw palmetto 320 mgm daily and alpha-blockers (such as Flomax, Hytrin, Cardura & Uroxatral). The latter require a prescription from you physician if he thinks it is indicated. More recently, a naturally occurring flavinoid with anti-oxidant and anti-inflammatory properties (such as quercetin) has been used in prostatitis. It's success is yet to be confirmed.
Prostatitis may also be classified as acute (severe), subacute (mild), or asymptomatic. It may also occur as a single episode, be recurrent or chronic. In chronic bacterial prostatitis, long term low dose antibacterial therapy often works well in suppressing symptoms. In refractory cases, culture of the prostatic fluid or semen often will disclose the offending bacteria. If found, sensitivity studies can identify which antibiotics are most likely to eliminate that particular germ. One should be off of all antibiotics for 7-10 days before the culture is taken. Otherwise, if there is residual antibiotics in your system, this may prevent bacteria from growing in culture.
In other cases refractory to treatment, there is another condition that can produce similar symptoms. This disorder is ejaculatory duct obstruction. Usually the doctor will find the seminal vesicles to be very swollen on rectal examination. The patient will notice either absence or a markedly diminished semen volume. The diagnosis is made by doing a transrectal ultrasound of the prostate and seminal vesicles.
Therefore, if symptoms persist, consultation with a urologist should be scheduled. In cases with recurrent prostatitis or hematuria, it often is necessary to study the urinary tract more completely. Predisposing factors to prostatitis such as a urethral stricture (narrowing) and other disorders can then be evaluated. A man should learn to listen to his body. Good luck.
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QUESTION: on day 10 of cipro,no improvement,still have urethral awareness,no libido,pain on urination,I masturbated once and it hurt bad on ejaculation.and to make matters worse i just lost my health ins.dont know what to do.internet is full of stories of people with similar symptoms who cannot find out whats wrong and are suffering with this.I showed dr patch of tiny clustered bumps bottom of penis shaft that i was worried could be hpv,he said no,too small.Ive read hpv can be tiny or not visible so his statement makes no sense to me.what if i have hpv it in urethra?something is wrong,penis feels sick,stays very flaccid(tiny)and hurts.
Mac, sorry about your loss of insurance but you still need to see a urologist. As suggested, a different urologist would be best as you do not seem to have confidence in your present urologist. A correct diagnosis must be made so that proper treatment can be recommended. It is hard to do so over the internet.
As far as HPV is concerned, examination of the penis and urethral meatus usually reveals the typical warts. If not seen or there is a question as to the diagnosis, wetting the area with acetic acid solution for 5 minutes generally will turn the warts white (but not other lesions). After staining with the acetic acid, magnification with a lens is suggested to get a better look at the area.
As far as your urinary and sexual symptoms are concerned, I still believe you have one of the types of prostatitis. If bacterial, it generally takes at least 4 weeks of antibacterial therapy to clear. At this point, as you have had no response to Cipro, it suggests a resistant bacteria or one of the other types of prostatitis. I would recommend a culture of your prostatic fluid to try and identify which (if any) bacteria is present. This can be done from either your semen or expressed prostatic fluid. If identified, sensitivity tests can be done to determine which antibiotics are best to eradicate this particular germ.
I do not believe the penile lesions and your other symptoms (urinary and sexual) are related but rather represent separate issues. Good luck.