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irritated urethral channel
irritated urethral cha  
red meatus
red meatus  
QUESTION: Hello Stephen;

3 months ago I sustained a injury to my penis head.  The injury occurred when semen from my penis tip bonded itself to my underwear unknowingly, and I went to urinate and because I was unaware that it had basically glued itself to my underwear, was torn off.  There was immediate pain and discomfort for a day or so but it went away.  There hasn't been any bleeding.

Few days to 1 week later I start to notice redness, pain, and discomfort.  It gets worse after sex.  So I have been abstaining from sex for nearly 2 and half months now.  I even toned down masturbation.

I have been tested for Gono and Chlamydia, which were negative, there is no blood in urine tests and there is no discharge to my knowledge.  I was also tested for UTI and bacterial infection, both of which came back negative.  The jury is still out on other STD test results but personally I don't feel I show any signs of any.

I have been to 3 primary care doctors and they can't seem to nail this diagnosis. I had one tell me it was trauma and it would go away after a time, it hasn't and it's been about 3 months now. I had one tell me it could be Herpes, gave me meds, which did not help. I had another tell me it was Yeast Infection and gave me Nystatin ( on the 11th) and that only mildly helped and I'm guessing it's because the head and tip were coated.  Now that the 2 week treatment is done we are back to square one.

My symptoms are as follows;

Red meatus area around urethra
My urethra looks very red and slightly swollen, even down inside, at least to me
Lips of penis head also look odd, possibly very slightly swollen
Pain about 3 or 4 on the pain scale, when it happens it feels sharp like I've been stabbed.
A nagging discomfort, is this itching?  It doesn't feel like itching to me but it's annoying!  Happens on and off throughout the day.
urethral opening is overly sensitive
dye-like urine effect, akin to how it looks when you put food coloring in water.
Heightened arousal from the nagging feeling

All of this is in the head and tip of the penis, I occasionally get a twinge down the shaft towards the base but I think it's acute, then again it wasn't doing that before injury..

I have posted pictures.

What do you think is going on here?  I'm flying blind.  Is trauma possible from the nature of my injury? Nerve damage?

Help me Doc. I'm scared and upset. I'm forgetting to remember what it was like to have a normal penis.

ANSWER: Mark:

First, it was most likely not semen that got stuck.  Despite the negative studies, the most likely cause of your symptoms is urethritis.  This is best determined by a direct examination by a skilled expert and a first voided urine specimen and/or urethral culture.  It isn't clear but I doubt these have been done yet.

I would suggest you consult a local urologist for a definitive answer.

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

QUESTION: Thanks for you reply doctor.

Unfortunately,I know for certain it was semen.  I had masturbated prior to the event happening, cleaned up, thought I got out all the semen, and then passed out for 1 hour or so.  After I woke up is when the injury happened because I had to urinate and by then the leftover/missed semen from inside leaked out and bonded myself to my clothing.  It hurt like hell when it was torn off :/

What is a voided urine culture?

No, they haven't done a urethral swab yet.

Here's all the test they have done on me;
Urinalysis
Urine culture for bacterial infection, I can't be certain about Fungal
STD testing via urine and blood (jury is still out)

It hurt pretty badly when it was torn off are you sure it can't be trauma or nerve damage?

I had suspected Urethritis for a long while but none of the 3 doctors I've seen have diagnosed me with it and if you bring up that you were googling your symptoms, well they get antsy.

Could it be possible to get trauma induced Urethritis and have no infection?

If yes, what is done for that?

I thank you for your time doctor.

Oh, I noticed that you practice in Omaha, NE.  I was born and raised there and if I still lived there, I'd have you look at me.

Answer
Mark:

A first voided urine specimen means to collect the very first part of the urine stream for a culture.  Most of the time, we collect the mid-stream as being more representative of the bladder urine.

From here, I can't be sure about any possible trauma, but the nature of semen is that it is not a very good adhesive.

It might be conceivable to have a trauma induced irritation that could technically be considered a urethritis, but if so it should have cleared up by now.  A course of antibiotics for a presumed urethritis would be reasonable at this point, but check with a urologist to find out for sure.

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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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