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Urology/penile discomfort


Dear Dr Leslie

Please could you advise on my problem ?

October last year I masturbated rather vigorously squeezing the right side of the meatus rather hard and I believe causing damage.

On ejaculation I felt a slight burning on the inner right side of the ureathra, about 2 cm from the external tip, there was no blood. The next day there was pain, but no significant swelling or discolouration. I did notice that the tip of the right side of the meatus was inflamed and extended about 1-2 mm compared to the pain-free left hand side, this has subsided now. There was and has been no burning during urination.

After I few days I went to the doctors who did a swab test and the prescribed antibiotics (one week ?). Since then I get reoccurring penile discomfort and have recently seen a urologist. I had the following investigations: pelvic mri, ultrasound from kidneys to flaccid penis, urine flow test, and Stamey localisation test followed a couple of minutes later by a swab test.

The main findings were a possible AVM in the gland penis and 10 white cells per high magnification field (no infection), no signs of prostate infection/inflammation. The urologist believes that the possible AVM is not the cause of my discomfort and suggested that if my discomfort continues a cryoscopic investigation my be useful.

My questions are:
1. Do you think I should get another swab to see if there is still an infection, as I read that a swab test should be taken at the earliest one hour after urination?
2. As I can still get and maintain erections and there is no loss of sensation, do you think it is likely that I have had a tear anywhere within the penis head?
3. Should I get the possible AVM further investigated and do you think it is a consequence of my stupidity.

With very many thanks for your advice.


I doubt another swab is going to help, but it's easy enough to do.  A tear of the penis head is exceedingly unlikely.  Further investigation of an AVM is also not terribly likely to be helpful, especially given the extensive workup you've already had.

A cystoscopy would be quite reasonable.  If that is negative, a prolonged antibiotic course may be considered since the WBC's suggest a possible infection.  Good luck.


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Stephen W. Leslie, MD


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


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.

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

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.

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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