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Dear doctor,

I'm 24 and not taking any medication. I had a burning/stinging sensation while urinating and after. I got tested for gonnereagonherea, syphillis, hiv, and chlymidia but all came back negative. While I was there I was giving a penicillin shot and 2 pills to take while waiting for the results. That was on a Thursday and over the weekend symptoms seemed to get worse but by the following Tuesday I had no more pain while urinating. I do have 3 white painless bumps on the inside of my foreskin.  I have phismosis. Now when I urinate I feel pain/discomfort but no stinging. It feels like the urine is too much for the small hole of my foreskin. Today while urinating u noticed blood coming out and the pain increased. It feels like something popped. I'm afraid I have genital herpes. I'm unable to see anyone for a week. Would love some peace of mind.

Answer
James, basically you have 3 complaints: phimosis, pain and recently blood when urinating, "3 white painless bumps" inside your foreskin & concern about herpes and other STDs.  Let's take them one at a time.


A tight foreskin is called phimosis.  A male may be born with the condition or it can be acquired, usually from chronic infection (bacterial or fungal) under the foreskin  from improper cleaning.  Repeated trauma to the skin during sexual activity can also be a factor.   As the phimosis is more common in diabetics, a blood test for diabetes should be performed.   If you are able to gently retract the foreskin (prepuce) and stretch it, this may help.  However,  if you develop a fissure (a crack in the foreskin) , retraction  will only create more scarring and worsen the tautness.  If you can pull it back to expose the glans penis completely, wash thoroughly with soap and water then pat dry.  Next apply 3% hydrogen peroxide (available over-the-counter from your local pharmacist) with a cotton tipped applicator to the inner foreskin, glans penis and groove  behind the glans.  After the bubbling stops, pat dry and pull the foreskin forward. You can do the washing in the shower and apply the hydrogen peroxide once you dry yourself off. Do this on a daily basis.  This treatment will not correct the phimosis but will help to prevent infection and further constriction.   If the problem worsens, you are best seen by a urologist.   If infection is present, an appropriate topical cream can be prescribed.  If you do not respond to treatment or the phimosis is so severe that you cannot retract the foreskin, your best option is surgical. 
There are several operations available.  Traditionally this is done via circumcision.   If you are not concerned about cosmetics, a simpler procedure called a dorsal slit can be utilized.  In this operation the foreskin is left intact but an incision is made through part of the prepuce so as to release the constriction.   The incision is continued to the area of the coronal sulcus of the glans penis.  The foreskin is otherwise left intact and "V" shaped incision is then sutured to retain the "V" opening.  In my experience, these procedures have worked 100% of the time.  I must confess that initially they look a bit odd cosmetically as the foreskin falls to the sides.  However, once healed, to the untrained eye they look just like a circumcision (except all of the foreskin is still present).   Another option is a preputioplasties which basically are plastic surgical techniques that involve making a more limited incision into the foreskin and then suturing the incision in a manner to prevent re-stricturing.  Although generally successful, recurrence of phimosis can occur.  All of these operations can all be done on an out-patient basis.  Bed rest is not required.    Even with a circumcision, most men can return to work in 1 week and be back to full activity in 4-6 weeks.  With a dorsal slit or preputioplasty, you could probably return to work in a few days.  

The pain with urination means something is irritating the lining of the urinary tract.  If a routine urinalysis was not done, this would be the initial basic test.  Usually this is due to an infection.  The most common cause would be an inflammation of the prostate gland, so called prostatitis.  I have written about this extensively on this web site and you can find out more information about it there.  Urinary stones can also cause this.  Blood in the urine or coming out through the urethra has many causes.  At age 24, it would be unusual for any of them to be serious.  Urinary bleeding  requires an evaluation and studies by a urologist.  This usually includes imaging of the upper urinary tract (such as with an ultrasound, MRI or CT) and a cystoscopic examination.   If your doctor's appointment next week is not with a urologist, make an appointment to see one.

Without being able to examine you, I can't be too specific about the penile bumps.  However, most often they are totally benign lesions called Fordyce glands.  These are extremely common, have no clinical significance and require no treatment.

Nothing in your history suggests genital herpes and, therefore, I have no resin to suspect you have herpes.  Good luck!

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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