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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Painful urination after sex


 GandG - Mon Feb 08, 2010 11:01 pm

Hi,

I experience painful urination, increased frequency, and pain near the tip of the penis as the bladder becomes filled. The pain is relieved by urination, however, there is usually a mild stinging most of the time. There is usually a delayed start of the urine flow lasting few seconds (10 to 15) as well. The pain is usually enough to wake me up every couple of hours at night. This happens especially after sex and may last for as long as a week. Spicy foods may also cause the same symptoms generally only for a couple of days. I have seen a couple of urologists about this issue and have had a cystoscopy last year but still no answers. I was wondering if anyone might have a suggestion of a new direction to investigate this issue as it has been a problem since my mid 30’s. I am now 61 and take FlowMax once a day.

Gary
 Dr.M.Aroon kamath - Fri Feb 12, 2010 8:41 am

User avatar Hi,
Your symptoms have certain features which seem to suggest a chronic seminal vesiculitis. Pain of seminal vesiculitis is frequently referred to the tip of the penis and may be worsened by sexual activity.

Gonococcal infection was the most common cause of acute and chronic seminal vesiculitis in the past, but organisms such as chlamydia trachomatis are frequently the offending pathogens now-a days(especially in patients <40 years). Recurrent epididymitis may be frequently associated with this condition.
In some parts of the world,high incidence of chronic seminal vesiculitis is attributed to underlying bilharziasis.

On transrectal ultrasonography, dilatation of the seminal vesicle on the side ipsilateral to epididymitis may be seen. Seminal vesicular fluid from the affected side usually shows inflammatory findings in almost all patients. Cullture of the first voided sample may grow the microorganism.

Treatment usually consists of
- antibiotic therapy(tetracyclins/macrolides/quinolones) and
- symptomatic management.

In patients who don't respond to these measures,transperineal seminal vesicle puncture under ultrasound guidance and continuous transcatheter antibiotic drugs instillation may be considered.

Best wishes!

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