Helped Over 500,000 patients with 98%+ satisfaction.

Connect & Get Personalized 1-to-1 Answers from Expert Doctors

DoctorSpring > Question Home


Resolved Question:

I am a 29 year old male with urological problems related to irritation in the urethra and very frequent urination, which have persisted for about 2 years.

In November 2011, I woke up one morning with an itch in my penis. It felt like it was inside the tube and I really wanted to scratch it. The night before I had been at a friend’s birthday, I’d had around 6 pints of beer (more than I’d normally drink in a normal week but nothing severe), and I hadn’t had sex or done anything else unusual. I don’t recall any problems at all until the itch when I woke up in the morning.

The itch persisted and about a week later inflammation appeared on the head of my penis. The foreskin looked kind of crackled while the head was sticky and red and very sensitive to touch. I arranged a doctor’s appointment but the inflammation had disappeared by the time I saw him - it lasted around 4 days.

The doctor gave me a topical clotrimazole cream, and I also tried other changes he advised like changing to a non-bio detergent, sensitive deodorant and shower gel etc.

Over the weeks that followed the itch came and went, sometimes it would be bad for a couple of days then ok for a week, then bad for a week etc. I continued using clotrimazole cream and was unsure if it was helping or if the symptoms were coming and going on their own.

However, over this period the symptoms gradually developed, and I noticed this irritation grew and felt more and more like an urge to pee. Eventually, by Summer 2012, it had gradually grown into an almost constant urge to urinate, which has persisted to today. At the same time, I also found I struggled to keep erections with my girlfriend, as I constantly felt like I needed to pee or might leak which was very off putting. I would say we manage to have sex 4 or 5 times in the last year, the rest of the time the irritation is too much whenever we try.

Over the last 18 months the symptoms have stayed fairly consistent, perhaps gradually worsening, and now the feeling is pretty much constant. I feel like peeing all the time, although I have no problems holding it. When I do pee, there is often not much volume. By the time I’ve left the bathroom the feeling has usually returned. It feels worse when I’m moving around - walking can be torturous but when sitting at home it’s not so bad. I constantly feel a mixture of an irritation / itch in my urethra combined with a feeling of needing to pee. It’s been like this for so long now that it’s hard for me to remember what normal felt like to give a comparison.

When I do pee, it does not hurt, and it feels like relief - scratching the itch - although the relief passes very quickly and I often have a feeling after I finish like there’s still a drop in there and I just can’t squeeze it out. I don’t wake up to pee during the night, but I do usually wake up in the morning with a very strong urge.

I have had many tests - my blood and urine glucose levels have been checked and came up normal, I was checked for STDs and nothing was found, my prostate was examined and seemed normal, and I was on alpha blocker pills for a month to see if it might help if it was prostatitis, but I saw no change. I had long courses of Doxycycline and Ofloxacin to catch urinary tract infections which did not help (I think I may have got worse after the antibiotics but I’m not sure, it could have been getting worse anyway)

Most recently I was referred to a urologist and have had my bladder examined. An ultrasound was normal, then I was anti-cholinergics for a couple of months which did not help. I then underwent urodynamic tests which showed my bladder was normal, followed by a cystoscopy which found no problems. I am next scheduled for a cystoscopy under general anaesthetic with cystodistension. I don’t have any expectations of this helping - personally I don’t believe it is a bladder problem as that doesn’t explain the irritation and inflammation around my penis.

Going back to the inflammation, which first occurred when these symptoms first started, it has appeared infrequently since then - maybe once every ten weeks on average, usually just for a day. I have not been able to get seen by a doctor while it is present, but I showed my GP a photograph who thought it looked a lot like Thrush. I was put on a four week course of fluconazole, with three pills during the first week and one pill per week afterwards, alongside clotrimazole cream. I saw no improvement after this. I went to an STD clinic who took a swab from my penis and they found no fungal infections. The doctor taking the swab did say they could see feint spots around the head that looked a lot like they could have been caused by thrush however.

Since my fluconazole course about 2-3 months ago, the external inflammation has not reappeared. The internal itching and urge to pee are as strong as ever however. I have also had periods this long without the inflammation appearing in the past so it’s possible it could return.

I’m not sure what the relationship between the rash / possible thrush and the frequent urination is, but they both developed at the same time so surely they must be connected.

I am lactose intolerant and have read you shouldn’t take Fluconazole if this is the case. After taking them I did suffer similar stomach cramps that I get when drinking milk - at the time I didn’t connect it to the pills and thought it must have been something I ate. I was wondering if this would stop the active ingredient getting into my bloodstream? Is my problem as simple as a fungal infection that the drugs haven’t been able to reach?

I was wondering what other possible causes there are. For me it feels like the urologist I’ve seen has focussed way too much on my bladder and brushed aside the other symptoms I have described. It is true that my biggest symptom now is frequent urination, but it has come alongside other symptoms that must have other causes.

I have also tried all the standard bladder dietary advice - avoid citrus, avoid caffeine etc, but I have not seen any difference from this either. I am overweight (250lbs and 5”10), so am trying to work on this to see if it helps. I have never had any other health problems, I am not sporty but I am relatively young and have no problem running up stairs etc, though as mentioned above I do find even short walks to be arduous lately because of the constant irritation I feel.

Category: Urologist

Ask Your Own Question

Category: Andrologist
 19 Doctors Online


Thank you for choosing DoctorSpring.

Thank you for providing a detailed medical history. I have gone through it and the symptoms are suggestive of a diagnosis called "LUTS". t has been used as a general term to refer to any combination of urinary symptoms or as a more specific term to refer to those symptoms primarily associated with overactive bladder (frequency, urgency, and nocturia etc).

There are few things you need to understand in case of a LUTS

1. There is no major structural or functional abnormalities (no serious issues)
2. LUTS has been reported in utpo 35% of individuals in certain population
3. The investigation is time consuming (and can be frustrating ) , but it can be successfully treated.
4. in many cases the symptoms disappear over time.

I would like to know where Uroflowmetry, Postvoid residual urine volume, Pressure-flow/ urodynamic study has been done and if so please share the reports. Also I would like to know how soon did you get the response for fluconazole ? (the external inflammation started subsiding with days/weeks / months ?)

Also are you taking any medications currently ?

Thank you

Patient replied :


I don't have all the results to hand but I have information that the urologist put in the letter.

From one urodynamic study:
"Urodynamic studies showed that he has got a stable but small capacity of 148"

After flexible cystoscopy:
"The urethra was noted to be normal, the prostate non occlusive, the bladder lining normal. There was no trabeculation and no diverticula seen. The bladder fill normally."

"He managed to do a urinary flow rate afterwards and managed to void 520 ml with a maximum flow of 21.8 ml/s, and the pattern suggested terminal dribble. Residual urine was only 34 ml. This was tested today after his flow rate."

I am not taking medications currently but it has been suggested that I try nortriptyline so I will be trying that.

With regard to fluconazole, it's hard to say how soon it worked / if it worked. The external symptoms weren't there permanently, they come and go every few weeks, and are only ever present for a day or so. They had already disappeared before I took fluconazole. However, normally I would have expected them to return by now and they haven't, so I'm guessing that it worked.

Another possible symptom that I've noticed is that when I feel bloated the symptoms are not is strong, but after a bowel movement they come back. Could there be some link there?

Dear Patient,
Your uroflowmetry report is normal so is your cystoscopy details. You start Tab. DARIFENACIN 7.5 mg once daily. If there is not much externsl symptomd don't take fluconazole. Along with there do kegel exercises as adviced.

Dr Gautam Banga

Dr. Gautam Banga
Category: Andrologist
MS Surgery: MGM Medical College & M.Y Hospital Indore
Residency: M.Ch, Urology, SMS Medical College & Hospitals Jaipur
Medical School: MBBS, BJ Medical College, Pune, 2001
Training in Urethral Reconstructive surgery: Kulkarni Reconstructive Urology center, Pune
Dr. Gautam Banga and 4 other Medical Specialists are ready to help you

Users who read this, also read:

Make informed and better medical decisions.

Join the 500,000 people who found a smarter, quicker way to get Answers, Recommendations & Expert Opinions.

Expert Doctors at fingertips

Recommendation on next step. Second-opinion.Multi-specialty.

Save Time

Average time for answers: 6 hours.

Save Money

$35 for typical specialist consult vs. $120 for a local appointment.

Free Follow-ups

Clarify, ask further questions for free in private conversation.

100% Satisfaction

Money back guarantee for the 1st reply. MEDNET Quality Board.

Start My Consultation



Doctor Spring is a novel online Doctor consultation platform where you can get your medical questions answered by leading Doctors. Just Submit your question and rest assured that you will consult a Doctor easily. Once you submit the question, the Doctor from the concerned specialty will reply within hours. You can always ask more questions or add details with follow-up question options and make it an online doctor chat. You may use this service to consult a specialty or for getting medical second opinion. All paid services come with a MEDNET quality assurance and 100% money back guarantee.

DoctorSpring in news