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Hi Doc! Please help.
Possible Prostatitis.
I am a 43 yr old white male. 5'7" 190lbs. Pretty good shape, and i normally eat really well.

For maybe the last 2 months, I've noticed a pain in the tip of my penis. It comes and goes, usually over the course of hours or days. sometimes i'm fine for many days, but always the pain eventually returns, and right now its been about 36 hours straight and getting to be too much. Also, for maybe the last year or two my urine stream has been weaker most of the time. stop start urination and sometimes dribbly slow almost nothing urination when it feels like i really have to go (especially lately), but if my bladder is full, i can usually pee like old times til right near the end. This pain gives me the sensation lately like i feel like i wanna pee, but usually when i do not much comes out so i've been gritting out the pain and going to the bathroom less frequently. Urination does not ease the pain afterwards.

Thru alot of research the most likely candidate is Prostatitis and i have an appt for a Urologist on January 7, but man i really dont want to wait that long and want to make sure this isnt more urgent.

Other symptoms.
- I have Ankylosing Spondylitis,currently on Celebrex which usually works well. I thought this was related to AS at first but now i dont. pain usually manifests in my hips, but last year i had a horrible pain in my tailbone due to AS. got back on Celebrex and sat in cushy seats and still took about 6 months to completely get past it. My AS still flares, usually in my hipsand i am actively taking celebrex for several months now. AS is mostly not a problem right now.

- no pain during urination at all, except for just the same pain in the tip of my penis that is always there. But zero added pain during urination.

- when i first started noticing something wrong, i was also feeling a pressure in the underside of my groin for several days. slight pain, it "10" is go to the hospital this was a 2, but you notice it when its in your groin :-)

- last week for a day my scrotum was in constant pain. that might possibly be because i thought i found a lump on my right testicle and maybe i aggravated it self testing. i dont think i have a lump but will def tell Urologist when i see him. that pain only lasted a day and was more localized to my right scrotum.

- when ejaculating recently, i have noticed sometimes increased pain in the tip of my penis and my urethra ejaculating and occasionally that pain will last for hours after. It feels like my normal penis pain amplified. No pain urinating at all other than the normal pain i have regardless.

- Vasectomy in 2010. no complications.

- i sit a lot for work and often work long hours, but i do have a Herman Miller Aeron chair which takes the pressure off your tailbone and is about the most comfortable chair to use.

- i dont know if this is what premature ejaculation is, but recently seemingly related to this, i have noticed that sometimes before i come, i'll have a small stream of very clear fluid coming from my penis, much thicker than urine but not nearly as thick as my regular ejaculate. Its like right at the point when your getting close and you slow down or stop for a moment so you don't ejaculate, but then this clear fluid comes out and i cant stop it. And sometimes, it just starts coming out only a few seconds right before the regular orgasm. this has never happened to me before, but its almost regularly happening lately. i have no problem attaining or keeping an erection.

- 2 nights ago, i had acute lower abdominal pains for about 18 hours, peaking at around 3 hours in and staying that bad for 8 more hours. I thought i was constipated, but 3 cups of coffee and 3 decent but not large bowel movements later (which helped reduce pain but not alleviate the abdominal pain) and the pain and constipated feeling were still strong. all of that seems to have worked itself out over the course of about 18 hours. This is the first time in a long time something like that has happened. might be completely unrelated. def not food poisoning, and i dont eat fried foods, and i take fiber suppliments.

- i have always had low blood pressure. I dont smoke. I drink one or two beers or glasses of wine a day typically, and i also typically get high at the end of most nights on edible pot (is helping the pain alot too). I currently take celebrex 2x day, fiber suppliments, a couple baby asprin, multi vitamin, simvastatin. I drink a fair amount of coffee daily. No other drugs or vices. I have typically low stress, i make music every day, even on a bad day its pretty good.

- Simvastatin. in 2007 i had single bypass open heart surgery to correct a 100% blockage of my Left Anterior Descending artery. No other arteries were even slightly narrowed. Surgery fixed the problem, but my docs want my cholesterol levels super low so they keep me on Simvastatin and baby asprin. i believe all precautionary. i had ZERO risk factors for my heart problem. I mean NO risk factors except 1. Sleep deprivation. I get good sleep now but i spent most of my 20's awake more than most humans on earth (i work in the music industry).

OK, i think i've thrown the book at you. what is your advice? should i get to a doctor ASAP? or is January 7 with a urologist fine? is there any chance this is testicular cancer? The diagnosis which seems to have the closest alignment i have found is prostatitis. I cant thank you enough for any help and advice.

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Rajiv Goel is online now

Expert:  Dr. Rajiv Goel replied 4 Days.

Dear sir,

Thank you for the consult at

You seem to be suffering from prostatitis and it gets aggravated with constipation. You should see the urologist and start treatment under his care. There is no need to panic and you are not suffering from testicular cancer.

Till you see urologist, you can start yourself on T. Flomax 0.4 mg once daily.

Hope this helps, please let me know if you have any queries.

Take care.

Dr Rajiv Goel
Fellow, Urooncology and Robotic urology, Australia
Fellow, Laparoscopic urology, Germany
Consultant Urologist

Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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