Do you ever get a slight burning sensation when you pee? Or is it more like, as Eddie Murphy once said, “No doc, I mean there is actual fire coming out of my dick!” No matter where you are on the spectrum of dysuria, maybe I can help. So let’s talk about the major players:
Urinary tract infections are common in women, but not so common in men. It’s really a matter of anatomy. You see women have short urethras. (The urethra is the tube that carries your pee from the bladder.) In addition to their short urethras, women have the unfortunate anatomical feature of having the “p-hole” and “b-hole” in close proximity. Really, not smart from a design standpoint… Hopefully, this will all get straightened out in the Girl 3.0 model.
Men, on the other hand, have evolved to have long urethras (some longer than others…insert smiley face here) allowing us to hunt and gather and pee standing up. Despite our long urethras, we still occasionally get UTIs, but they are rare. As a matter of fact, if you are an otherwise healthy male less than age 50, you may be referred to a urologist if you get frequent UTIs to look for an anatomical problem. As we age, our prostates get bigger which can cause some “plumbing problems”. Thus, over age 50, UTIs are slightly more common in men. In addition to burning with urination, other symptoms of UTIs include: frequency, urgency, bloody or blood tinged urine. If you have these symptoms, you need to see your medical provider and provide a urine sample for analysis and culture. The treatment is usually straight forward with antibiotics once the infection is diagnosed.
This infection, also called “the clap,””the drip,”or “the morning drip,” is caused by a nasty little bacteria called “Neisseria gonorrhoea.” In addition to painful urination, gonorrhea urethritis usually causes a yellow, white or green discharge from your penis. Some men notice it on their underwear. Occasionally, this infection can spread to the epididymis or testicle causing testicular or scrotal pain. Even more rarely, this infection can spread in your blood stream to infect one of your joints. Typically, this causes a red, swollen, warm joint with systemic symptoms like fever and chills. (Thats crazy, right? Don’t be that guy with an STD in his knee!)
So if you have a drippy penis, you need to see your medical provider right away. This infection can be screened for by putting a small cotton tipped swab in the end of your penis; or more humanely, by having you pee in a cup. To get gonorrhea urethritis, your penis has to come in contact with an infected mouth or anus. While gay men have grown accustomed to using a condom for anal penetration, no one likes a condom in their mouth. Unfortunately, our throats are a great place for these nasty little critters to hide out, breed, and develop resistance to common antibiotics. So for now, this guy is easy to treat with a shot of ceftriaxone in North America. But Japan, France and Spain are beginning to see antibiotic resistant gonorrhea. Think about that next time someone on a hookup site wants “just oral!”
Nongonococcal Urethritis (NGU)
Another nasty little bacteria that can infect your urethra is “Chlamydia trachomatis.” Like gonorrhea, chlamydia infections can cause painful urination, discharge, and testicular pain. But, you know what else it can cause? NOTHING! That’s right, you can be completely symptomatic and still spread the disease to others. In both women and men, it can cause scaring of the reproductive tract leading to infertility. This infection is diagnosed with the same test as gonorrhea. The treatment is either a single dose of azithromycin or a 7 day course of doxycycline. In addition to chlamydia, there are a few other organisms like mycoplasma and ureaplasma that cause similar symptoms. They are not usually tested for, but generally respond to the same antibiotics as chlamydia. This is why, if you are symptomatic and had recent unprotected sex, your provided will generally treat you before the tests come back to confirm your illness.
The prostate is a walnut sized gland that sits right below your bladder. So naturally, when it’s angry, it causes urinary symptoms like frequency, urgency and some times blood tinged urine. In addition, men often complain of pelvic pain, fever, chills and even painful bowel movements. Your provider might need to check for prostate tenderness or enlargement by putting a finger in you rectum and pressing against your prostate. (Seriously that’s a real thing. I wouldn’t lie.) When the prostate is inflamed or infected, this is exam is quite painful. Unfortunately for gay men, anal intercourse is one of the risk factors for infectious prostatitis. While prostatitis is much less common than the other causes of painful urination, it can make you very sick if left untreated. In addition, the antibiotic treatment for infectious prostatitis is typically of longer duration than the other previously mentioned causes of dysuria.
So there you have it! That’s the skinny on dysuria. There are other, non-infectious causes of urethritis. This can be caused by anything from soaps, to lubricants to overzealous masturbation. Seriously, that’s really a thing “overzealous masturbation urethritis.” You see the prostate produces prostaglandin E2 which can act as inflammatory hormone and…..blah, blah, blah. If you really want to know about that you can click here. All that to say, don’t go packing your boyfriend’s stuff and throwing it out in the yard, if you develop dysuria. Maybe you just need to, you know, stop burping the baloney so much.
Seriously, if you have pain when you pee, go get it checked out. Simple as that!