Dr. Rahul Kansal
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My penis is not soft in a flaccid state. It is always a little hard even when in a flaccid state. It is also a little painful when squeezed and after sexual activity. The color of my semen is always mild yellow. When I urinate, it takes four or five minutes to empty the bladder. It comes out fully, but then the last bit takes longer. I feel like the muscles in that area are constantly tight. My testicles get sore easily if they are squashed or I sleep on them. It feels like the penis is constantly engorged with extra blood flow and makes me feel aroused when I do not want to. For instance, when I urinate, even its touching seems to stimulate it easily, with no sexual thoughts. But if I have a sexual thought on other occasions, it also responds very quickly without much time. I only have very little control over it. When it get erect for the sexual activity, it does not feel the same sensation as it used to. Instead, it feels rubbery. It never used to be this way previously. I also find that the unwanted erections and hard flaccid state are much worse for three days after sexual activity. It never goes away, but it is terrible in those days. Because it is firm and looks semi-hard under my clothing, it can cause a great deal of embarrassment and unwanted impressions. Please help.
Hello,
Welcome to icliniq.com.
Your describing symptoms are suggestive of an infection (epididymo-orchitis). Please state the exact duration of these symptoms. Get a urine routine and microscopy test by giving your urine sample. A repeat ultrasound scrotum (testicles) would also be advised. These two reports will define your condition correctly and help in diagnosis. I would suggest the following medicine course to treat it prophylactically. Take Tablet Cefpodoxime 200 mg twice a day, Capsule Pantoprazole 20 mg twice a day, and Tablet Diclofenac 50 mg (SOS) for tenderness or swelling. Have a follow up after seven days of following this course of treatment.
Patient's Query
Thank you doctor,
I have had a problem with my testicles for the last four years. And the issues with the penis for two to three years. The penis has a slight twist to the left, which it never used to be before. It looks damaged. I have sent the photos and videos to show the thickness and hardness of the shaft.
Hello,
Welcome back to icliniq.com.
I have seen the attachment (attachment removed to protect patient identity). Hardness or fibrous band needs physical examination. Chronic pelvic pain can affect genitalia which is also a differential diagnosis. Let us follow this course of treatment and get the required tests to move forward with our diagnosis. Both of them will help in making a more definitive diagnosis. Chronic pelvic pain treatment is different. Treatment may also last for six months to a year. Let us follow up with the test reports and report of response to prophylactic antibiotics.
Patient's Query
Thank you doctor,
I will try the antibiotic treatment. I am wondering though you are a psychiatrist and you do male genital prescriptions. Thank you.
Hello,
Welcome back to icliniq.com.
Sexology practice routinely involves the treatment of genital infections. I have an offline practice in Sexology. It is a prophylactic antibiotic treatment to see the response to this management. Tests are mandatory before making a definitive diagnosis.
Patient's Query
Thank you doctor,
I have done some tests for STDs. Please tell me what other tests should be done? I will also get an ultrasound on testicles as per your previous recommendation. Should I begin antibiotics yet, or wait for more tests? Here are the first test results taken from the urine sample.
Hello,
Welcome back to icliniq.com.
I have seen the report (attachment removed to protect patient identity). There is no sign of an infection by urine PCR (polymerase chain reaction) for the four most common organisms. There seems to be no need for an antibiotic course now as the test has ruled out any trace or evidence of infection. Let us go through the US (ultrasound) scrotum and penile Doppler next to get an inside look at your problem by an imaging test.
Investigations to be done
Patient's Query
Thank you doctor,
I had an ultrasound done to my penis already. They claim nothing unusual. But when I urinate, it can often come out sideways. Although I have noticed an improvement in that it happened for some years. I can probably find and send an ultrasound of the penis, but found nothing.
Hello,
Welcome back to icliniq.com.
I have analyzed your case history and test reports thoroughly. Only two likely diagnoses come to my mind that can medically explain your unique symptoms now. The diagnosis are prostate problems and stress-related pelvic muscle tension. So go for the underlying tests to diagnose your symptoms such as penile ultrasound, Trans-rectal ultrasound (to look for prostate issues regarding your urinary symptoms), DRE (digital rectal examination) by a general practitioner who can assess or physically examine the prostate's size, and PSA (prostate-specific antigen). Suppose the conditions of the penis and prostate are ruled out. We can proceed with the treatment of condition stress-related pelvic muscle tension.
Patient's Query
Thank you doctor,
I had the scrotum US done yesterday. The radiologist found nothing unusual. He said he would send off the footage for another doctor to double-check it. Regarding penile ultrasound, the penis was scanned with MRI, and the report was nothing unusual, on Trans-rectal ultrasound - I will ask my doctor to give me a referral for this then?, DRE - Last year, my urologist did this and said my prostate was enlarged and PSA - I will check and see if there is a test already done. If not, I will get a referral.
Hello,
Welcome back to icliniq.com.
Every complaint needs a thorough and detailed assessment. Only after all this assessment we can reach a definitive diagnosis.
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Psychiatry
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