Dr. Khant Shahil Ramesh Bhai
Urology
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,
I am a 43 year old male. Since the start of the year, I have severe (before that mild) erection problems. It got bad, hardly any erection, hardly felt glans anymore during masturbation (been a few years since I had penetrative sex). The penis is feeling sore. Nearly two weeks ago, I got itching and pain in glans/tip and a part of the outer skin discolored (also caused by masturbation friction). I saw a GP, did not see glans as I had never retracted foreskin in my life and told me to see a urologist. The next day, I used coconut oil outside and tip and it was soothing for the tip and pain but sore feeling stayed. After a week, I got so far that I retracted foreskin (a bit difficult but no pain) and there was a white substance on the left side. The GP told me to keep it clean and prescribed Miconazole. There was an adhesion with the white substance which I massaged loose after a few days (left side where white stuff was). This spot makes it hard to roll back the skin as the inside skin sticks/rolls. This skin is cracked as you can see from the picture. I showed different GPs and they told me the glans looks healthy and to keep using Miconazole, see a urologist, etc. I am considering taking Diflucan 150 mg to rid infection asap. I cannot really roll back the skin further as in the picture for cleaning further due to foreskin rolling/sticking, also afraid of paraphimosis. Your view, please.
Hello,
Welcome to icliniq.com.
I have seen the images sent by you (attachment removed to protect patient identity). You are concerned with two problems: Infection of the glans and retraction of the foreskin, and erection problems. Regarding glans, the retraction of the foreskin is good. It is almost maximum. So, nothing to worry about the retraction. The glans is normal and fine. Glans is sore and slight whitish due to mild infection as it was not cleaned for many years. You will have a sore feeling because it is exposed to the new environment. The white substance you are talking about was smegma. But, it is cleared now. I suggest you take Diflucan (Fluconazole) as it will speed up the healing infection. Soreness is due to drying of glans when exposed to the outside. You just need to apply a soothing ointment like Lignocaine jelly during bedtime. You can stop Miconazole cream also when finished.
Regarding erectile dysfunction, get some blood tests done if possible as we need to find the cause of ED. Serum TSH (thyroid-stimulating hormone), FSH, LH, prolactin, HbA1c, and penile doppler with a vasoactive drug (Prostaglandin). Treatment of ED depends on the cause.
Patient's Query
Thank you doctor,
I appreciate you putting me at ease. This is quite stressful since treatment started so late. The issue with retracting is that it is sticking to the glans and rolling outwards. The sticking I guess is from the damage from the adhesion/infection to the glans where the skin is wrinkled/cracked. So, I have doubts that the glans is fine at all. Also, when just applying the creams, the glans just looks very dry, like it has lost it is natural moisture. I also felt dryness when masturbating before the pain started two weeks ago. This must be the balanitis at work. The glans does not appear to be right at all. I guess there is nothing else to do but have the cream all the time on the glans but I wonder if the cream is any good as there is also bacterial balanitis. The GP failed to take a sample of the smegma which could have shown what kind of infection it was. Perhaps, it would be a good idea to apply coconut oil at night as this is supposed to be antibacterial and the cream during the day. I have an appointment with a local urologist in a week's time. I fear that with the damage done and that is going on, there will be a long road of medical treatment ahead. I will work on being less stressed about it, at least there is no pain so far like yesterday.
Appreciate you replying to my concerns.
Hello,
Welcome back to icliniq.com.
Your glans is absolutely fine. So, relax and do not worry at all. If it stays exposed for some time then naturally it would get dry. So, about dryness, it is fine and expected. There is no need to keep foreskin behind continuously. You just need to clean the glans when bathing. Do not apply soap, just clean with water. Semega for testing really will not help much. No harm in applying coconut oil if you feel better and to lessen dryness of glans. It is because you have never exposed the glans to the external environment that you are feeling weird. Anyhow, let your urologist have a look and examine.
Patient's Query
Thank you doctor,
It is new to this world, and I should treat it accordingly. If it looks fine why apply Miconazole now? I have washed it off and will not use anymore, and I have put on vaseline as it is safe at least. But, it is not what the GP told me to do. What is your opinion about not using the mico? I still worry about the infection, if there is any. Also concerning skin, because the foreskin is discolored and sore on the spot where the friction happens, I treat it outside with moisturizer and let it breathe as much as possible to heal and planned abstinence for a month. When there is no pain, things can heal I guess. The urologist I am afraid will just suggest circumsission.
Hello,
Welcome back to icliniq.com.
Actually, I wanted you to finish the Miconazole course which you have started. But as the glans looks fine now, you can stop it, no problem. Sores and cracks on the skin is due to tight foreskin which rubs every time when it is pulled back. So, it gets damaged and does not heal. It is better if the urologist has a look. If required, he may suggest circumcision as you already have cracks and damages on the foreskin. He will advise it only if it is really required. So, do not worry about it. Circumcision is a minor surgery. It is very common and without any side effects. So, do not get afraid if he suggests circumcision.
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