[Question #380] Genital/anal itching; itching after urination/ejaculation

34 months ago

Issue: 27 y/o male attorney w/constant itching in pubic area, penis/scrotum, perineum and anus over 2-year period. After defecation, urination or ejaculation, itching is felt in urethra/anus and external itching intensifies. Have been examined by numerous professionals; nothing external on skin, STI tests negative; blood and urine tests fine; testicular ultrasound fine; spinal MRI fine.

 

Failed treatments: moisturizers, steroid creams, anti-bacterial cream, antibiotics, anti-fungal cream, anti-histamines, amitriptyline (urologist thought it might be nerve pain), switching to unscented soaps and detergents, tea tree oil, warm baths/showers

 

I’ve been through the ringer with numerous doctors who basically just give up when I don’t show any symptom relief. One suggested it was all in my head, but it seems disingenuous to explain such symptoms away as being psychosomatic.

 

My sexual partner has tested positive for HPV. I know there isn’t a test for males, but I imagine it’s safe to say I have it as well, given how contagious it is. However, doctors and my own research both indicate that my symptoms are not at all consistent with HPV. If I do have HPV, though, is it possible my body is having some bizarre reaction in trying to clear the virus from my body? Have you ever had anyone present with these types of symptoms in HPV?

 

Or is it possible that I have some type of yeast/fungal infection that simply did not respond to the cream? Could it be some weird type of nerve pain? Could this be explained by a food allergy like gluten or something else?

 

Other than that, I’m not sure what it could be. Do you have any ideas? Understandably, I’d like to get to the root cause of the problem, so I can expunge whatever issue this is. Additionally, though, I’ll settle for any sort of symptom relief, as the itching is causing anxiety and depression, interferes with my work, sex life and social life. So even if we can’t identify the problem, could you recommend anything for symptom relief?

 

Thank you – please let me know if I can provide any further detail.

Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Welcome to the Forum.  I will try to help, adding to what you have heard from the extensive evaluations that you have already had.   Two questions are helpful to me in sorting out these sorts of issues.  First,  was there was an event which corresponded with the beginning of your symptoms.  Secondly, are you as aware of the itching when you are engaged in an active conversation or an activity?  When I have encountered symptoms such as yours, I have found that the symptoms are most apparent when a person is getting ready to go to sleep or at "quiet times" when persons are checking themselves out for itching or other symptoms.

In my experience itching of the sort you describe often is the result of looking for symptoms or for possible abnormalities.  In these situations, persons often become aware of sensations that they normally would "filter" out of their consciousness.  For example, most of us to not think about the sensations associated with the presence of a watch on our wrist, contact of a shirt collar or sleeve on our skin, or the sensations which might occur in our genital areas.  However, when we do focus on such things, the most common sensation people tend to be aware of is typically described as an itch.  To demonstrate this, focus for a minute or two on the presence of your watch on your wrist or where a piece of clothing contacts your skin.

Getting back to the subject of STIs however, itching, particularly chronic itching is a most unusual sensation for STIs.  I would agree with you that as a sexually active adult, you, like most people probably do or have had HPV but itching is not a symptoms of this infection. 

I hope some of my comments are helpful.  EWH

---
34 months ago
Thank you for the response. I'm under the care of a psychiatrist; we discussed this issue, and he was of the opinion that the itching is not the result of overthinking or looking for a problem, particularly because the itch is constant regardless of whether I'm talking to someone or playing sports. The sensation never goes away, which is why it takes me so long to fall asleep. I also notice it intensify internally and externally after ejaculation when obviously that's not the first thought on my mind.

The itching likely began after somewhat rough intercourse with my partner at the time. I developed a small cut on my penis and other small red bumps on my penis and noticed immediately after I pulled out. Since then, the itching has progressed to being throughout my genital area.

I don't know if this is related, but I've also developed somewhat watery semen over this amount of time, as well as a decrease in my ability to get and maintain an erection.

Are there other potential causes, such as those I mentioned in my original post or otherwise? It's such a nuisance and is incredibly frustrating.
Edward W. Hook M.D.
Edward W. Hook M.D.
34 months ago

Thanks for the clarification - I'm sure this is quite frustrating and the constancy of what you are experiencing seems to argue against this being purely a perceptual problem..  there are no STIs for which symptoms such as yours have been described.  Fungal infections can itch but typically there is visible evidence of infection as well.  Neuropathic problems originating in the low back might conceivably cause such symptoms.

It is difficult for me to relate changes in your ejaculate to this problem as well, sorry.  EWH

---