Do I have urethritis or something else?

Dear Reader,

It's unclear from your question whether your boyfriend always or only sometimes has pain with urination and ejaculation. A good rule to go by is the following: whenever someone has either constant or recurrent pain, it may be time to speak with a health care provider to get some answers. It's common for people with penises to have a burning sensation, discomfort, or pain when they first urinate directly after ejaculation; this is because friction applied during masturbation, anal or vaginal sex, or receiving oral sex can cause some minor irritation to the tissues of the urethra. The urine passing over these irritated tissues can cause a burning sensation. Oral sex alone is unlikely to cause damage to the urethra due to the amount of force necessary to cause constant pain. However, pain while urinating (called dysuria) or ejaculating can also occur with inflammation or infection of many of the structures of the urinary/reproductive tract, such as the urethra, prostate, or epididymis. Both sexually-transmitted and other types of infections, such as urinary tract infections, can affect all of these structures. Allergies to ingredients used in lube and latex condoms, or mechanical injury to the urethra from objects inserted into the penis, could also cause discomfort. A health care provider would be able to help decipher the cause of pain, and any appropriate course of action moving forward. Read on for more information related to discomfort, potential damage, and treatment. 

Damage to the urethra, the tube that leads from the bladder out the end of the penis, is less likely to occur due to oral sex because quite a bit of force is necessary to cause constant pain. Urethra trauma is more commonly due to intense injuries such as falls or pelvis fractures. These types of injuries can cause the urethra to swell or become infected, potentially leading to stomach pain and difficulty passing urine (or even seeing blood in it). Urethra injuries likely require medical treatment, sometimes even surgery. Swelling of the urethra can also cause urethritis, an infection within the urethra typically caused by an STI, either gonorrhea bacteria or some other bacteria such as chlamydia trachomatis. Irritating products or chemicals, or even arthritis, can also cause urethritis, though STIs are more common causes. 

Prostatitis, the infection and inflammation of the prostate gland (which encircles the neck of the bladder and urethra), can also cause discomfort during urination or ejaculation. Bacterial infections can be the culprit behind prostatitis as well, and left untreated, prostatitis can become chronic, or lead to complications such as epididymitis, which is swelling in the epididymis (the sperm-carrying tube within the testicles).

To relieve the discomfort your partner is experiencing, experimenting with emptying the bladder prior to (and after) sex can possibly reduce irritation and may be worth giving the good 'ol "college try." That said, in order to properly diagnose and treat an infection or injury in the reproductive/urinary tract, a visit with a health care provider may be necessary. During an appointment, urine samples are typically needed for testing. In addition, a sterile swab may be inserted into the tip of the penis to get material from the urethra for analysis. Pressure on the prostate may also be applied during a rectal exam, in order to obtain prostate fluid for examination. A health care provider will likely ask questions about sexual history and may do a physical exam as well to identify any potentially irregular urethra discharge. 

If an infection, such as urethritis, is diagnosed, it'll probably be treated with antibiotics directed against the specific organism that's identified. Sometimes, even if no organism is identified, a trial of antibiotics is given to see if the symptoms are relieved. If antibiotics don't relieve the symptoms, a referral may be made to a specialist in the urinary tract (urologist), who may wish to use a magnifying scope instrument to examine the urinary tract in an attempt to figure out the source of the discomfort and pain.

To summarize: receiving oral sex may cause irritation to the urethra, but it's unlikely to cause actual physical damage. However, inserting items into the urethra could potentially cause irritation or damage, and could also certainly introduce a variety of organisms that could cause serious infection. There are many different causes of pain during urination/ejaculation, including some infections that require antibiotics or other treatments, so visiting a health care provider may be the quickest and most effective way to identify and reduce discomfort.