Q: Hello, Doctor. GOD bless you for the good work that you are doing to help us.
I am your follower from Zambia and really need your help now.
I have two problems.
1. I got circumcised in 2012, and for the past months I have been feeling pain inside my penis just before the head when the penis erects. I have never had sex before, but I usually feel this pain when I get an erection in the morning and when I am aroused. I am scared this could be worse when engaging in sex with my wife when I get married Doctor.
2. My penis bends to the left when it erects, could this cause me any problem to my sexual life when i get married?  
Doctor, I have never opened up to anybody of my conditions, I need your help. Thank you, and GOD bless you.

A: Hi dear, thanks for opening up to me. I hope this post helps you

Typically, after a circumcision, especially in adults, there’s bruising and swelling of the penile area for about 2 to 3 weeks. Urination may also be painful during this period but although there is general discomfort following the procedure, the pain level is not really severe and analgesics can help.

Some tips to help recovery…

• People think wearing loose fitting boxers or underwear is ideal but the opposite is actually recommended. Use underwear that hald the penis in place
• Make sure that your urine is dilute to prevent the burning pain that could happen with acidic urine during urination. How do you do that? Drink a lot of water and put a dab of petroleum jelly to the penile tip to reduce the burning pain
• Apply only those creams that have been prescribed by your doctor to the circumcision site to encourage healing and avoid infections
• Physical activity may be difficult for a couple of weeks; so leave well alone 😀

Erections are typically painful after this procedure and while in recovery. So you don’t really want to have erections at this time. To reduce the chances of nocturnal emissions:

• Try lying on your side when sleeping
• Try drawing your knees up too in a fetal position
• Urinate and ensure your bladder is empty before bedtime

Now, if indeed your circumcision was seven years ago (in 2012), the symptoms you are experiencing may not be associated with the procedure.

Some causes of penile pain include:

• Priapism: Priapism is a condition, in which there is a sustained and oftentimes, painful erection of the penis, continues for hours beyond sexual stimulation or even when there is no sexual stimulation. It is more common in men in their 30s.

There are three types of priapism (ischaemic, non-ischaemic and recurrent) but to understand this, we’ll take a look at the mechanism of erection. An erection occurs in response to stimulation, physical or psychological. As a result of this stimulation, the blood vessels and smooth muscles of the penis relax, allowing increased blood flow to the penis. This is what causes erection. When the stimulation is over, the vessels and smooth muscles constrict causing the blood to flow out of the penis and become flaccid. In priapism, the order of events causing the blood to flow out of the penis is changed such that the blood does not flow out of the penis

In ischaemic priapism, which is the more common type due to inability of blood to leave the penis, there is pain, rigid penile shaft but flaccid glans (penile tip) and the erection lasts more than 4 hours! Causes include blood disorders like sickle cell anaemia and injuries to the penis and/or pelvis, alcohol, cocaine and other illicit drug use, some medications like blood thinners and antidepressants, cancer of the penis etc.

Non-ischaemic priapism is usually due to an injury to the perineum or genitals that results in poor regulation of penile blood flow. It is not usually painful and manifests as erection that lasts for more than 4 hours but the penile shaft is not fully rigid.

In recurrent priapism, situation is similar to ischaemic priapism with erections that are painful, recurrent but ease after 2 to 3 hours. These erections may subsequently progress to become more frequent and more prolonged. It is common in males with sickle cell anaemia

Any sort of priapism should be checked out with a medical doctor (urologist) to determine type, cause and management. Erection lasting more than 4 hours is an emergency and may led to damage of the penis and subsequent erectile dysfunction. Treatment depends on cause and should be started as soon as possible.

Options include aspiration (in which blood is drained out of the penis with a syringe), use of medications to constrict the penile blood vessels, treatment of underlying medical condition like sickle cell anaemia and surgery in some cases. Note of warning, though it sounds very simple to use a syringe to drain out the blood in the penis, you must never attempt it on your own. You must visit a hospital and let a doctor work out the best treatment option(s) for you. Patients who do not get treated early enough and some that went through surgery eventually end up with poor erectile functions despite the successful treatment.

• Balanitis: Skin irritation of the head of the penis, known as balanitis, could present with itching as you described. Causes include:
  Irritation under the foreskin caused by urine
  • Candidiasis
  • Use of shower gels, soaps and other skin irritants
  • Skin conditions like eczema
  • STI
  • Poor hygiene

Your doctor will work with you to determine the cause and treatment is dependent on that.

• Urinary tract infections: In men, UTIs are not so common and would happen more in people who have an enlarged prostate, people who have a poor immune system and people who have kidney and bladder infections. Symptoms include frequent urination, difficulty with urination, pain during urination, fever etc. Involvement if the kidney leads to loin pain in addition to worsening of feelings if illness.
  The doctor will usually send a urine sample to the laboratory to check for bacteria present in the urine and what antibiotic(s) are effective against them. Be sure to take the antibiotics for the prescribed period of time, even if you feel better before you finish the course to prevent backtracking of infection into the kidneys. Drink a lot of water and take analgesics for pain, if needed.In summary, your specific treatment depends on the organism that is found in your urine at the laboratory. Be sure not to prescribe antibiotics for yourself!

For more on urinary tract infections, please click on the link below:
https://chatwithdrketch.com/2014/05/16/daily-health-tips-urinary-tract-infections/

• Sexually transmitted infections like syphilis, gonorrhea and chlamydia, injuries to the penis, penile cancer, phimosis in which the foreskin of the penis is stretched too tight and cannot be pulled away from the head of the penis, can cause penile pain.

Treatment depends on cause and some have been described above. Antibiotics can be used to treat UTIs and some STIs, including chlamydia, gonorrhea, and syphilis. Stretching the foreskin with fingers may make it looser in phimosis. Steroid creams rubbed on the penis can also help. In some cases, surgery is necessary in phimosis and/or cancer. In the latter, radiation treatment or chemotherapy could be included.

So, your first step is to see your doctor for a proper diagnosis and treatment.

As to your second question, it’s quite common for the penis to bend slightly to the left or right when erect. But if you think it curves more than it should and probably causes pain, then please see your doctor.

All the best!