Penile discharge is the fluid that comes out of the urethra when you are not urinating.
The urethra is a tube over the urinary system that allows the flow of urine and semen from the bladder or ejaculatory ducts to the opening of the penis and thus the external body.
Urethral/penile discharge can sometimes be physiological and a normal part of the male body mechanism. However, when should we be alarmed about discharge from the penis? This article aims to educate readers on understanding the possible differentials and red flags that one should be looking out for in penile discharge.
Penile discharge can either be a normal part of the male body mechanism or something that needs to be treated.
Penile discharge can be perfectly normal
Penile discharge can be completely normal and acts as the body’s mechanism to lubricate the penis. It is normal for the penis to produce discharge when a person is sexually aroused or during intercourse. You may notice penile discharge just before ejaculation or during ejaculation. Occasionally you may notice a white coating overlying the tip of the penis after a long day out or on a hot day.
Types of penile discharge include:
Pre-ejaculated penile discharge: a mucus-like liquid that is produced from the bulbourethral glands which are located just below the prostate. Pre-ejaculated discharge is produced when a person is sexually aroused. This fluid helps to lubricate the semen and the tip of the penis. It also creates an alkaline environment and reduces acidity due to urine thus allowing the sperm to survive longer.
Ejaculated penile discharge: also known as the ejaculated semen. It is usually milky-cloudy in nature that is produced during orgasm. During sexual orgasm, the sperm that is produced by the testes will be mixed with the semen fluid. The ejaculated semen fluid is produced by the seminal vesicles which are situated next to the prostate glands.
Smegma: a white coating/substance that can be found over the head/glans of penis and the foreskin. It is made up of a combination of sebaceous oil, dead skin cells, and moisture, and it behaves as a natural lubricant to keep the genital moist and allows the foreskin to be retracted during sexual intercourse. Excessive smegma can predispose a person to bacteria or fungal infection and one may notice an odorous penis. If you have such symptoms, you can speak to your doctor for general lifestyle and hygiene advice.
Penile discharge can be abnormal
While some types of penile discharge are normal, there are others that are abnormal and may even be infectious.
Examples of abnormal penile discharge include:
Penile discharge that is non-infectious/non-sexually transmitted disease related
Balanitis: benign medical condition associated with inflammation of the head of the penis. The cause of developing balanitis is multifactorial. The accumulation of dead skin, residual urine, sweat, oil beneath the foreskin, combined with a warm and moist environment is a conducive breeding ground for bacteria and fungus. Underlying skin conditions such as eczema, psoriasis can also worsen the situation. Chemicals from soap, condom, or lubricants can also irritate the skin. Underlying medical conditions such as diabetes can predispose a patient towards balanitis.
Patients with balanitis can present with penis discharge and also associated redness, inflammation or irritation over the head of penis. One may notice odour over the genital region, and in more severe cases, an itch or burning sensation upon urination. The symptoms of balanitis can come and go over time. You are advised to speak to your doctor if you have concerns of balanitis.
Balantis is characterised by penile discharge, redness, inflammation, and itchiness of the penis head.
Urinary tract infection: although males can develop urinary tract infection, it is less common in comparison to females due to a shorter urethra in women. This makes the urethra, bladder, and kidneys more accessible to bacteria.
Urinary tract infection (UTI) can affect any part of the urinary system including the urethra, bladder, or kidneys. Urinary tract infection occurs when bacteria from the surrounding area (skin or rectum) enters the urinary tract and causes inflammation and infection.
Risk factors for males developing urinary tract infection include:
Unprotected sexual activity
History of previous urinary tract infection
History of abnormal urinary/renal anatomy
History of kidney stones
History of prostate issues
Has used external instrumentation such as catheter
Underlying medical condition affecting general immune system including diabetes, underlying anti-retroviral disease (HIV)
Patients with urinary tract infection can present with abnormal penile discharge and developing symptoms such as:
Painful or burning sensation during urination
Increased urinary frequency
Blood in the urine
Smelly urine
Fever
Lower back pain, nausea vomiting
Urinary tract infection is not contagious but must be promptly treated so as to avoid complications such as kidney infections or blood infection. Do seek medical attention if you have penile discharge or urinary tract infection symptoms.
Prostatitis: the prostate is a chestnut-sized gland that sits below the bladder of a male person. It functions to produce semen fluid. Prostatitis occurs when the prostate gland becomes inflamed or irritated, commonly due to bacterial infections. Patients with prostatitis may present with abnormal urinary symptoms including penile discharge, painful urination, increased urinary frequency, or even abnormal urine flow. Antibiotics are usually required to treat prostatitis, you are advised to seek medical attention if you develop any prostatitis symptoms.
Prostatitis occurs when the prostate gland becomes inflamed or irritated.
Penile discharge that is infectious/related to sexually transmitted infections (STIs)
Interestingly some patients with STIs can be completely asymptomatic but it is important to note that asymptomatic individuals can still spread STIs to their sexual partners. Not only is untreated STIs contagious, they are also associated with infertility in both men and women.
If you are experiencing penile discharge with unusual colour and consistency, itchiness, burning sensation over the penis, inflammation,rashes over the penis, and testicular pain or swelling, seek further medical investigation to screen for underlying medical condition.
When should I see a doctor if I have penis discharge?
You are advised to seek advice from your doctor if you notice penile discharge when you are not:
Urinating
Pre-ejaculating
Ejaculating
OR if you are experiencing:
Unusual penis odour
Unusual penile discharge colour
Increased urinary frequency
Abnormal urinary flow
Itch, discomfort, or pain during urination
Lower pelvic pain
Important note
While penile discharge can be a healthy physiological part of life, it can also signify underlying infection, inflammation, or medical condition. The silver lining– penile discharge that is abnormal is usually treatable. If you have concerns about penile discharge symptoms, avoid further hesitation, do see your trusted physician early.
References
Adler MW. Urethral Discharge: Diagnosis. British Medical Journal (Clinical Research Edition)Vol. 287, No. 6402 (Nov. 5, 1983), pp. 1360-1362 (3 pages)
In females, this occurrence is known as menopause. The male counterpart to this is known as Andropause. Male levels of sexual hormones start to gradually decline when they enter their 4th or 5th decades of life. There are some men who start to undergo this change much earlier, such as in their 3rd decade of life.
What is the Cause of Andropause?
Andropause occurs when a man’s testosterone level is low. Testosterone is a hormone produced by the testes. It Is the male hormone responsible for a male’s physical characteristics such as sexual drive (libido), facial and body hair, deep voice, muscle mass, and competitive personality.
The onset of Andropause can occur earlier. This can be attributed to multiple factors, including genetic cases, lifestyle and certain medical conditions. Common chronic medical conditions such as metabolic conditions (i.e. obesity, hypertension, diabetes, raised cholesterol) are associated with earlier Andropause. Andropause can also occur in patients with testicular cancer, or patients who are taking medication to lower their testosterone as part of treatment of prostate cancer.
Your doctor will take relevant medical histories, understanding your concerns and expectations, and perform general physical examination. Your doctor will offer you blood tests such as blood sugar counts, cholesterol levels, kidney, liver and cell count blood tests. This is to screen for chronic medical conditions. Hormonal blood tests will be offered as well.Diagnosis will be based on physical examination and hormonal blood tests to determine if the patient has low testosterone levels.
What are the treatment options of Andropause?
While testosterone replacement is the backbone treatment for Andropause, this condition should be managed in a holistic manner, targeting different psychosocial and medical aspect of the associated condition.
Few important aspects to focus on:
Managing any long term concurrent chronic metabolic conditions
Encouraging a healthy lifestyle, moderating alcohol consumption, quitting smoking, exercising regularly to maintain a good body weight
Addressing other sexual health problems such as erectile dysfunction, ejaculation problems, testosterone deficiency symptoms
Considering mood management through seeing a psychologist
As mentioned, treatment of Andropause largely revolves on testosterone replacement in the form of
Testosterone gel
They are easy to use, and should be applied every morning over the shoulders or upper arms.
You are advised not to shower or swim for at least 5 hours after application to ensure absorption of gel into the body.
Importantly, avoid coming near a naked flame or smoking as testosterone gel is flammable.
Ensure that you wash your hands after application and cover the application site with clothes.
Avoid people around you from touching the gel, especially women and children. This may cause unwanted hair growth and more aggressive behaviors in those who has contact with the gel.
Testosterone pills
This is an oral medication to be taken 2-3 times a day. In general, only a short treatment cycle is recommended as prolonged use of oral testosterone can lead to heart diseases, raised cholesterol level or even stroke.
Testosterone injections
Effects are instantaneous and a patient will only need to repeat the injection every 3 months. However, the injection may be painful to some.
Is Testosterone Replacement Safe?
Common side effects of testosterone replacement
Increase risks of heart disease, stroke, raised cholesterol and liver disease
Increase stickiness of blood and red blood cell concentration, leading toincreased risk of blood clotting
Causes enlarged prostate
Acne
As testosterone replacement can promote and increase the growth of prostate tissue, the treatment may not be suitable in men with prostate cancer or if they have an enlarged prostate.
When you are on testosterone replacement, it is important to follow up regularly with your doctor. Your doctor will monitor your condition closely and conduct frequent blood tests to watch for side effects.
