Penile Discharge: Is it normal to have liquid coming out of my penis?

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 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.

• 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.

Penile discharge that is infectious/related to sexually transmitted infections (STIs) 

Abnormal penile discharge can be due to underlying sexually transmitted infections (STIs) .

Common STIs that can be associated with penile discharge include:

• Chlamydia trachomatis 
• Neisseria gonorrhoeae 
• Mycoplasma genitalium
• Trichomonas vaginalis

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

1. Adler MW. Urethral Discharge: Diagnosis. British Medical Journal (Clinical Research Edition)Vol. 287, No. 6402 (Nov. 5, 1983), pp. 1360-1362 (3 pages)
2. Zenilman JM. Chapter 3. Urethral Discharge. In: Klausner JD, Hook EW, III. eds. CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases. McGraw Hill; 2007. Accessed April 24, 2023. 
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