Dr. Pegs Prescription

There’s a guy we have seen a few times lately. Not the same guy, but the same essential story, and one worth telling because it is happening more often. I’ll call him Dennis.

Dennis is a young man whose chief complaint is dysuria. That’s medical speak meaning it burns when he pees. The burning is at the tip of his penis, just inside the opening. That opening, by the way, is called the meatus, and the rest of that tube up into the penis is called the urethra. Normally, when you urinate, it doesn’t hurt; but for this guy, for the past week or so, whenever urine comes out, it burns in his urethra. Naturally, he would like this to stop.

Now before you jump to the conclusion that Dennis has been jumping into the wrong bed, let me tell you that this is not necessarily a sexually transmitted infection. There are lots of potential reasons for dysuria. The most benign reason is dehydration. If you don’t drink enough water, your body tries to hang onto fluids, resulting in very concentrated urine. The concentration process can produce crystals (think high school chemistry), and crystals have sharp edges and points. Imagine that.

Dennis is not dehydrated. In truth, dehydration is not a very common cause of this. Actually, that conclusion you almost jumped to is usually the correct one: it is usually Chlamydia, but not in this case. It turns out that Dennis has a urinary tract infection.

Most women know all about these, because UTIs, as we call them in the business, are quite common in women, much more so than in men.

This has to do with the difference in anatomy between women and men. A urinary tract infection is usually caused when bacteria that live in the normal human intestine get into the bladder. In women, the opening from the intestine, aka the anus, is much closer to the opening from the bladder, aka the meatus, than it is in men. Much easier for bacteria to sneak up where they don’t belong. For a bacterium, the distance between a man’s anus and meatus is like the distance from here to the moon for us. Not an easy journey on foot.

So how did this happen? Some respectful discussion with Dennis about his sexual practices provided the answer. It turns out Dennis and his partner enjoy anal sex. Now, before you jump to a conclusion about Dennis’ sexual orientation, let me tell you that he happens to be straight. He has a steady girlfriend. She is taking birth control pills, so they don’t use condoms when they have intercourse, whether it be vaginal or anal, and there’s the rub. Anal intercourse without a condom provides intestinal bacteria a direct route to the meatus. Warp speed.

Many people of all genders and sexual orientations engage in anal sex. Most people do it because they enjoy it. Some do it to avoid pregnancy. Some female virgins have anal sex instead of vaginal sex, feeling that this preserves their virginity. Why you do it and with whom is your business, but if you use a condom, you will stay healthier.

Dennis did not have fever and aching pain behind his scrotum, which could have indicated a prostate infection. Nor did he have tenderness of the bundle of vessels nestled behind the testes, which is symptomatic of an infection called epididymitis. He didn’t have a drip or discharge from his urethra, or any bumps or sores, which could have indicated STIs. All three of these scenarios are actually a lot more common than what he did have.

Guys, I would urge you to come see us if you have any strange genital symptoms like burning, rashes, sores, bumps, drips or pain, but in my experience most men don’t need urging when it comes to these matters. Call us for an appointment at (505) 277-3136.

We gave Dennis — and the other Dennises we have seen — a prescription for antibiotics. He should be fine. After the pharmacy, he went to get some free condoms from one of the 14 condoms-and-mints locations around campus. See shac.unm.edu/he-condom-mint.html to find the location nearest you.

Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.