copyright Amy Stein 2008Fiona McMahon PT, DPT It’s been a while since we’ve done a “What’s Neater than Your Peter” series so it’s definitely time for another addition! Today we will cover urethral burning. For people with penises, this can be an alarming symptom. By itself it can be a pretty non- specific symptom. Thus, for anyone experiencing urethral burning, it is important to visit your healthcare provider right away, to find out what is causing your symptoms. In this blog we review potential causes of urethral burning, which is by no means an exhaustive list, and discuss what can be done for urethral burning caused by musculoskeletal conditions as well as some food items that can irritate the urethra. If you are saying “ureth- what?” you are not alone. Both people with male and female anatomy have a urethra. The urethra, or the “pee hole” as it is colloquially known, the passageway from the bladder to the outside of the body. In people with male anatomy, the urethra also transports ejaculate out during ejaculation. Nifty. For people with penises, your urethra is longer than those of us with female anatomy, which is somewhat protective against urinary tract infections(UTIs), you lucky duck, you. Pain and stinging in your urethra could indicate a lot of things. Things that you definitely don’t want to wait on treating include; sexually transmitted infection (i.e herpes, chlamydia, and gonorrhea), bladder infection, which untreated can progress to kidney infection, reaction to personal care products, prostatitis, and pelvic floor dysfunction, which can cause non- bacterial prostatitis), amongst other conditions. The thought of potentially having an STI can keep people away from the doctor secondary to embarrassment, cost barriers, etc. According to an up to date article cited in the sources, more than half of the United States population who is eligible for screening fails to do so. Don’t let it be you. The complications of untreated STIs can be much worse than the initial infection, not to mention the risk of harming your future partners. Also know that STI’s are fairly common and having one does not make you a “dirty” or “bad” person. It’s so common! Nearly 1 in 2 people will acquire an STI in their lifetime, so if you do have one, you aren’t alone and you deserve to feel better. So what happens if you’ve ruled out STI, bladder infection, prostate infection, and reactions to personal care products? What in the actual heck could be causing your urethral discomfort? At this point it is important to look at your pelvic floor and your diet. Let’s talk about diet first. There are some substances that can irritate the bladder and urethra, and give the feeling of burning in the urethra as well as increased urinary frequency and urgency. I write about bladder irritants in my recent blog and you can check out a list of bladder irritants here. (INSERT BOTH BLOG AND bladder irritant list). But if you are too busy to read the whole blog, the long and short of it is, not every irritant on this list will bother your symptoms. Be mindful when eating foods with these irritants. If your symptoms flare 2-3 hours following eating an irritant, consider eliminating it from your diet and see how you do. The most common irritants we see at BBPT are caffeine, citrus, alcohol and spicy food. Now let’s talk about urethral burning and its relationship to the pelvic floor, shall we? The pelvic floor is the area of muscles that live between the pubic bone in front and the tailbone in back. Like an onion, the pelvic floor has layers: three to be precise. The outermost layer contains a muscle called the bulbospongiosus (bulbo), along with its buddy the ischiocavernosus, and the superficial transverse perineum. The bulbo surrounds the urethra and is at the base of the penis. If it is tight, it can make it harder to pee and also cause urethral burning with urination and ejaculation. In addition, the layer below: the urogenital diaphragm and the layer below that, which consist of a whole bunch of muscles called the levator ani, can contribute to these symptoms as well. In fact, dysfunction in these muscles causes almost 95% of non bacterial prostatitis cases. Wowzah, no? I discuss prostatitis in much more detail in this blog (INSERT). How can you tell if your muscles are tight? The best way to tell is getting yourself to a skilled pelvic floor physical therapist, who can accurately diagnose issues with the pelvic floor as well as provide you with a plan to start feeling better. Sources: American Sexual Health Association. Statistics. http://www.ashasexualhealth.org/stdsstis/statistics/ < Accessed January 14, 2020> Ghanem K, Tuddenham S. Screening for sexually transmitted infections. Up to Date. October 11, 2019 Mayo Clinic. Painful urination (dysuria). https://www.mayoclinic.org/symptoms/painful-urination/basics/causes/sym-20050772 .