For boys and men

SHAC - Sexual Health Advice Centre

Painful sex and erections

What will I notice?

You might experience pain during an erection or when you put your penis in your partner. You might have always experienced such pain or it might have come on slowly, or suddenly. You might also have a rash, and or sores, ulcers or blisters, and/or itching.

What is the most likely cause?

A tight foreskin can cause painful erections, this might be something you have always had, or it might be a more recent reaction to an infection or skin condition. If you have pain and a rash, which might be itchy, you probably have candida, thrush, which is caught during sex but is not usually classed as a sexually transmitted disease.

What other causes are possible?

Irritation, you can get a painful, sore penis from overwashing or washing with scented soaps or shower gel that your skin has reacted to.
Genital herpes, if you also have small sores, ulcers or blisters on your penis, you might have an infection with the herpes simplex virus, which is caught during sex or from close genital-to-genital or mouth-to-genital contact.

What should I do?

Don't have unprotected sex, especially if you think that you or your partner might have an infection. Even if you think that you might 'just' have a skin irritation it would be a good idea to get yourself 'checked out' by a doctor, who can make sure there isn't another cause.

If your symptoms don't improve or you think you might have an infection, go to see a doctor, who can test you for infections. Or come and see us at SHAC.
If you think that your foreskin might be too tight go to see a doctor who can give you advice and, if necessary, treatment.

What if I just ignore the pain?

If the pain is caused by skin irritation alone and you take steps to avoid the cause of the irritation it will probably clear up on its own. Most herpes infections clear up without treatment, but might be very painful in the short term. Because Genital Herpes can recur you would be wise to find out how to both avoid and treat further attacks. You might have caught another infection at the same time as the herpes simplex virus. You can discuss all this at SHAC at Clinic 1A.

If you have an untreated infection it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Usually, the problem can be sorted out easily with tablets and general advice.

How can I avoid painful sex?

To avoid getting a sore penis from skin irritation make sure you wash under your foreskin each day with gentle, unscented soap. If you tend to be sensitive to some soaps, or washing powders, it might help to find the simplest, unscented one you can, and use only non-biological powders for washing your underclothes.

Bleeding from your penis or genitals

What will I notice?

You might notice blood coming from the end of your penis, or it might be mixed with fluid including semen. You might have bleeding from other areas of your genitals. You might have other symptoms including pain, or burning, when you urinate (pee) or have sex (more about pain on urination), rashes (More about rashes), or sores, ulcers or blisters (more about sores etc). You might have always experienced such pain or it might have come on slowly, or suddenly. You might also have a rash, and or sores, ulcers or blisters, and/or itching.

What is the most likely cause?

An infection of the bladder or another part of the urinary tract.

Trauma/assault: if someone (maybe during sex) has hurt you, you might have torn something, which might cause you to bleed.

What other causes are possible?

Chlamydia
Gonorrhoea
Genital warts
Very rarely bleeding from the penis might be a symptom of a tumour

What should I do?

Although this can be a frightening symptom it is rarely serious. If you have any blood coming from your penis you should go to see a doctor. When making an appointment you should explain over the telephone what your problem is, so that the nurse can ensure that you don't wait too long.

What if I just ignore bleeding?

Generally, bleeding from the penis is due to little tears to the foreskin or urinary tract infections. Much more rarely, bleeding can be caused by infections that are caught during sex. If you have an untreated infection, it can damage your health and anyone else you have sex with. If untreated, these infections can sometimes make you or your partner infertile. Usually, the problem can be easily sorted out.

How can I avoid getting it?

There are many reasons that can cause this type for bleeding. For example, urinary 'kidney' stones which can be treated, it might be that you were injured by someone during sex or, it might be that you have caught an infection from having unprotected sex. To help avoid catching infections you should practice safe sex.

Itching

What will I notice?

You might have a mild itch or a 'real scratcher'. It might be anywhere around your genitals and also on other parts of your skin. It might be under the foreskin, if you haven't been circumcised, or on the head of the penis under the foreskin. You can also get itching inside the penis along the urethra, water pipe. You might have other symptoms including pain when you pee. You might also have a discharge coming out of your penis.

What is the most likely cause?

Itching under the foreskin or on the head of the penis is usually caused by not washing under the foreskin or by candida.

What other causes are possible?

If you have itching inside your penis, along the urethra, you might have caught an infection during sex.

What should I do?

If you think that the itching might just be an irritation, you could try changing your soap, shower gel or clothes-washing powder or liquid to a gentler, unscented one.
If you have had unprotected sex, have an itch that won't go away or have an itch inside your penis go to see a doctor soon so that you can be checked for infections.
If you are uncircumcised, gently wash under the foreskin and put on a small amount of an aqueous cream which you can buy from any chemist.

What if I just ignore it?

Most itching caused by irritation will clear up on its own if you remove the cause of the irritation. If you are worried, do seek advice either from your doctor or from SHAC.
Most candida infections clear up after a few days, but you could try using the treatments that you can buy over the counter at a pharmacy.
If you have an untreated infection it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile. If you think that you have an infection you should see your doctor or visit us at SHAC.

How can I avoid getting it?

The genitals are covered in sensitive skin which is quite easily irritated. Keep the genitals clean, wash daily, but be gentle and don't overdo it. If you have problems try using unscented soap products or something instead of soap, an aqueous cream, which you can buy from any chemist.

Pain when you urinate, 'pee'

What will I notice?

Pain when you urinate, pee, is often described as a burning sensation. You might experience this either while you are peeing or shortly afterwards.

What is the most likely cause?

Pain on urination is usually caused by an infection in your urethra, the water passage that your urine comes out of. Often this infection is caused by chlamydia which can be caught from having unprotected sex. Chlamydia is very common in young people with some estimates saying that one in ten, or one in five, young people are infected. Many people don't know that they have an infection because they have no symptoms. Chlamydia can be a serious infection it can also cause infertility. The good news is that it is easy for a sexual health doctor to test you for a chlamydial infection and it can be easily treated completely with antibiotics.

What other causes are possible?

Non-specific urethritis, NSU: a bacterial infection, which is caught by having sex with someone who is infectious.
Gonorrhoea: a bacterial infection, which is caught by having sex with an infected partner.
Genital herpes: a virus infection, which is caught by having sex or close genital contact with someone who is infectious.
Trichomonas vaginalis TV: a protozoan infection, which is caught by having sex with someone who is infectious.
Bladder infection, cystitis: usually a bacterial infection, but this is quite uncommon in boys/men.

What should I do?

If you experience pain on urination, it is important that you:

Don't have unprotected sex until you have been checked by a doctor.
Get yourself 'checked out' by a doctor at SHAC or another genitourinary medicine clinic, where they can do the right tests for infections.

What if I just ignore it?

If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile. Usually the problem can be easily sorted out with tablets and general advice. Also, if you ignore it, you will worry for longer.

Painful testicles

What will I notice?

If you have ever been hit in the testicles you will know how painful it can be. Unexpected pain in the testicles can be felt anywhere around the testicle. It is usually felt as tenderness, sore when they are touched, at the back and top of the testicles where the coiled-up sperm tube, epididymis, is found. You might also get swelling around the testicles at the same time.

What is the most likely cause?

Pain in the testicles is often caused by an infection of the sperm tube, epididymis. In young men this is usually caused by chlamydia or another infection that was caught from having unprotected sex with someone. Chlamydia is very common in young people. Many people don't know that they have an infection because they have no symptoms.

What other causes of painful testicles are possible?

Torsion: this is quite uncommon and is when one of your testicles becomes twisted on itself. You will experience a sudden, very severe pain.
Very rarely, painful testicles can be a symptom of cancer of the testicles. Generally, men who have cancer of the testicles are fine in the long term, as long as the cancer is caught early and treated in the right way.

What should I do?

If you get a sudden, very severe, pain in your testicles, without having been hit there, you might have torsion. You should get immediate help from a doctor. If you can't get to see a doctor immediately go to a hospital Accident and Emergency Department. They will be able to find out if you have torsion and give you treatment for it. It is important that you are seen as soon as possible. If you get a less severe pain, do get yourself 'checked out' by a doctor at a genitourinary medicine clinic such as SHAC at Clinic 1A, where you can be tested for infections.

What if I just ignore it?

If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile.
If you ignore torsion, you can lose a testicle.
If you ignore pain from a cancer, it might progress to a stage when it is much more difficult to treat.

How can I avoid getting it?

If you or your partner has had unprotected sex in the past, get yourselves 'checked out' by a doctor.
Don't have unprotected sex, especially if you are worried that you or your partner might have an infection.
Learn about safer sex.

Lumps in testicles

What might I notice?

It is quite common to find one or more lumps in or around your testicles. These might be painful or can just feel rubbery. The best time to check for lumps is in a warm bath, or shower, when both you and your testicles are relaxed.

What is the most likely cause?

Your normal epididymis: The back of your testicles is naturally quite lumpy. These lumps are actually the coiled-up sperm tube the epididymis. This is why it is good to know what your testicles normally feel like, so that you can tell if a problem has developed.
Cysts: It is quite common for boys and men to develop small cysts around the epididymis. These are nothing to worry about but only a doctor can tell the difference between cysts and something else that needs to be investigated further.

What else can cause lumps in my testicles?

If you have a painful lump this might be caused by an infection with chlamydia, Ecoli or another bacterium.
Very rarely, a lump in a testicle can be a symptom of cancer of the testicles. Generally, men who have cancer of the testicles are fine in the long term, as long as the cancer is caught early and treated in the right way.

What should I do if I find a lump?

Get yourself 'checked out' by a doctor.
Don't have unprotected sex, especially if the lump is painful, you might have an infection.

What if I just ignore it?

If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile.
If you ignore a lump that might be a cancer, it might progress to a stage when it is much more difficult to treat.

How can I avoid getting it?

All boys and men should check themselves regularly for lumps and changes in the size or weight of their testicles.
At SHAC (at Clinic 1A), we can examine you to check for any of these causes of lumps in the testicles. We are always happy to test you for infections, to help put your mind at rest.

Lumps, bumps and spots, including warts, on your genitals

What will I notice?

You might find or feel small lumps and bumps on your penis and scrotum. They might look like rows of tiny slivers of skin around the head of the penis. Or they might look like a firm, worm-like, structure just below the head of the penis. The lumps might be whitish, yellow or pink. You might have purple areas of skin that are slightly raised. They can be tiny or larger. They might look like small cauliflowers. You might have pain or soreness, and they might ooze or bleed.

What are they most likely to be?

Sebaceous glands: The skin of the genitals has lots of small sebaceous glands, which produce an oily substance, and can become enlarged and look like small, yellowish spots. They can also become blocked and infected like a spot that you might get on your face or neck.
Pearly pink papules: If you have rows of tiny slivers of skin around the head of the penis, these might be 'pearly pink papules', which are normal skin structures that are present in 30 percent of men.
Genital warts: A viral infection. These are caught by having sex with someone who has genital warts and can look like small, skin-coloured cauliflowers. The same virus can also infect the anus, back passage. Having genital warts in and around your anus doesn't imply you have had anal sex.
Lymphocele: This can look like a firm, worm-like, structure just below the head of the penis. It can occur after sex and will disappear on its own with time. It is caused by minor damage to the channels that drain lymph from the penis.
Molluscum contagium: A viral infection of the skin which is caught during close skin-to-skin contact, or sharing towels and flannels. It can look a little like genital warts and is often treated in the same way.
Some lumps and bumps are symptoms of general skin conditions such as, lichen planus (purplish areas), lichen sclerosus (white or red areas) or psoriasis.
Very rarely, lumps and bumps on the genitals can be a symptom of syphilis.

What should I do?

If you are worried about any lumps and bumps on your genitals, get yourself 'checked out' by a doctor at SHAC, or by your GP, who can help you decide what is the cause. This might involve doing tests for other infections.
If you have a blocked sebaceous gland, washing it gently in warm, salty water might soothe it until it clears on its own.
Get yourself 'checked out' by a doctor at SHAC or another genitourinary medicine clinic, where they can do the right tests for infections.
Don't have unprotected sex, especially if you have a lump and don't know what it is (you might have an infection, which your partner might catch and give back to you later).

What if I just ignore it?

Most lumps and bumps are "normal for you" and others will go away on their own. Some of them, however, might look like other lumps and will need to be treated, so it is best to get them 'checked out' by a doctor, especially if you haven't noticed them before and have had them for more than a few days.
If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future.

How can I avoid getting them?

If you or your partner has had unprotected sex in the past, get yourselves 'checked out' by a doctor.
Don't have unprotected sex, especially if you are worried that you or your partner might have an infection.
Learn about safe sex.

Discharge from the penis

What will I notice?

A discharge is a watery, cloudy, or thick fluid that you might see dripping from the end of your penis or staining your pants. It might be clear, white, yellow, or greenish and it might smell.

What is the most likely cause?

It might just be ejaculation fluid. This is the fluid, full of sperm, that you see when you ejaculate, 'come'. This is normal, and you don't need to see a doctor about it. You might notice this when you wake up in the morning.
White, yellow or cloudy discharges are often a symptom of an infection. The most common causes being chlamydia, non-specific urethritis, NSU and gonorrhoea.

What other causes are possible?

The discharge might be caused by a urinary tract infection.

What should I do?

If you have a discharge from your penis, it is important that you:

Don't have unprotected sex until you have been checked by a doctor .
Get yourself 'checked out' by a doctor at SHAC or another genitourinary medicine clinic, where they can do the right tests for infections.

What if I just ignore it?

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