Gynecologist Vs. Urologist

Author’s note: To protect the privacy of all persons involved, certain key facts have been altered. None of the alterations materially impact the story and any related to the medical facts of the case have been vetted for accuracy in the primary and secondary medical literature.

Among medical professionals gynecologists and urologists are without a doubt the undisputed champions of embarrassing problems that are difficult to talk about, and many times, even more difficult to treat. Historically gynecologists have been the go to resource for women while urologists mostly see men. Though women do see urologists it is in much lesser numbers, and I do not know of any men who have ever visited a gynecologist except perhaps with their significant other or close female relative.

As a microbiologist and doctor (Ph.D. doctor not MD doctor) friends or even sometimes strangers occasionally confide in me about personal medical issues, or approach me seeking advice about particular medical problems. As much as I point out over and over again that I am not that kind of doctor, and that I have no real medical training they are rarely dissuaded and the typical response I hear is “you’re close enough.” Mostly I thinks this points to the tremendously poor quality of health care that many Americans deal with, and the difficulty they have finding anyone who will actually listen to them without judgement and without a time clock. In this particular instance a close friend whom I had not spoken with in close to a year called out of the blue and asked if I might be able to help her with a medical question. I went through my normal spiel, but she cut me off by saying, “this is about microbiology.” At that point my curiosity was piqued. Though I am not a clinical microbiologist by training, I have considerable knowledge in the area from years of interactions with my clinical microbiology colleagues, and I felt confident enough that I thought I might be able to provide some actually helpful advice for once.

The story she relayed was quite personal in nature and there will be some frank language and graphic descriptions. If this sort of material makes you squeamish or uncomfortable click away now. This particular friend is a rather unique individual, and as you will see if you read on, this is not the type of story most people would share with a friend over the phone with zero hesitation. I will call her Sam for the remainder though that is not her real name. In any event Sam began by noting that she had been struggling with a yeast infection that had been recurring regularly over the past six months or so. She would get an infection, seek treatment, receive either antifugal cream or pills or both, it would go away and then a short time later would always return. It took her some time to puzzle this part out, but she eventually realized that the yeast infections always happened a day or two after her and her husband (I will call him Mike, also not his real name) had sex, specifically intercourse, and more specifically intercourse with him ejaculating in her vagina. Any other type or format of sex, of which apparently there was quite a wide variety which I will leave to your imagination, did not result in a yeast infection in the following days. This included intercourse without ejaculation or ejaculation in a different location.

Meanwhile Mike was also experiencing some odd (to say the least) symptoms. His testicles felt heavy and Sam described how he (and she) had been convinced at one point that he had testicular cancer. He went through a significant round of testing including urinalysis, blood tests, and abdominal and testicular CT scans. No cancer was found nor was anything else unusual noted. Urine cultures always came back negative with no growth and no other signs of disease or infection. The heavy testicles were not the only symptoms, he also occasionally had burning pain upon ejaculation, but only when ejaculating from sex with her but never when masturbating. He also claimed to have possibly seen blood in his semen on at least one occasion though was not 100% sure. Finally he had been struggling with lower back pain but that may have been due to a sports related injury that had never really healed correctly. All of these symptoms Mike relayed to his primary care doctor and then a urologist, but with no signs of cancer or other disease both were stumped. The urologist had initially suspected prostatitis (infection of the prostate) but again all cultures had come back negative and no enlargement of the prostate was noted. Not once during his visits with doctors did he mention his wife’s recurrent yeast infections. It never even crossed his mind was how Sam put it.

When Sam first began getting the yeast infections she would go to a walk in clinic to seek treatment, but with the infections returning so often she eventually made an appointment to see a gynecologist. Around that same time she had begun to seriously suspect that her husbands symptoms and her own problems were somehow connected. When her appointment finally arrived appointment she laid it all out in great detail, including her own suspicions. She said the gynecologist only took about ten seconds or so of thought and asked just a few questions before explaining that it was very likely Mike has a yeast infection, probably of the prostate, and every time you have sex he is giving it back to you. You two may actually be passing it back and forth whenever you have sex. She suggested that Sam instruct her husband to seek treatment with antifungals from a urologist immediately and prescribed her more antifungals.

After the visit with the gynecologist Sam had Mike schedule an appointment with another urologist and this time she went with him for the visit. They spoke to the urologist together and Sam relayed everything her gynecologist had told her expecting a quick nod of the head, agreement, and treatment prescribed for Mike, what she got was something totally different. Absolute denial of the possibility. Men do not get yeast infections the urologist told her flat out. It is a woman problem. His exact words according to Sam. Leaving aside how sexist and fucked up that is, the urologist was in this case flat out wrong. A quick review of the medical literature revealed case after case of men with chronic and persistent yeast infections of the prostate and other part of the reproductive system including the testicles and urethra. The symptoms that Mike described were classical right from the literature and the fact that this urologist was completely ignorant of it all seemed downright insane.

In the end I could not provide much helpful advice for Sam and Mike other than to find a more competent urologist. Mike clearly needed antifungals and possibly other drugs to aid in penetration of the drug to the right tissues. Many cases of male yeast infections in the literature required very long term (out to 6 months or more) treatment to fully resolve and until Mike was clear of infection Sam would never be infection free and vice versa. I don’t know if this is true in general but in this case the gynecologist was clearly in the right and the urologist totally, completely, outrageously wrong. By my score that is gynecologists 1, urologists 0.