A 36 year old male with no past medical history presents reporting two weeks of worsening penile pain and notes pain when retracting his foreskin. Vital signs are within normal limits. Without giving the answer away with the patient’s exam, let’s make a differential!
Breaking it down further – penile pain in…
The uncircumcised male – paraphimosis and balanitis
The flaccid penis – balanoposthitis or STD
The erect penis – priapism or Peyronie’s disease
What are our differential diagnoses?
• Urinary tract calculi
• Trauma
• Balanitis
• Prostatitis
• Sickle cell anemia
• Peyronie’s disease
• Reiter syndrome
• Urethritis
• Phimosis
• Paraphimosis
• Scrotal disorders
• Priapism
Some background….
Balanitis
Inflammation of the glans penis and foreskin
Secondary to viral, bacterial, or fungal infections
Increased risk if diabetic
Peyronie’s disease
Connective tissue disorder involving the formation of scar tissue in the tunica
albuginea. This causes abnormal curvature, erectile dysfunction, etc.
Phimosis
The foreskin cannot be fully retracted over the glans penis; puts patients at risk for
urinary retention and carcinoma
Treatment – steroid creams (bethamethasone), manual stretching, preputioplasty,
circumcision
Paraphimosis
The foreskin becomes trapped behind the glans penis and cannot be reduced
This can result in gangrene
It happens when a retracted foreskin becomes edematous
Our patient ended up with phimosis, complicated by candidal infection.
