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.