Differential Diagnosis for Inability to Retract Foreskin

• Single Most Likely Diagnosis
  • Phimosis: This condition is characterized by the inability to retract the foreskin over the glans penis, often due to a narrow or tight foreskin. It is a common issue, especially in uncircumcised males, and can be physiological in young boys but may require medical attention if it persists or causes symptoms.
• Other Likely Diagnoses
  • Balanitis: Inflammation of the glans penis, which can cause pain, swelling, and sometimes difficulty retracting the foreskin due to discomfort or adhesions.
  • Poor Hygiene: Accumulation of smegma under the foreskin can lead to irritation, inflammation, and difficulty retracting the foreskin.
  • Scarring from Injury or Infection: Previous infections, injuries, or surgeries can lead to scarring, which may restrict the movement of the foreskin.
• Do Not Miss Diagnoses
  • Paraphimosis: A condition where the retracted foreskin cannot be returned to its original position, which can cut off blood flow to the glans penis and is a medical emergency.
  • Penile Cancer: Though rare, any unusual lesions, ulcers, or unexplained changes in the appearance of the penis should be evaluated for cancer, as early detection is crucial.
• Rare Diagnoses
  • Lichen Sclerosus: A chronic inflammatory skin condition that can cause scarring and tightening of the foreskin, making retraction difficult.
  • Congenital Conditions: Certain rare congenital conditions can affect the development of the penis and foreskin, potentially leading to issues with foreskin retraction.