Differential Diagnosis for Pain when Pulling Back at Penis Foreskin during Erection

• Single Most Likely Diagnosis
  • Phimosis: This condition is characterized by the inability to retract the foreskin over the glans penis, which can cause pain, especially during erection when the foreskin is pulled back. It's a common issue that fits the symptoms described.
• Other Likely Diagnoses
  • Paraphimosis: A condition where the foreskin is retracted behind the glans and cannot return to its original position, which can cause pain and swelling. It's likely if the pain occurs after the foreskin has been pulled back.
  • Foreskin tears or fissures: Small tears in the foreskin can cause pain, especially during retraction or sexual activity.
  • Balanitis: Inflammation of the glans penis, which can be caused by poor hygiene, infections, or irritants, leading to pain and discomfort, including when the foreskin is retracted.
• Do Not Miss Diagnoses
  • Penile cancer: Although rare, penile cancer can present with pain, especially if a tumor is present under the foreskin. It's crucial to rule out this diagnosis due to its severe implications.
  • Gangrene of the penis: A rare but serious condition that can result from paraphimosis or other conditions leading to reduced blood flow to the penis. It requires immediate medical attention.
• Rare Diagnoses
  • Peyronie's disease: A condition characterized by the development of scar tissue inside the penis, leading to curved, painful erections. While it can cause pain during erection, it's less directly related to the act of pulling back the foreskin.
  • Lichen sclerosus: A skin condition that can affect the genital area, causing thinning and tightening of the skin, which might lead to discomfort or pain, especially during sexual activity or foreskin retraction.