Differential Diagnosis for Bruising of Meatus after Sex

Single Most Likely Diagnosis

• Trauma during sexual activity: This is the most straightforward explanation for bruising of the meatus after sex, as physical trauma during intercourse can cause bruising.

Other Likely Diagnoses

• Sexually Transmitted Infections (STIs): Certain STIs, such as herpes or syphilis, can cause lesions or ulcers that may bleed or bruise, especially if they are irritated during sex.
• Urethral stricture or urethral tear: These conditions can cause bleeding or bruising, especially if there is forceful or traumatic intercourse.
• Vaginal or penile dryness: Lack of lubrication can lead to friction and minor trauma during sex, potentially causing bruising.

Do Not Miss Diagnoses

• Penile fracture: Although rare, a penile fracture is a medical emergency that requires immediate attention. It can occur during vigorous sexual activity and may present with bruising, swelling, and deformity of the penis.
• Urethral rupture: Similar to a penile fracture, a urethral rupture is a serious condition that can occur due to trauma during sex, leading to severe consequences if not promptly treated.

Rare Diagnoses

• Bleeding disorders: Conditions like hemophilia or von Willebrand disease can increase the risk of bruising and bleeding, including after minor trauma such as sexual activity.
• Vasculitis: Certain types of vasculitis, such as Henoch-Schönlein purpura, can cause bruising and may be associated with sexual activity, although this is extremely rare.
• Tumors: Although very rare, tumors of the urethra or penis could potentially cause bruising, especially if they bleed or are irritated during sex.