Differential Diagnosis for Painful Orgasm
- Single most likely diagnosis
- Peyronie's disease: A condition characterized by the development of fibrous scar tissue inside the penis, leading to curved, painful erections and potentially painful orgasms. This condition is relatively common and directly affects the physical aspects of sexual function, making it a likely cause of painful orgasm.
- Other Likely diagnoses
- Prostatitis: Inflammation of the prostate gland, which can cause pain during ejaculation and orgasm. Given the proximity of the prostate to the urethra and its role in the male reproductive system, prostatitis is a plausible cause of painful orgasm.
- Epididymitis: Inflammation of the epididymis, a tube at the back of the testicle that stores and carries sperm. This condition can cause pain in the testicles, which may be exacerbated during sexual activity, including orgasm.
- Orchitis: Inflammation of one or both testicles, usually caused by bacterial or viral infections. Like epididymitis, orchitis can lead to testicular pain that may worsen during orgasm.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Testicular torsion: A medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. While less common, testicular torsion can cause severe pain and must be promptly treated to save the affected testicle.
- Testicular cancer: Although rare, testicular cancer can cause pain, especially if a tumor is large enough to press on surrounding structures. Early detection is crucial for effective treatment.
- Rare diagnoses
- Interstitial cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can worsen with sexual activity, including orgasm, though it's less directly associated with painful orgasm compared to other conditions listed.
- Penile fracture: A rare injury that occurs when the penis is forcibly bent, causing a crack in the tunica albuginea, the tissue surrounding the corpora cavernosa. This could potentially lead to painful erections and orgasms if not properly treated.
- Neurological disorders: Certain conditions like multiple sclerosis, peripheral neuropathy, or nerve damage can affect sexual function and lead to painful sensations during orgasm, though these are less common causes.