Differential Diagnosis for Testicular Pain and No Erection when Walking Distance

Single Most Likely Diagnosis

• Atherosclerotic Peripheral Artery Disease (PAD): This condition is characterized by the narrowing or blockage of the arteries, which can lead to reduced blood flow to the extremities, including the penis, resulting in erectile dysfunction, especially during physical activity like walking. Testicular pain could be referred pain from the lower extremities or a separate issue but is less commonly directly related to PAD.

Other Likely Diagnoses

• Varicocele: A varicocele is an enlargement of the veins within the scrotum, similar to varicose veins. It can cause testicular pain and, in some cases, affect sperm quality and potentially contribute to erectile dysfunction, especially if the condition is severe and affects blood flow.
• Epididymitis or Orchitis: Inflammation of the epididymis (epididymitis) or testis (orchitis) can cause testicular pain. While these conditions might not directly cause erectile dysfunction, the pain and discomfort could indirectly affect sexual function, especially during physical activity.
• Peyronie's Disease: This condition involves the development of scar tissue inside the penis, leading to curved, painful erections. The pain and deformity could contribute to difficulties in achieving or maintaining an erection, especially with physical exertion.

Do Not Miss Diagnoses

• Testicular Torsion: Although typically presenting with acute, severe testicular pain, testicular torsion is a medical emergency that requires immediate attention. It could potentially lead to erectile dysfunction if not promptly treated due to the interruption of blood flow.
• Aortic Aneurysm or Dissection: These are life-threatening conditions that could present with back or abdominal pain and might radiate to the testicles. They could also affect blood flow, potentially leading to erectile dysfunction.
• Prostate Cancer: Advanced prostate cancer can metastasize to the bones, including the pelvis, causing pain that might be referred to the testicles. It can also lead to erectile dysfunction due to local effects on the prostate and surrounding structures.

Rare Diagnoses

• Fabry Disease: A genetic disorder that can lead to the accumulation of a particular type of fat in the body's cells, affecting many parts of the body. It can cause pain in the hands and feet, and less commonly, might affect the testicles. Erectile dysfunction can also be a symptom due to the vascular effects of the disease.
• Sickle Cell Disease: This genetic disorder affects hemoglobin production and can cause episodes of pain, including testicular pain, due to sickling crises. It might also contribute to erectile dysfunction due to the effects on blood flow and nitric oxide production.