Differential Diagnosis for Low Libido, Weak Erection, and Unsatisfied Ejaculation in a 20-Year-Old Virgin Male

Single Most Likely Diagnosis

• Performance Anxiety or Psychological Factors: Given the patient's age and virgin status, anxiety or fear of sexual performance could significantly contribute to his symptoms. This is a common issue in young males experiencing sexual encounters for the first time.

Other Likely Diagnoses

• Hormonal Imbalance: Low levels of testosterone can affect libido and erectile function. Although less common in young males, it's a plausible cause that needs evaluation.
• Depression or Anxiety Disorders: These conditions can significantly impact sexual function, including libido and the ability to achieve or maintain an erection.
• Lifestyle Factors: Excessive alcohol consumption, smoking, lack of sleep, or a sedentary lifestyle can contribute to sexual dysfunction.
• Medication Side Effects: Certain medications, such as antidepressants, antihistamines, and blood pressure medications, can affect sexual function.

Do Not Miss Diagnoses

• Pituitary or Testicular Tumors: Although rare, these conditions can lead to hormonal imbalances affecting sexual function. Early detection is crucial for effective treatment.
• Diabetes: Can cause neuropathy and vascular problems, leading to erectile dysfunction. It's essential to screen for diabetes, especially if there are other risk factors present.
• Hyperprolactinemia: Elevated prolactin levels can suppress testosterone production, leading to sexual dysfunction.

Rare Diagnoses

• Klinefelter Syndrome: A genetic condition that affects male development and can lead to hormonal imbalances and sexual dysfunction.
• Multiple Sclerosis or Other Neurological Conditions: Can cause sexual dysfunction due to nerve damage.
• Penile Dysmorphophobia: A psychological condition where the individual has a distorted perception of their genitalia, leading to sexual performance anxiety.
• Priapism or Other Erectile Dysfunction Conditions: Conditions that affect the normal erection process, though these might present with different primary symptoms.

Each of these diagnoses requires a thorough medical and psychological evaluation to determine the underlying cause of the patient's symptoms. Treatment will depend on the specific diagnosis and may involve a combination of psychological counseling, lifestyle changes, and medical interventions.