Differential Diagnosis for Bilateral Leg Pain during Intercourse prior to Ejaculation

• Single most likely diagnosis:
  • Peyronie's disease with associated pelvic floor muscle spasms: This condition involves the development of scar tissue inside the penis, leading to curved, painful erections. The pain and muscle spasms associated with Peyronie's could radiate to the legs, especially during intense sexual activity.
• Other Likely diagnoses:
  • Prostatitis: Inflammation of the prostate gland can cause pain in the pelvic area, which may radiate to the legs, especially during sexual activity.
  • Chronic pelvic pain syndrome: A condition characterized by chronic pain in the pelvic region, which can be exacerbated by sexual activity and may radiate to the legs.
  • Pudendal neuralgia: Pain caused by damage to the pudendal nerve, which can cause pain in the pelvic area, including the genitals and legs, especially during sexual activity.
• Do Not Miss diagnoses:
  • Testicular torsion: Although less common, testicular torsion is a medical emergency that can cause severe pain, which might radiate to the legs. It requires immediate attention to preserve the testicle.
  • Epididymitis: Inflammation of the epididymis (the tube at the back of the testicle that stores and carries sperm) can cause severe pain that might radiate to the legs and is a condition that needs prompt treatment.
• Rare diagnoses:
  • Fabry disease: A rare genetic disorder that can cause pain in the hands and feet, and sometimes the legs, due to the buildup of a particular type of fat in the body's cells. It might be considered in cases where the pain is part of a broader set of systemic symptoms.
  • Sickle cell disease crisis: Individuals with sickle cell disease can experience episodes of severe pain due to sickling of red blood cells. Although less common, it could potentially cause leg pain during intense physical activity like intercourse, especially if the individual has a history of the disease.