Does an uncircumcised (not circumcised) male experience penile pain at the coronal sulcus (neck of the glans) during masturbation, particularly under water, after a prolonged period of abstinence (more than 5 days), which resolves with frequent masturbation (every 1-3 days)?

Differential Diagnosis

• Single most likely diagnosis + Phimosis: This condition, where the foreskin is too tight to be pulled back over the glans, could lead to pain and discomfort during masturbation, especially after a period of abstinence, due to the buildup of smegma and potential irritation. The fact that the pain resolves with frequent masturbation suggests that the condition may be related to the foreskin's tightness and the accumulation of secretions.
• Other Likely diagnoses + Balanitis: Inflammation of the glans penis, which could be caused by poor hygiene, especially in uncircumcised men. The pain during masturbation after a period of abstinence could be due to the accumulation of irritants under the foreskin. + Smegma buildup: The accumulation of smegma, a natural lubricant, under the foreskin can cause irritation and pain, especially if not regularly cleaned. This could be exacerbated by infrequent masturbation and relieved by more frequent sexual activity.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Penile cancer: Although rare, penile cancer can present with pain and discomfort, especially if a tumor is present on the glans or under the foreskin. It's crucial to rule out this diagnosis due to its severe consequences if left untreated. + Sexually Transmitted Infections (STIs): Certain STIs, like herpes or syphilis, can cause painful lesions or ulcers on the penis, which might be exacerbated by masturbation. It's essential to consider STIs in the differential diagnosis, especially if the patient is sexually active with multiple partners.
• Rare diagnoses + Peyronie's disease: A condition characterized by the formation of scar tissue inside the penis, leading to curved, painful erections. While less likely, it could potentially cause pain during masturbation, especially if the scar tissue is located near the glans. + Neuroma or nerve entrapment: Rare conditions where a nerve is compressed or damaged, potentially causing pain in the penis. This could be considered if other diagnoses are ruled out and the pain persists.