Differential Diagnosis for Painful Erection
When considering the causes of pain in the penis during erection, it's crucial to approach the diagnosis systematically to ensure that all potential causes are considered. The differential diagnosis can be organized into the following categories:
Single Most Likely Diagnosis
- Peyronie's Disease: This condition is characterized by the formation of fibrous scar tissue within the penis, leading to curved, painful erections. It is a common cause of painful erections and should be considered first due to its prevalence and direct association with the symptom.
Other Likely Diagnoses
- Phimosis: A condition where the foreskin cannot be fully retracted over the glans penis, which can cause pain during erection due to the constriction.
- Balanitis: Inflammation of the glans penis, which can be caused by infection or irritation, leading to pain, especially during erection.
- Urethritis: Inflammation of the urethra, often due to infection, which can cause pain during urination and erection.
- Prostatitis: Inflammation of the prostate gland, which can cause pain in the penis, perineum, and lower back, especially during erection.
Do Not Miss Diagnoses
- Penile Fracture: A serious condition that occurs when the penis is subjected to severe stress, causing a rupture of the tunica albuginea. It requires immediate medical attention.
- Priapism: A condition characterized by a prolonged erection that is not associated with sexual desire or stimulation, which can cause pain and potentially lead to permanent damage if not treated promptly.
- Testicular Torsion: Although it primarily affects the testicles, the pain can radiate to the penis and is a medical emergency requiring immediate intervention.
Rare Diagnoses
- Penile Cancer: A rare type of cancer that can cause pain, especially if it involves the glans or shaft of the penis.
- Sickle Cell Disease: Can cause priapism, which is painful and requires immediate medical attention.
- Fabry Disease: A genetic disorder that can lead to painful erections among other systemic symptoms.
Each of these conditions has a distinct set of symptoms and risk factors, and a thorough medical history, physical examination, and sometimes additional diagnostic tests are necessary to determine the underlying cause of painful erections.