Differential Diagnosis for Pain in the Shaft of the Penis in a 59-Year-Old Male
Single Most Likely Diagnosis
- Peyronie's Disease: Although the question states "NO PYTRNOIRS DISEASE ON EXAMINATION", it's possible that the condition is in its early stages or not yet visually apparent. Peyronie's disease can cause pain, especially during erections, due to the formation of fibrous scar tissue.
Other Likely Diagnoses
- Urethritis: Inflammation of the urethra can cause pain in the shaft of the penis, especially during erections. This could be due to infectious or non-infectious causes.
- Penile Fracture: Although less common, a penile fracture (a tear in the tunica albuginea) can occur during vigorous sexual activity and cause severe pain, especially if the penis is erect.
- Phimosis: A condition where the foreskin cannot be fully retracted over the glans penis, which can cause pain during erections due to the constriction.
Do Not Miss Diagnoses
- Penile Cancer: Although rare, penile cancer can present with pain and should not be missed due to its potential severity and impact on prognosis.
- Acute Epididymitis: Inflammation of the epididymis can cause severe pain that may radiate to the penis and is a medical emergency if not promptly treated.
- Testicular Torsion: While testicular torsion typically presents with testicular pain, it can sometimes radiate to the penis and is a surgical emergency.
Rare Diagnoses
- Sickle Cell Disease: Can cause priapism (prolonged erection) and pain due to the sickling of red blood cells within the penile vasculature.
- Fabry Disease: A genetic disorder that can cause neuropathic pain, including in the genital area, due to the accumulation of a particular type of fat in the body's cells.
- Penile Thrombosis: A blood clot in the penile veins can cause pain and swelling, although this is exceedingly rare.