PENILE PAIN
Perhaps no other pain will bring a patient to the doctor more quickly
in this age of sexual candor. Most cases
will be caused by inflammation, so a mnemonic of etiologies is, for
the most part, superfluous. Utilization of anatomy is valuable,
however. Let us begin, then, with the head of the penis and proceed
upward to the prostate, the bladder, and the kidney.
The head of the penis may be inflamed by a painful chancroid ulcer
or lymphogranuloma venereum, but one must remember that a chancre
(syphilitic ulcer) is not painful. Herpes progenitalis, in contrast, is
extremely painful. Balanitis is usually caused by a nonspecific infection,
but one should caution the uncircumcised patient about proper cleaning of
the area and rule out Reiter disease. (Look for conjunctivitis and joint
symptoms.) Trauma to the head of the penis should be obvious, but some
patients may be too shy to mention its origin without careful questioning.
Carcinoma of the penis rarely causes pain, but like all carcinomas, it will
often be painful when it is secondarily infected.
Next, let us consider the urethra. Inflammation here is probably
the most common cause of penile pain. It is almost invariably associated
with a discharge, and the smear will usually disclose the typical
Gram-negative intracellular diplococci of gonorrhea. The clinician is
reminded that nonspecific urethritis is more frequently encountered each
year and that Chlamydia and mima polymorpha are common causes. Reiter disease must
also be considered. Passage of a stone through the urethra causes pain in
the penis.
The shaft of the penis is one of the few areas in which a vascular
lesion may account for penile pain. Thrombosis of the corpus
cavernosum is often encountered in blood
dyscrasias (particularly leukemia), and the resulting permanent erection may
be enviable and even humorous to the observer but not to the patient.
Peyronie disease will cause a painful erection.
Moving to the prostate, one hardly needs to be reminded that both
acute and chronic prostatitis are frequent causes of penile pain. In
contrast, carcinoma and hypertrophy of the prostate are rarely associated
with pain unless there is associated infection.
The bladder is another common source of penile pain, but because
there is often an associated urethritis, it is uncertain whether pure
cystitis causes penile pain by itself except on urination. Bladder stones
cause pain in the penis, especially on urination. Carcinoma of the bladder
will not usually cause penile pain unless it is complicated by infection.
Hunner ulcer, in contrast, causes great pain in the penis at times.
Occasionally, ureteral and renal stones will cause penile pain, but
pyelonephritis is very unlikely to do so. Referred pain from the rectum
caused by hemorrhoids and fissures is common.
Approach to the Diagnosis
Finding any lesion of the penis should prompt a smear and culture of
the exudate or scrapings. A dark field examination will often be indicated
by the history of sexual contact. Any urethral discharge must also be
examined after a Gram stain and cultured for gonococci and Chlamydia. Prostatic
massage may be necessary to get adequate urethral material. Next, a
urinalysis is done and a fresh drop is examined under high power for motile
bacteria signifying cystitis or pyelonephritis. A urine culture and colony
count will be wise in any case. If the diagnosis is still obscure, it is
wise to consult a urologist before proceeding with an intravenous pyelogram
(IVP) or other expensive tests.
Other Useful Tests
-
Cystoscopy (stricture, tumor, stone)
-
Retrograde pyelography (tumor, stone, malformation)
-
CBC (infection)
-
Chemistry panel (hypercalcemia, hyperuricemia)
-
Strain urine for stone
-
CT scan of the abdomen and pelvis (tumors, stones, malformation)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Penis discharge
Read excerpts from these other book chapters related to Penis discharge:
Medical Books Excerpts
- Urethral Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Penis discharge
» Next page: URETHRAL DISCHARGE (Differential Diagnosis in Primary Care)
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