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.
PENILE PAIN
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, on the other hand, 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 cavernosis 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. On the other hand, 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, on the other hand, 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 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)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Penis pain
Read excerpts from these other book chapters related to Penis pain:
Medical Books Excerpts
- PRIAPISM
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- PRIAPISM
- "Differential Diagnosis in Primary Care" (2007)
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- Priapism
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Priapism
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Priapism
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Urethral Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Priapism
- "Nursing: Interpreting Signs and Symptoms" (2007)
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- PRIAPISM
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Penis pain
» Next page: Genital lesions in the male (Handbook of Signs & Symptoms (Third Edition))
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