A 27-year-old male presented with the chief complaint of persistent feelings of impending orgasm. He reported a sensation similar, but not identical, to sexual arousal that did not occur in the setting of sexual thoughts or desire. During these episodes, his penis would be extremely sensitive. With manual stimulation, he would achieve orgasm, which alleviated the arousal for only a short time, after which the symptoms would return. He also complained of an ache in the area of his coccyx.
The need to strain resolved with fiber supplementation and did not return, but the fecal urgency persisted. His arousal symptoms persisted as well. He denied any urinary frequency, hesitancy, or urgency. The patient reported normal erections and ejaculations. On genitourinary examination Circumcised phallus with a 1.5 cm plaque on the dorsum of the penis at the base Penile and perineal exams were normal…
