What symptom is associated with the inability to pull back the foreskin?

The symptom associated with the inability to pull back the foreskin is indeed paraphimosis. This condition occurs when the foreskin is retracted and cannot be returned to its normal position over the glans of the penis, leading to swelling and potential complications such as restricted blood flow. This inability to return the foreskin can cause significant discomfort and is considered a medical emergency if not treated promptly.

Paraphimosis contrasts with other terms in the choices presented: adnexal tenderness relates to pain in the area of the female reproductive organs, the cremasteric reflex involves the contraction of the cremaster muscle in response to temperature changes, and melena refers to black, tarry stools indicative of gastrointestinal bleeding. None of these are associated with the inability to retract the foreskin, which is why paraphimosis is the correct answer in this context.