Hard Flaccid Syndrome- Why is getting hard so hard?

According to the National Institutes of Health, chronic pelvic pain and chronic prostatitis may account for 2% to 16% of urological issues worldwide. It’s the most common urologic disease in men younger than 50 years old.

What is Hard Flaccid Syndrome?

Hard flaccid syndrome is a type of chronic pelvic pain syndrome which may occur in men of all ages. Symptoms described range from penile or perineal pain, shortening or cramping of the penis, penile numbness, erectile dysfunction, pain and or weakness with ejaculation or urination. Men may also need more physical stimulation in order to achieve or maintain erection. Men can describe the penis as feeling hollow, semi-engorged and somewhat rubbery.

Causes

The cause of hard flaccid is unfortunately unknown. Men usually end up seeing numerous specialists and undergo various tests, which have normal results. Because of this, it is theorized that the cause of hard flaccid can be multifactorial, with biological, social, and psychological triggers. A physical or psychological stressor can trigger an emotional response, which can then stimulate the pelvic muscles and cause a sustained muscle contraction. This can then lead to a shortening of the contractile tissues of the penis, thus leading to tightness of the surrounding muscles and tissue and then cause pain. A traumatic event, such as rough masturbation, can lead to injury of nerves and pelvic floor musculature, which can contribute to the onset of symptoms. This can then lead to psychological problems which can result in erectile dysfunction and decreased libido.

Mental Health Impact

Stress and anxiety about the condition can also exacerbate the condition. Chronic pain can change behaviors into catastrophic thinking about the condition. This can cause more muscle tension and and increased feelings of helplessness and negativity. Patients with chronic pelvic pain are likely to remain catastrophic in their thinking about pain for prolonged periods if they don’t or are unable to seek help.

Pelvic Health PT

Pelvic floor physical therapy can help men with hard flaccid. Treatment sessions can include internal and external pelvic floor trigger point release, learning relaxation strategies to reduce stress, and gentle core strengthening exercises to decrease stress on the pelvic floor musculature.

Written by: Roseanne Cruz Schoen, PT, DPT

References:

1. Kaylie Hughes, Arie Parnham and Marc Lucky. “Hard flaccid syndrome.” https://www.urologynews.uk.com/features/synopsis/post/hard-flaccid-syndrome
2. Hardflaccid.co
3. Smith, CP. “Male chronic pelvic pain: An update.” Indian J Urol. 2016 Jan-Mar; 32(1): 34–39.
4. Gul M, Towe M, Yafi FA, Serefoglu EC. “Hard flaccid syndrome: initial report of four cases.” Your Sexual Medicine Journal. https://doi.org/10.1038/s41443-019-0133-z