• Often characterized by a constant semi-rigid penis in the flaccid state
  • Most men will report a loss of erectile rigidity
  • Some men report sensory changes in the penis, particularly in the glans of the penis. These sensory changes are described as numbness, or a feeling of cold, or decreased sensitivity
  • Some men will report penile and perineal discomfort during urinating and ejaculation, often worse when standing
  • Some men will experience erectile dysfunction
  • Some men will report pelvic floor tension or pelvic floor muscle contractions
  • Most men will report that these symptoms have caused them a significant amount of psychological distress which include anxiety, depression, loss of libido and insomnia
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Associated Diagnoses

Chronic Pelvic Pain Syndrome (CPPS)/Male Pelvic Pain, Chronic Nonbacterial Prostatitis, Interstitial Cystitis/Painful Bladder Syndrome are all pain syndromes that may contribute to or in conjunction with Hard-flaccid Syndrome

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Causes of Hard-flaccid Syndrome

  • Could occur after a traumatic event, possibly after using a penile vacuum or pump, rough masturbation or intercourse, manually over-stretching the penis, otherwise known as jelqing, or excessive squatting
  • The injury to the base of the penis could impact the nerves or vessels that supply the penis and the pelvic floor muscles
  • The initial injury that causes emotional distress overstimulates a part of the nervous system that could result in the pelvic floor muscles to contract
  • The sustained pelvic floor muscle contractions then compress the surrounding nerves and vessels that can result in sensory changes, such as numbness or a cold sensation, and well as pelvic floor muscle tension and pain
  • The sustained contraction of the muscles that must contract to get and maintain an erection compromise the venous structures of the penis leading to a semi-erect penis in the flaccid state

Diagnostic Challenges

Although Hard-flaccid Syndrome is not a designated medical diagnosis, it is the name that the collection of symptoms has taken on over the years, primarily via online forums. Unfortunately there is very little information available within the medical literature; therefore, it is poorly understood and defined.

Additionally, many of the symptoms reported with Hard-flaccid syndrome are also reported with those suffering from CPPS/Male Pelvic Pain Syndrome and Chronic Nonbacterial Prostatitis. Although these are well defined diagnoses, they have challenges of their own when it comes to getting a correct diagnosis and undergoing an effective treatment plan. To complicate the matter further, many pelvic floor physical therapists are only trained to treat women. This is not the case at PHRC, in fact, some days we treat more men than women.

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How We Can Help You

Men experiencing Hard-flaccid Syndrome can benefit from an evaluation with a pelvic floor physical therapist specializing in pelvic pain. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most men are frustrated by the time they get to see us. During the physical examination the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the physical therapist completes the examination they review their findings with you. The physical therapist creates an assessment which explains how you developed the symptoms and creates short and long-term goals for your treatment plan.Typically, the frequency of physical therapy is one to two times per week for roughly 12 weeks. You are given a home exercise plan to compliment your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life!