Hard Flaccid: Causes, Treatments, and Symptoms

In Male Pelvic Pain, pelvic floor physical therapy, Pelvic Health by Elizabeth AkincilarLeave a Comment

By Elizabeth Akincilar, MPT, Cofounder, PHRC Merrimack

Although our knowledge is limited with regards to hard-flaccid syndrome, based upon the minimal medical literature dedicated to this syndrome and our own experience at PHRC, hard-flaccid syndrome most commonly occurs secondary to the following:


When the PFM, particularly the urogenital diaphragm, or superficial PFM, become too tight or hypertonic, they can contribute to hard-flaccid syndrome. These particular muscles are intimately involved in erectile function; therefore, if they aren’t functioning optimally, because they are too tight, they can contribute to erectile dysfunction and/or symptoms associated with hard-flaccid. Additionally, when these muscles are too tight they can also impede the vascular structures in the genitals, which can also negatively impact erectile function.


Jelqing – an exercise that stretches the penis in an attempt to elongate or enlarge it. When the penis is aggressively stretched, as with jelqing, the penile branch of the pudendal nerve, which travels along the penile shaft, is also stretched. Nerves can become painful and/or dysfunctional when they are overstretched. Therefore, if the penile branch of the pudendal nerve is overstretched during jelqing, it can contribute to the symptoms of hard-flaccid syndrome.


Similarly to jelqing, if the penis is aggressively stretched or manipulated during aggressive or prolonged masturbation, injury to the penile branch of the pudendal nerve can occur, contributing to the symptoms of hard-flaccid syndrome.


Lastly, compromised vascular structures, such as arteries and veins, can become compromised for a variety of reasons. As previously mentioned, tight pelvic floor muscles could play a role. Cardiovascular disease, high blood pressure, and/or diabetes are a few examples of health conditions that will negatively impact vascular structures. If you are suffering from hard-flaccid syndrome it is best to discuss all the health conditions that could be negatively impacting your vascular system with your physician to determine if these conditions are contributing to the symptoms of hard-flaccid.

hard flaccid treatments


If you are experiencing symptoms consistent with hard-flaccid syndrome, consider the following treatments.

Pelvic floor physical therapy can treat muscular impairments that may be negatively affecting the pudendal nerve as well as the surrounding vascular structures that can contribute to hard-flaccid syndrome.

Talk to your urologist about possible hormonal imbalances that could contribute to these symptoms.

Minimize comorbidities, especially concerning your cardiovascular system, such as high blood pressure, high cholesterol and diabetes. Improve your cardiovascular health by reducing alcohol consumption, quitting smoking, eating healthier and exercising regularly!

Although the jury is still out on shock wave therapy, some folks have reported improvements in their symptoms of hard-flaccid syndrome after undergoing shock wave therapy. Talk to your healthcare provider to see if you are a candidate!


hard flaccid symptoms


Common symptoms of hard-flaccid syndrome include the following:

  • Penile and/or perineal pain or discomfort
  • Inability to achieve a full erection or the feeling of a semi-erection when not aroused
  • Erectile dysfunction
  • Pain or discomfort during and/or after ejaculation
  • Reduced force of ejaculation
  • Feeling of coldness in the penis


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.


How We Can Help


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!



Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!


Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page

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