Hard flaccid syndrome (HF) is a sexual disorder that has not yet been formally recognized and defined by the sexual medicine community. However, Internet forums, chat groups, and social media groups have been created to support patients suffering from the symptoms of this disorder, indicating that it is a related condition that affects one’s health and sexual function.
What is stiff flaccid syndrome?
Although it lacks an official, evidence-based definition from the medical community, stiff flaccid syndrome researchers define it as a type of chronic pelvic pain syndrome (CPPS) characterized by a cluster of symptoms. Chronic pelvic pain is pain that occurs below the belly button and between the hips and lasts for at least six months.
What are the symptoms?
The symptoms of hard flaccid syndrome can vary slightly from patient to patient, but the following is a list of the most common heart failure symptoms:
- Feeling “hard” or “semi-rigid” even when the penis is in a relaxed state
- Penile pain and/or pain in the perineal area (between the scrotum and anus)
- A cramping or tightening sensation that shortens the penis
- Difficulty getting or keeping an erection (erectile dysfunction)
- Penile numbness
- Painful ejaculation
- Painful urination or weak urine stream
- Underlying anxiety and/or depression
- Penile deformity (recess), which is often variable with erections
What causes stiff flaccid syndrome?
Currently, the cause of stiff flaccid syndrome is unknown, but researchers believe it is multifactorial in origin, meaning it could be caused by biological, psychological, lifestyle, or environmental factors, and possibly some combination of these factors. Many heart failure patients report an injury or trauma to their penis during intercourse or masturbation as the trigger for their symptoms.
A possible cause of heart failure is an imbalance or dysregulation of the penile nervous system. Normally, the sympathetic nervous system triggers the body’s “fight or flight” responses to dangerous or stressful situations and inhibits or slows down processes such as erections or processing food. The parasympathetic nervous system is the “rest and digest” system that slows the heart rate, increases blood flow to process food, and supports erections. In healthy individuals, the body maintains the penis with the proper balance of sympathetic and parasympathetic tone, but some researchers believe that patients with heart failure experience increased sympathetic tone that can weaken their erections.
Early research also suggests that stress and anxiety about heart failure may worsen symptoms. If men begin to feel anxious about their sexual performance, they are more likely to experience sexual dysfunction. Additionally, HF patients may become overly focused on their condition and self-examine regularly or take multiple treatments, adding stress to an already sensitive area and further imbalance in the sympathetic/parasympathetic nervous system.
How is it treated or treated?
Because heart failure syndrome is not officially recognized by the sexual medicine community, there is no standard treatment protocol as outlined by medical professionals. In fact, the use of medical or other treatments to treat the condition is somewhat controversial, as they may exacerbate the problem by contributing to the underlying over-focus on the penis itself.
However, so far, research points to a multidisciplinary approach to care as the most effective form of treatment for stiff flaccid syndrome. Reminding the patient that the penis is physically functional, dispelling beliefs that HF patients are responsible for their condition, using cognitive behavioral therapy, and encouraging open communication between HF patients and their partners may help. in dealing with some of the psychological consequences of the syndrome. Some providers recommend pelvic floor exercises to reduce muscle tension in the area. Finally, mindfulness and meditation have been shown to support heart failure patients in their journeys with this chronic pelvic pain syndrome.
Resources:
Gül, M., & Serefoglu, EC (2019). Hard Flaccid: Is It a New Syndrome? The Journal of Sexual Medicine, 16(5), 58.
Hughes, K., Parnham, A., & Lucky, M. (2018). Hard Flaccid Syndrome. Urology News, 23(1).
