A recent webinar by Herman & Wallace Pelvic Rehabilitation Institute entitled “Sexual Medicine in Pelvic Rehab” featured the most current information on pelvic conditions, including Chronic Pelvic Pain Syndromes (CPPS). One syndrome, Hard Flaccid (HF), is so new to the medical world that most physicians have not heard of it. Indeed, a quick search on PubMed reaps only four research studies—all completed in 2020. Urology News in the UK published an article in November 2018, but people have been talking about it in chat rooms since around 2015.

HF may be mistaken for the more common Peyronie’s syndrome. They both share some symptoms such as pain, erectile dysfunction, loss of girth and shortening of the penis, and possible curvature of the penis. Whereas Peyronie’s tends to occur in the person’s 50s or 60s, caused by a build-up of scar tissue around the erectile tissue in the penis and a possible genetic propensity, HF happens to men in their 20s and 30s with unknown etiology, although they almost always have a history of trauma to the penis.

The name reflects the decreased blood flow to the area, causing the flaccid penis to remain partially hard. Men with HF also have decreased urine flow, sensory changes in the penis (numbness, tingling), constant cramping in the pelvis, and the glans remains flaccid during erection. Deformities such as indentations, hour-glass figure or a narrowed band toward the base sometimes occur.

Chronic pain causes psycho-emotional issues for an individual such as depression and anxiety. It may interfere with sexual pleasure, erode self-esteem or decrease quality of life. A good support system, regular exercise and good sleep architecture are essential to maintaining the rhythms of life that will help manage daily stress that can exacerbate chronic pain.

For those who feel they may have HF, get help immediately. While it is never too late to seek out assistance, chronic pain is harder to treat the longer it is left untreated. A pelvic floor specialist can administer acupuncture, biofeedback or cognitive behavioral therapy. Instruction in meditation/mindfulness techniques and breathing techniques will likely be given in order to down-regulate the nervous system. A plan of stress reduction will be discussed with a therapist who may also instruct how to use a pelvic wand for myofascial release and give exercises to perform at home. Medications or surgery are rarely required for CPPS conditions.

While there is much more to be learned about this particular disorder, HF can be treated now within the parameters of CPPS. There is hope and there are men who are finding lasting relief from this pain.

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