Hard Flaccid Syndrome

In men with hard flaccid syndrome (HFS), the penis is in an unwanted persistent semi-rigid flaccid state. Hard flaccid syndrome is an acquired, persistent, painful, and bothersome sexual dysfunction that is poorly understood. On physical examination, the flaccid penis appears to be contracted, shrunken, and non-compressible, and on palpation it feels hard, described by the patient as tender. People with hard flaccid syndrome tend to be in their 20s or 30s, with multiple biopsychosocial concerns. These include changes to the look of the penis such as wrinkles or indents; cold-feeling glans; decreased penile sensation especially in the glans; urinary symptoms such as decreased force of stream; constipation; high tone pelvic floor dysfunction; perineal and penile pain during ejaculation; and erectile dysfunction with loss of morning erections. These symptoms often worsen when standing. Hard flaccid syndrome can trigger significant emotional distress as well.