Hard flaccid syndrome

Medical condition

Hard flaccid syndrome (HFS), also known as hard flaccid (HF), is a rare, chronic condition characterized by a flaccid penis that remains in a firm, semi-rigid state in the absence of sexual arousal. Patients describe their flaccid penises as being firm to the touch, rubbery, shrunken, and retracted. This may be accompanied by pain, discomfort, and a range of additional symptoms. Though the exact cause is poorly understood, current research suggests that HFS is the result of excessive sympathetic activity in the smooth muscle tissue of the penis that is induced by a pathological activation of a theorized pelvic/pudendal-hypogastric reflex. This reflex is thought to be triggered by an injury to the erect penis, blunt trauma to the perineum, and cauda equina, among others. An emerging theory suggests that the real explanation for HFS is sympathetic nerve sprouting in the dorsal root ganglia following a peripheral nerve injury. The majority of patients are in their 20s–30s and symptoms significantly affect one's quality of life. Treatment usually involves a multi-modal approach utilizing a combination of alpha blockers, PDE5 inhibitors, and specialized pelvic floor physical therapy though there is not much evidence to support their efficacy and most patients reportedly do not benefit from currently available treatment options. Due to limited awareness and understanding of the condition within the scientific and medical communities, definitive treatment for HFS does not exist.

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