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Watch any movie (both of the Hollywood and X-rated variety) and it will tell you that if you're a man, sex is simple. You hop into bed and you're immediately good to go with little to no warm-up.
But, as most blokes can attest, that's not always the reality. There's a multitude of different factors that can affect male libido and sexual performance, from anxiety to self-esteem to general health issues.
Making the art of 'getting (and keeping) it up' even more complicated is the fact that it's possible to be both hard and soft at the same time.
Yep, 'hard flaccid syndrome' may sound like an oxymoron, but it's a very real condition affecting men in their 20s, 30s, and beyond.
Sound a little too close to home? Whether you're seeking answers for yourself or a partner, here's everything you need to know about hard flaccid syndrome — including the causes, symptoms, and treatment options.
What is hard flaccid syndrome?
Often shortened to HFS, hard flaccid syndrome is a rare condition affecting the penis. For those experiencing the condition, the penis essentially stays in its shorter position even when hard.
Instead of being soft and stretchable like a typical erection, the penis is retracted to the lower abdomen like a turtle head, in a semi-rigid state [1].
It goes without saying, this makes it difficult to maintain an erection hard enough for intercourse.
But, not only does the condition affect erectile function, it can make sex uncomfortable for both parties and lead to chronic pelvic pain (yep, that's not just a thing for women).
Another name for 'hard flaccid syndrome' is 'non-erect erections' (yet another oxymoron) [2].
High-flow priapism is also a common differential diagnosis (a condition that shares similar symptoms), however specifically involves ruptured arteries and is not typically as painful [3]. Given the similarities in clinical presentation, misdiagnosis is unfortunately uncommon with hard flaccid syndrome.
What are the symptoms of hard flaccid syndrome?
As well as a retracted, painful penis during erections, hard flaccid symptoms [4] include:
- Temperature or penile sensory changes, such as coolness or numbness
- Pain during ejaculation or urination
- Difficulty getting or maintaining an erection, particularly when standing
- A rubbery texture (as opposed to spongey)
- Changes in the appearance of the penis, including curvature
- Bowel or bladder issues
- Decreased sensitivity or the need for excessive sexual stimulation in order to get hard
Hard flaccid syndrome can also cause significant emotional distress, which can manifest in mental health issues, chronic stress or decreased libido [5]. It can also negatively impact the sufferer's social life, confidence and wellbeing in relationships.
Is hard flaccid syndrome a type of erectile dysfunction?
Erectile dysfunction or ED is an umbrella term for when men struggle to get or maintain an erection for satisfactory sexual performance.
While it usually involves poor blood flow to the penis, there are many different causes — ranging from mental health and physical conditions to medical side effects and alcohol consumption (we've all heard of whiskey dick).
As hard flaccid syndrome impacts the ability to have healthy erections, it would be considered a type of impotence.
However, as it is usually linked to a specific injury, it tends to have a clearer trigger than other types of ED.
If you suspect you may be experiencing erectile dysfunction — whether it be more psychological or physical in nature — the good news is that help is available.
And, you don't have to have all the answers yourself. Through our personalised ED program, Pilot's team of experienced medical professionals can help you get to the root of the problem.
As part of your treatment, you’ll access limitless free follow-ups with a Pilot practitioner, and you can either opt for ongoing or on-the-spot treatments that are delivered right to your door.
What causes hard flaccid syndrome?
Having only been first described in medical literature in 2020, there is limited research into exactly what cases hard flaccid syndrome [6].
However, unlike other forms of erectile dysfunction, it's not typically linked to psychological, hormonal, or general health factors. Rather, it's believed that hard flaccid syndrome is usually caused specifically by physical trauma in the groin region.
This might be the result of an injury, rough masturbation or intercourse or ill-advised penis enlarging exercises like jelqing or Kegels. These traumatic events cause neurovascular structures in the shaft of the penis to be damaged [7].
This means the muscles are no longer about to fully relax or contract — restricting blood supply and leaving you with a semi-rigid penis.
There's also evidence that in some cases, a specific injury is not the only contributing factor to hard flaccid syndrome.
Pudendal neuralgia (entrapment or inflammation of the nerve running between your pubic bone and your tailbone) is a common co-morbid condition with HFS [8].
While not usually the primary cause, issues with the spine or sacral (the spot just between your back and bottom) can exacerbate hard flaccid syndrome.
Meanwhile, pelvic floor function also plays an important role — with poor posture and overactive pelvic floor muscles often making the condition worse.
How common is hard flaccid syndrome?
While hard flaccid syndrome is considered one of the rarer male sexual disorders, a lack of research and awareness makes it difficult to estimate prevalence. Plus, the stigma around male sexual dysfunction means this condition is likely underreported.
A survey of sexual medicine practitioners found that approximately 1/3 had never encountered the condition in their practices, while 74% reported seeing between 1 to 10 cases, and a smaller number had observed up to 50 cases [9].
Meanwhile, a qualitative analysis of internet forum discussions found that many sufferers seek help online, rather than visiting a doctor about their hard flaccid syndrome symptoms [10].
This may be due to shame, embarrassment, or fear that they will need to present their erect penis to a medical professional (which is not typically the case).
Unfortunately, this means that many men with HFS miss out on the support and effective treatment strategies to manage the condition — which results in living with chronic pain for longer than they need to.
How do you test for hard flaccid syndrome?
It's important to note that 'hard flaccid syndrome' is a term coined by patients, not doctors. While the condition is very much real, there's no one official clinical test for it.
That said, if you think you may be experiencing the symptoms, a doctor should be your first port of call — ideally, one is well-experienced in male sexual dysfunction.
Typically, a medical professional will ask you questions about your symptoms, lifestyle factors, and medical history.
They may also want to also do a physical examination of the penis (in its flaccid state) and run some medical imaging tests to check for any tears or damage.
Feel a little confronting? You can also have a free phone consult with one of our qualified medical professionals at Pilot. Through a quick, easy and discrete process, they'll be able to assess whether you're a good fit for our ED treatment. No physical exam or dick pics required!
Treating hard flaccid syndrome
Like most injuries, hard flaccid syndrome normally resolves itself with time. However, how long it takes to heal will depend on the nature and severity of the penile trauma.
Much like women experiencing vaginismus (a condition where the pelvic floor involuntarily tightens, which can make sex painful), stressing about symptoms during intercourse can ironically make the condition worse.
Therefore, most of the treatments for hard flaccid syndrome involve down-regulating the pelvic floor muscles.
This might involve doing pelvic floor therapy with a physiotherapist, to teach you ways to relax the overactive muscles.
There's also growing research around using shockwave therapy (involving low-frequency soundwaves to the penis to increase blood flow) as a treatment for hard flaccid syndrome.
However, studies indicate that this novel treatment is most effective when combined with other modalities, such as physical therapy [11].
Other treatment options focus on techniques to calm the mind before sexual intercourse, such as breathing exercises, meditation, and progressive muscle relaxation [12].
How to cure hard flaccid syndrome: A holistic approach
While hard flaccid syndrome usually doesn't last forever, that doesn't mean you have to just put up with the chronic penile pain and disruption to sexual function.
As well as the treatment options mentioned above, you may also want to explore other ways to improve blood flow and sexual arousal.
Whether you need daily or occasional support, our ED treatment helps put strong, lasting erections back in your hands again. Take our short questionnaire to find out if it's right for you.
Image credit: RDNE Stock project via Pexels
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