Diagram of the pelvic floorThe emergence of Hard Flaccid Syndrome (HFS) as a clinical diagnosis is still relatively new to many medical professionals. However, as a Men’s Pelvic Health physical therapist, this is something I have seen in the clinic for years. The vast majority of patients are left frustrated and concerned when they are unable to get a proper diagnosis from their doctor. Often they are told everything looks “normal” and that there is nothing they can do. Fortunately, physical therapy can be very effective at reducing the clinical manifestations of HFS, which include:

  1. Constant semi-erect/semi-flaccid penis (stuck in limbo between erect and flaccid)
  2. Pain in the shaft of the penis and pelvic floor area (base of the penis to sit bones)
  3. Weak, painful, or unable to achieve an ejaculation
  4. Decreased sensation or control of the penis and surrounding pelvic floor muscles
  5. Pale appearance of the penis shaft and head

The prevailing thought was that HFS was only caused by excessive masturbation. However, this is often not the case, as I have seen several cases that are related to sexual trauma, pelvic floor muscle dysfunction, and athletic injuries. As the pelvic floor muscles become tight and sensitive, they can create a cascade of autonomic symptoms that can influence and dampen sexual arousal and activity.

Treatment of HFS relies on a thorough evaluation from a Men’s Health PT who can properly identify the involved musculature. After identifying contributing factors, it then becomes rehab just like any area of the body: decrease muscle guarding/tightness, increase blood flow and awareness of the area, gradually restore the function of muscles (control, strength, endurance), introduce back to desired activities (sexual activity).

Dr. Nathan Mayberry PT, DPT, OCS, CMTPT, CSCS