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Hard Flaccid Syndrome: Symptoms & Treatments

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Geoffrey C. Whittaker

Published 10/22/2022

Updated 03/11/2024

Sexual dysfunction is something most men associate with erectile dysfunction (ED) — the inability to get or maintain an erection. But ED isn’t the only pelvic health condition that can affect your ability to maintain an erect penis.

Sexual medicine doesn’t widely recognize hard flaccid syndrome (HFS), a condition characterized by a semi-rigid penis in the flaccid state and numerous other symptoms including pain, urinary symptoms and psychological distress. But individuals reporting these issues certainly do, and many of them go through repeated urology visits — and probably a lot of Google searching —  in an attempt to get answers. 

The state of current knowledge on this condition isn’t all that impressive, but below we’ve shared what little information we could find about the symptoms, potential causes and treatment theories for dealing with hard flaccid syndrome. If it’s a sexual health issue you believe you might be dealing with, here’s what you need to know.

Hard flaccid syndrome, also called simply hard flaccid, is a condition in which the semi-rigid penis never fully relaxes but also may have difficulty hardening all the way.

Hard flaccid is considered a type of chronic pelvic pain syndrome. It varies in severity, but when a guy is sexually aroused, hard flaccid can prevent their penis from functioning as expected. Moreover, it can cause a bunch of other symptoms, including numbness or penile pain.

Although hard flaccid syndrome hasn’t been recognized as an official medical condition by healthcare professionals, thousands of men have reported their symptoms and experiences in men’s health forums and to healthcare providers, prompting more research into causes and treatments.

Hard flaccid isn’t exactly a type of ED, but it can result in erectile dysfunction. This is because, when you have hard flaccid syndrome, your pelvic floor muscles may be constantly tensed, which could limit blood flow and nerve signals to the penis. There could also be structural damage or malformations that impact blood flow and nerve signaling. Blood flow is a necessary part of developing and maintaining normal erections.

This condition most commonly affects men in their 20s and 30s.

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We’ve already stated the obvious primary symptom, but over time, hard flaccid can cause other problems, such as a lack of interest in sex and emotional distress.

Commonly reported hard flaccid symptoms include:

  • Constant rigidity

  • Numbness

  • A “hollow” feeling in the penis

  • Cold penis

  • Difficulty getting an erection, including morning erections

  • Emotional distress

  • Painful ejaculation

  • Pain in the glans, shaft or base of the penis

  • Perineal pain due to tight pelvic floor muscles

  • Pain or trouble urinating, or lower volume stream of urine 

The cause of hard flaccid syndrome is unclear right now, but like other chronic pelvic pain syndromes, many different factors could be at play. 

Some factors thought to contribute to hard flaccid syndrome include injury to the penis during sex or vigorous masturbation. And the initial symptoms may cause distress and sympathetic stimulation, which can lead to worsening symptoms.

Many men self-diagnose hard flaccid by reading online forums and, until recently, those who did visit a doctor were often misdiagnosed.

Hard flaccid syndrome is, fortunately, gaining more attention from researchers and healthcare professionals who deal with male sexual dysfunctions.

If you’re looking for a diagnosis, your healthcare provider may ask to run some medical tests, such as blood tests, an imaging test (or Doppler ultrasound) of the penis, urine test and sexually transmitted infection screening.

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Although hard flaccid syndrome treatment doesn’t have a standard protocol, researchers believe a combination of treatments can help. Treatment may include medications for pain management, pelvic floor physical therapy, stress reduction techniques and/or counseling.

Specifically, your healthcare provider may suggest:

Erectile Dysfunction Treatments

Hard flaccid syndrome can make it difficult to get or keep an erection during sexual intercourse. 

If you’re dealing with erectile dysfunction as a symptom of hard flaccid, there are currently several FDA-approved oral ED medications on the market, such as Viagra® (sildenafil), Cialis® (tadalafil) and Stendra® (avanafil ). These medications, which are in a class of drugs called PDE5 inhibitors, may be able to help you get and sustain an erection by increasing blood flow to your penis.

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Finding yourself in a permanent flaccid state is not what any man wants, so if your erectile function seems off, it’s important to talk to a healthcare professional about it ASAP. Your sexual quality of life is important — whether medical science has caught up with your symptoms or not, getting help is crucial early on.

In the meantime, here’s what you should know, no Reddit forums required:

  • Hard flaccid syndrome is a condition in which men can be stuck in a semi-erect state, potentially making it difficult to get to a full erection and being unable to return to a fully flaccid penis.

  • Various potential causes are linked to hard flaccid — a traumatic event or injury to the penis, perineum or pudendal nerves could be responsible.

  • Hard flaccid may produce chronic pain, sensory changes in your sensitivity and other secondary side effects.

  • Treatment options include physiotherapy, medication and mental health support, but they all begin with a conversation with a healthcare professional.

5 Sources

  1. U.S. Department of Health and Human Services. (n.d.-e). Treatment for erectile dysfunction - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment.
  2. Abdessater, M., Kanbar, A., Akakpo, W., & Beley, S. (2020). Hard flaccid syndrome: state of current knowledge. Basic and clinical andrology, 30, 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271516/.
  3. Baxter, R. (2021, September 13). What is hard flaccid syndrome?. ISSM. https://www.issm.info/sexual-health-qa/what-is-hard-flaccid-syndrome.
  4. Dorey, G., Speakman, M., Feneley, R., Swinkels, A., Dunn, C., & Ewings, P. (2004). Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. The British journal of general practice : the journal of the Royal College of General Practitioners, 54(508), 819–825. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324914/.
  5. Gul, M., Huynh, L. M., El-Khatib, F. M., Yafi, F. A., & Serefoglu, E. C. (2020). A qualitative analysis of Internet forum discussions on hard flaccid syndrome. International journal of impotence research, 32(5), 503–509. https://pubmed.ncbi.nlm.nih.gov/31175339/.
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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