Man holding his crotch

Painful Semi-erections: Could You Have Hard-Flaccid Syndrome?


  • Hard-flaccid syndrome (HFS)is a newly recognized form of chronic pelvic pain in men. 
  • HFS is thought to be a form of chronic pelvic pain syndrome (CPPS).
  • The primary symptom is a penis that can feel hard but is not erect, with the glans remaining flaccid (soft).
  • The causes of HFS are not yet completely understood. 
  • Recommended treatment is currently a mix of behavioral and physical measures. 

If you’re having pain in your pelvis, unusual sensations in your penis, and a near-constant semi-erection, you may have a newly identified condition called hard-flaccid syndrome. Read on to find out more about this condition, the causes, symptoms, and possible treatments. 

What is Hard-Flaccid Syndrome, and Who Is Susceptible?

Hard-flaccid syndrome is a condition that is emerging from the reports of physiologists and physiotherapists, who are recognizing it with increased frequency in men from their teens to their seventies. The majority of cases seem to occur in men in their thirties. These medical professionals, who work with chronic pelvic pain syndromes (CPPS), have recently begun focusing attention on men who report constant pelvic pain with associated penile symptoms. 

Men who seek medical care from urologists and physiotherapists for their pelvic pain report:

  • Penile and perineal pain that is worse in a standing position, usually better when sitting, and not present at all when the patient is lying down
  • A visibly shortened penis with a sensation of constant cramping and clenching
  • Changes in penile sensation, sometimes numbness 
  • Erectile dysfunction and especially a loss of regular morning erections
  • Needing excessive stimulation to achieve an erection while the glans (tip) of the penis sometimes remains flaccid  
  • Painful ejaculations and painful urination, sometimes accompanied by reduced urinary flow 
  • Psychological symptoms such as insomnia, anxiety, depression, and feelings of low self-worth

When doctors examine patients with these symptoms, they often find that the penis in its flaccid state has engorged corpora cavernosa muscles (as if it were erect). The erect penis feels very tight but with a flaccid glans. 

Diagram of male reproduction system.

What Causes Hard-Flaccid Syndrome?

The causes of the syndrome are not yet well known, as it has only recently been identified. More research and studies are necessary. Some research suggests that an injury to the base of an erect penis causes the first symptoms. Many physicians also suggest that stress is likely the biggest factor in causing the syndrome.

Stress can cause prolonged contraction of the muscles in the pelvic floor, leading to cramping and clenching. The surge of adrenaline and cortisol associated with stress affects blood flow and muscle contraction as well. The pain associated with the symptoms can then cause additional stress, causing the condition to worsen. 

What are the Symptoms of Hard-Flaccid Syndrome?  

The symptoms most commonly experienced by men with HFS include: 

  • Pain in the penis or perineum (the area between the penis and anus)
  • Feelings of constant cramping and clenching in the pelvis
  • Sensory changes to the penis (like feeling numb to the touch)
  • Erectile dysfunction (impotence)
  • Pain with ejaculation

Treatment and Management of Hard-Flaccid Syndrome

Because this is a newly recognized condition for men, treatment and management techniques are in the early stages of development. Indeed, there is not yet a consensus on the best approach. While some physicians recommend counseling or therapy to deal with the trauma, stress, and anxiety related to the disorder, other experts caution that these can actually make the problem worse by increasing the patient’s focus on his penis. 

The best option as of early 2021 seems to be a multi-faceted approach to treating the condition that includes:

  • Education for the patient reminding them that the penis is fully functional even with the syndrome and dispelling any belief that they are to blame for their condition
  • Behavioral therapy that encourages communication between the patient and their partner
  • Pelvic floor exercises, such as Kegel exercises, which may help ease muscle tension
  • Relaxation techniques such as breathing exercises, meditation, yoga, and other types of exercise
Man sitting on a beach in a meditative pose.

If you believe you are suffering from hard-flaccid syndrome, remember that you are not alone. Talk to your doctor about what you are experiencing, and consider making a free, confidential appointment with physicians to discuss possible treatment options. We are available at 1-800-467-5146 seven days a week, and we are committed to discreet, compassionate care for men of all ages.  

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