Hard-flaccid syndrome: a systematic review of aetiopathophysiology, clinical presentation and management.
Level 4 - case-series / case-control
Systematic review of low-level observational and case-series evidence (8 studies)
PubMed 40624184 · doi:10.1038/s41443-025-01118-2
What was done
A systematic review was conducted to assess the aetiopathophysiology, clinical presentation, diagnostic evaluation, and management options for hard-flaccid syndrome (HFS). The search identified 8 eligible studies.
What was found
The abstract reports no numerical data, pooled estimates, or patient counts. It identifies penile trauma as a hypothesized initial trigger leading to neurovascular and inflammatory changes perpetuated by psychological distress. Documented features include perineal pain, urinary disturbances, and erectile or ejaculatory dysfunction. Reported interventions include phosphodiesterase-5 inhibitors, anxiolytics, low-intensity shockwave therapy, pelvic floor physical therapy, spinal surgery, and biopsychosocial therapy.
Why it matters
This review compiles the limited literature on an underrecognized condition, describing presenting symptoms and the diverse empirical treatments currently used.
Limits
The evidence base is extremely small (8 studies) and lacks randomized controlled trials or standardized diagnostic criteria. The abstract provides no quantitative outcomes, treatment efficacy metrics, or patient sample sizes.
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