Men’s Health - Hard Flaccid Syndrome
June is Men’s Health Month—and we're using this opportunity to highlight an often overlooked topic: how pelvic floor dysfunction shows up in men.
In a previous post, we covered signs that pelvic therapy might be right for you as a male patient, including discussions on nonbacterial prostatitis and interstitial cystitis—both of which can be closely tied to the pelvic floor.
In this article, we’re focusing on something newer to the clinical conversation: Hard Flaccid Syndrome (HFS).
At The Pelvic Model, we frequently see individuals navigating complex pelvic symptoms—some of which are only now beginning to gain recognition in medical literature. Hard Flaccid is one of those conditions. While it's still poorly understood in mainstream healthcare, we’ve seen firsthand how real and disruptive it can be. Our goal here is to bring clarity to this topic and share how pelvic therapy can play a meaningful role in recovery.
Hard Flaccid Syndrome:
The history of Hard Flaccid Syndrome is very interesting as it did not start with a urological or pelvic therapy origin. In fact, the term was coined by online forums like Reddit, and people would share their experience with the symptoms including:
Semi-erect penis – neither fully erect or fully soft
Penile sensory changes
Erectile dysfunction and decreased morning/nocturnal erections
Associated with pain with urination and ejaculation
Often accompanied by anxiety and depression
A Quick History:
Hard Flaccid Syndrome wasn’t originally described in medical textbooks—it was identified by patients themselves.
Around the mid-2000s, men began posting on online health forums about this perplexing set of symptoms: a semi-hard penis, numbness, loss of spontaneous erections, and intense anxiety. As patterns emerged, they gave it a name—"hard flaccid"—to describe the paradoxical experience of being partially erect without arousal.
For years, the condition lived mostly online. But in 2020, a review article titled “Hard Flaccid Syndrome: State of Current Knowledge” was published in Translational Andrology and Urology, formally acknowledging the syndrome in academic literature. Since then, a growing number of case reports and practitioner surveys have called for broader recognition and clinical research.
While HFS is not yet a formally coded medical diagnosis, it is increasingly understood among pelvic health and sexual medicine providers.
What Causes It?
Because HFS is still being defined by the medical community, it is still unclear what actually causes it. However, most people who experience this report their symptoms started after a traumatic event (e.g. use of vacuum, rough masturbation or sex, jelqing, excessive squatting). Several patients on forums report that this occurred after use of substances like marijuana and bremelanotide.
The penis is supplied by a bundle of vessels, innervated by the pudendal and dorsal nerve of the penis creating vascular and sensory changes reported by the individual experiencing symptoms. Further, the initial symptoms of Hard Flaccid often set off a cycle of emotional stress and nervous system overdrive. This stress response can lead to ongoing tension in the pelvic floor muscles, which may compress important nerves and blood vessels in the area. Over time, this can reduce blood flow (causing penile hypoxia), irritate nerves (leading to sensory changes), and interfere with how the pelvic muscles work.
What Can Pelvic Therapy Do?
At The Pelvic Model, we approach Hard Flaccid through a comprehensive, biopsychosocial lens. Our treatments are individualized, evidence-informed, and collaborative.
Treatment may include:
Pelvic floor manual therapy to reduce muscle tension
Neuromuscular re-education for healthy coordination and tone
Nerve desensitization techniques and gentle mobility work
Breath-led movement to regulate the nervous system
Education and support around pain, sexuality, and function
Coordination with urology or mental health if needed
You are not alone –
We know that it is difficult to find providers who know about HFS and have seen this condition before. We want to let you know that we know about HFS, and that you are not alone! We are equipped with the current knowledge, and we are here to guide you through. Feel free to reach out, and we can help you get started on your healing journey.
