Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 10/23/2022
Male sexual dysfunctions aren’t just limited to well-known conditions like erectile dysfunction and premature ejaculation. Hard flaccid syndrome is a sexual dysfunction that’s only recently being recognized and researched.
At first glance, it sounds like a contradiction. How can you be hard and flaccid at the same time? But hard flaccid syndrome is a chronic condition that affects many men, as well as their social and sexual health.
Hard flaccid syndrome, or hard flaccid, is when the penis is constantly partially hard while it’s flaccid or when the penis doesn’t hang as low when not fully erect. When sexually aroused, this condition can prevent the penis from getting fully erect.
Like other sexual dysfunctions, hard flaccid can vary in severity. Symptoms can range from the penis feeling numb at rest to constant pain. This can also result in erectile dysfunction, as men may have problems maintaining erections or have painful erections. Hard flaccid is considered a type of chronic pelvic pain syndrome.
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 online men’s health forums and to their healthcare providers, prompting more research into the cause and treatment.
Hard flaccid can either be mild and last for only a few months or become a more persistent problem that lasts for years before being properly diagnosed.
Hard flaccid syndrome is typically present in men anywhere from their last teens through mid-thirties, although cases have been reported online from men just past puberty to their seventies.
While there is still a lot to learn about this condition, hard flaccid syndrome is fortunately gaining more attention from those dealing with male sexual dysfunctions, as well as from healthcare professionals and scientists.
The most common symptom of hard flaccid syndrome is exactly as the name says — having a hard or semi-hard penis while it’s also flaccid or soft. If symptoms persist, hard flaccid can cause other problems such as a lack of interest in sex and emotional distress.
Here are several other commonly reported symptoms of hard flaccid:
Not a typical erection, hard flaccid is most often recognized by the feeling of being hard or semi-hard even when the penis is not erect. The penis may also feel or appear shorter when flaccid.
Another noted symptom of hard flaccid is the penis feeling cold, numb or even a “hollow” sensation, as well as decreased sensitivity. This is because of low blood flow, as opposed to an erection with proper blood flow that feels warm to the touch.
While the penis is typically semi-hard as a result of hard flaccid syndrome, there can also be a loss of morning erections and further erectile dysfunction. You may be having trouble maintaining an erection during sex or find you need more stimulation than usual to get an erection. The head of the penis may also remain soft when you have an erection.
Whether you’re in constant pain or are having trouble maintaining an erection, hard flaccid can also result in anxiety, depression and stress. And the more you worry about what’s going on down there, the more stressed and anxious you’ll be, leaving you open to a vicious cycle of sorts.
Hard flaccid syndrome can also be characterized by pain most commonly while standing. Pain may occur anywhere between your navel and hips (due to tight pelvic floor muscles) or in the penis (because of muscle tension).
A tight or constantly tense pelvic floor makes urinating or having a bowel movement very difficult. This can result in a slower or lower volume stream of urine or even pain when going to the bathroom.
The actual cause of hard flaccid syndrome is unclear, but like other chronic pelvic pain syndromes, there are believed to be many different factors. Some men have reported that symptoms began after an injury to the penis during intercourse or vigorous masturbation.
In a normal erection, the muscles of the corpora cavernosa (the erectile chambers that run on the left and right sides of the penis) relax and allow blood to flow to and expand the penis.
When you have hard flaccid syndrome, these muscles may be constantly tensed, which limits blood flow in and out of the penis. Blood flow is a necessary part of developing and maintaining normal erections.
Our guide on how erections work goes into more detail about how blood vessels, nerves and other parts all work together for developing an erection.
Other causes of hard flaccid may include:
Stress. Whether physical (like an injury) or psychological (like anxiety), stress is believed to be a major contributing cause of hard flaccid syndrome.
Physical damage. Damage to the penis and surrounding area can affect nerve function and blood flow. This can happen with excessive or rough masturbation, aggressive intercourse (such as hitting the pubic bone of your partner) and excessive squatting (when weight lifting, for example).
Tight muscles. When the muscles that make up the pelvic floor or penis are contracted for long periods of time, the flow of blood is slowed down.
Nervous system imbalance. Our bodies' “fight or flight” response (caused by our sympathetic nervous system and used for survival) directs blood away from the penis and slows down erections. Some researchers believe hard flaccid patients experience increased “fight or flight” responses.
Anxiety or depression. When anxiety or worry about sex is severe or persistent, it may affect your ability to get and maintain an erection. Those dealing with hard flaccid may be overly focused on their condition, making their situation more stressful.
With very little clinical research on hard flaccid, many have self-diagnosed by reading online forums. Until recently, many men have been misdiagnosed with non-bacterial chronic prostatitis or Peyronie’s disease.
If you think you have hard flaccid syndrome, talk to your healthcare provider about your symptoms. Some key symptoms to look out for include chronic pain (especially while standing), a numb or “hollow” feeling in the penis and a semi-hard penis while in its flaccid state.
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.
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.
A good first step toward treating hard flaccid is understanding the condition. The more you know, the less stressed or anxious you may feel, which may help lessen the effects.
Another important step is reassuring yourself that you aren’t to blame for your hard flaccid condition.
Pelvic floor physical therapy may help lessen symptoms of hard flaccid syndrome. A physiotherapist can teach you exercises that target the pelvic floor muscles to strengthen them and ease tension.
Additionally, there are pelvic floor exercises every man can benefit from and try at home. Pelvic floor exercises can improve muscle control, relieve pelvic tension and increase strength, stamina and control in the penile muscles, improving erectile dysfunction.
Alleviating stress and anxiety is helpful for sexual health. Stress creates tension in the muscles, which reduces erectile function and makes the symptoms of hard flaccid syndrome worse.
Even if you think stressing less is easier said than done, it’s possible. A 2011 literature review showed that mindfulness and meditation are two useful stress-relieving techniques for chronic conditions. Communication between you and your partner(s) can also help relieve some of the stress you may be feeling.
Mental health issues like anxiety and depression can affect the way you think or feel about sex, especially when dealing with hard flaccid syndrome. Some treatment options that may be effective include:
Cognitive-behavioral therapy (CBT). A type of therapy that involves learning techniques to change thought patterns and behavior. Research suggests that CBT may help to treat hard flaccid syndrome.
Sex therapy. Sex therapy is a specialized form of counseling that’s intended to help people with sexual difficulties overcome them.
Counseling. Talking with a therapy practitioner, either from home or locally, may help those dealing with hard flaccid.
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 drugs on the market to help increase blood flow to the penis, such as sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®) and avanafil (Stendra®).
These medications work to increase blood flow to the penis, making it easier to get an erection during sexual stimulation. Some FDA-approved erectile dysfunction treatments include:
Sildenafil is the most common ED medication on the market. It works in 30 to 60 minutes and offers relief from erectile dysfunction for approximately four hours.
Vardenafil is a short-acting ED medication that’s available as a generic or as Levitra®. It has similar effects to sildenafil, but typically lasts for slightly longer.
Tadalafil is a longer-acting ED medication that’s available as a generic and as Cialis. A typical dose of tadalafil starts working in about one hour and may provide relief from ED for up to 36 hours.
Avanafil is a newer, more selective ED medication. It starts working in 15 to 30 minutes and is less likely to cause side effects than older ED medications. Currently, avanafil is only available under the brand name Stendra.
It’s important to talk to a healthcare provider before taking any medications. Our erectile dysfunction medications are available online, following a consultation with a licensed healthcare provider who will deem if medication is necessary.
Keep yourself physically active. Exercise can help with managing hard flaccid syndrome as well as the ability to maintain an erection and reduce stress. Try to get at least 150 minutes of moderate-intensity exercise each week.
Dealing with a relatively unknown condition like hard flaccid can be scary. But luckily, more information is being discovered every day. Your symptoms are valid and there’s no reason to be ashamed or embarrassed.
Talking with your healthcare provider is a good first step to treating hard flaccid syndrome. You can also talk with your partner and/or a therapy provider or counselor.
Starting a mindfulness or meditation practice or even something as simple as breathing techniques can reduce stress.
You can also try FDA-approved ED medications online via our telehealth platform following a consultation with a licensed healthcare provider.
Your journey to recovery from hard flaccid may take a combination of the treatments mentioned and time. So, please be patient with yourself and remember you are not alone in dealing with this condition.