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Niedenfuehr J et al.,2024: Hard flaccid syndrome symptoms, comorbidities, and self-reported efficacy and satisfaction of treatments: a cross-sectional survey.

Niedenfuehr J, Stevens DM.
College of Public Health & Health Professions, University of Florida, Gainesville, FL, 32611, USA.
Independent researcher, Houston, TX, 77025, USA.
#Contributed equally.

Abstract

Hard flaccid syndrome (HFS) is a poorly understood condition with no formal consensus on its definition. We aimed to advance the understanding of HFS by evaluating symptom prevalence, cause of symptom onset, comorbidities, and self-reported efficacy and satisfaction with current treatments. An online, open, 42-question survey on Qualtrics with purposive and convenience sampling methods was conducted between May 9 and June 9, 2023 on participants self-identifying as having HFS. Participants were recruited through social media platforms. Only 58.0% of participants reported their HFS symptoms began following a specific incident/injury. Changes in penis shape/size (92.3%) and rigid penis when not erect (90.9%) were the most common complaints. Activities such as laying down and stretching improved symptoms in 73.0% and 44.1% of the participants, respectively, while masturbation and standing worsened symptoms in 75.9%, and 64.5% of the participants, respectively. Pudendal neuralgia (16.9%) was the most prevalent comorbid condition. Of those who participated in therapies, phosphodiesterase-5 (PDE5) inhibitor treatment had the highest patient global impression of change (PGIC) score (2.6 ± 1.1), indicating little to moderate improvement in symptoms. All other therapies scored between 1 and 2, indicating no change to little improvement in symptoms: pelvic floor physical therapy (PFPT) (1.8 ± 0.9), shockwave therapy (1.6 ± 1.1), diet/nutrition changes (1.6 ± 0.8), nerve blocks (1.6 ± 0.8), muscle relaxants (1.5 ± 0.6), anti-inflammatory medications (1.5 ± 0.7), cognitive therapy (1.4 ± 0.7), and nerve pain medications (1.4 ± 0.5). Overall, a direct injury to the penis may not necessarily be the only cause of HFS for some patients, and current therapies generally do not benefit most patients. A better understanding of the root causes of HFS and innovative treatment strategies are greatly needed for HFS patients.

Int J Impot Res. 2024 Feb 28. doi: 10.1038/s41443-024-00853-2. Online ahead of print. PMID: 38418867

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Comments 1

Jens Rassweiler on Tuesday, 21 May 2024 11:00

The article discusses Hard Flaccid Syndrome (HFS), a condition characterized by symptoms affecting the quality of life in individuals with a penis. These symptoms include urinary issues, constipation, difficulty with ejaculation, non-erections or pain, and pain at the base of the penis. The exact cause of HFS remains unclear, but several theories have been proposed:
o Traumatic injury to the penis
o Excessive masturbation
o Jelqing (a penis enlargement technique)
o Vascular issues
o Genito-pelvic dysesthesia (GPD), which suggests a nerve-related dysfunction involving the pelvis and genitals
o Pelvic floor dysfunction

HFS is a complex and poorly understood condition that can significantly impact the quality of life for those affected. Treatments attempted to alleviate symptoms include phosphodiesterase-5 inhibitors, shockwave therapy, nerve blocks, pelvic floor physical therapy (PFPT), and behavioral modifications, among others. However, minimal improvements have been reported, and the cause of HFS remains unclear, with theories ranging from traumatic injury to vascular issues.
The study conducted a cross-sectional online survey to evaluate symptoms, treatments, comorbidities, and activities affecting HFS symptoms. Convenience and purposive sampling methods were used, targeting online communities. Participants reported various symptoms, activities that worsen or improve symptoms, comorbidities including pudendal neuralgia and spinal issues, and areas of pain in the body. Treatment efficacy was generally poor, with phosphodiesterase-5 inhibitors receiving the highest average rating, but overall satisfaction with treatments was low:

Self-reported satisfaction with treatments was assessed with an 11-point slider scale (0 = completely dissatisfied to 10 = completely satisfied). PDE5 inhibitor treatment received the highest satisfaction score (4.8 ± 2.6), followed by PFPT (3.5 ± 2.4), cognitive therapy (2.9 ± 2.4), diet/nutrition changes (2.8 ± 2.6), nerve pain medications (2.7 ± 2.6), anti-inflammatory medications (2.6 ± 2.1), muscle relaxants (2.5 ± 2.0), shockwave therapy (2.0 ± 2.4), and nerve blocks (1.9 ± 1.5).
The study provides insights into HFS symptoms, potential causes, and comorbidities, highlighting the need for better understanding and treatment options. Limitations include potential sampling bias, self-reported diagnoses, and variable participant responses. Nonetheless, the findings contribute to future research and patient-centered care for HFS.
Extracorporeal Shockwave Therapy (ESWT) has been explored as a potential treatment option for Hard Flaccid Syndrome (HFS), although its role in managing this condition is still being investigated. Research on the use of ESWT specifically for HFS is limited. While some studies have investigated the use of shockwave therapy for related conditions such as erectile dysfunction and pelvic pain disorders, there is currently a lack of robust clinical evidence specifically examining the efficacy of ESWT for HFS.
Given the multifaceted nature of HFS and the variability in symptoms among individuals, a multidisciplinary approach to management is often recommended. This may involve a combination of treatments such as pelvic floor physical therapy, medications, behavioral modifications, and possibly ESWT, tailored to the specific needs of each patient.

The article discusses Hard Flaccid Syndrome (HFS), a condition characterized by symptoms affecting the quality of life in individuals with a penis. These symptoms include urinary issues, constipation, difficulty with ejaculation, non-erections or pain, and pain at the base of the penis. The exact cause of HFS remains unclear, but several theories have been proposed: o Traumatic injury to the penis o Excessive masturbation o Jelqing (a penis enlargement technique) o Vascular issues o Genito-pelvic dysesthesia (GPD), which suggests a nerve-related dysfunction involving the pelvis and genitals o Pelvic floor dysfunction HFS is a complex and poorly understood condition that can significantly impact the quality of life for those affected. Treatments attempted to alleviate symptoms include phosphodiesterase-5 inhibitors, shockwave therapy, nerve blocks, pelvic floor physical therapy (PFPT), and behavioral modifications, among others. However, minimal improvements have been reported, and the cause of HFS remains unclear, with theories ranging from traumatic injury to vascular issues. The study conducted a cross-sectional online survey to evaluate symptoms, treatments, comorbidities, and activities affecting HFS symptoms. Convenience and purposive sampling methods were used, targeting online communities. Participants reported various symptoms, activities that worsen or improve symptoms, comorbidities including pudendal neuralgia and spinal issues, and areas of pain in the body. Treatment efficacy was generally poor, with phosphodiesterase-5 inhibitors receiving the highest average rating, but overall satisfaction with treatments was low: Self-reported satisfaction with treatments was assessed with an 11-point slider scale (0 = completely dissatisfied to 10 = completely satisfied). PDE5 inhibitor treatment received the highest satisfaction score (4.8 ± 2.6), followed by PFPT (3.5 ± 2.4), cognitive therapy (2.9 ± 2.4), diet/nutrition changes (2.8 ± 2.6), nerve pain medications (2.7 ± 2.6), anti-inflammatory medications (2.6 ± 2.1), muscle relaxants (2.5 ± 2.0), shockwave therapy (2.0 ± 2.4), and nerve blocks (1.9 ± 1.5). The study provides insights into HFS symptoms, potential causes, and comorbidities, highlighting the need for better understanding and treatment options. Limitations include potential sampling bias, self-reported diagnoses, and variable participant responses. Nonetheless, the findings contribute to future research and patient-centered care for HFS. Extracorporeal Shockwave Therapy (ESWT) has been explored as a potential treatment option for Hard Flaccid Syndrome (HFS), although its role in managing this condition is still being investigated. Research on the use of ESWT specifically for HFS is limited. While some studies have investigated the use of shockwave therapy for related conditions such as erectile dysfunction and pelvic pain disorders, there is currently a lack of robust clinical evidence specifically examining the efficacy of ESWT for HFS. Given the multifaceted nature of HFS and the variability in symptoms among individuals, a multidisciplinary approach to management is often recommended. This may involve a combination of treatments such as pelvic floor physical therapy, medications, behavioral modifications, and possibly ESWT, tailored to the specific needs of each patient.
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