Hard Flaccid Syndrome: Causes, Symptoms and Treatment

In the last couple of years, hard flaccid syndrome (HFS) gained momentum. This condition sparked debates on online forums.

Some of the most common questions that pop up are “why do I go limp right before ejaculating” and “why is my erection not strong enough”.

It’s important to talk about HFS in detail, as it can be poorly understood. 

Those affected experience a loss in erectile rigidity and a semi-rigid penis at the flaccid state.

Characterized by erectile dysfunction, pelvic floor muscle contraction, penile sensory changes, and mental distress, there is a need to better understand the condition. Including the currently available treatment choices.

Here is a quick overview of the hard flaccid syndrome and its underlying mechanisms. 

What Is Hard Flaccid Syndrome (HFS)?

Many patients want to know, what does flaccid mean with HFS? A hard flaccid syndrome is known for causing chronic pain in the perineum (the spot between the anus and genitals) and the penis.

The penis is semi-rigid, even when it is not erect (flaccid). But, this sexual disorder has yet to be defined or formally recognized by the medical community of sexual and reproductive health.

What Are the Symptoms of Hard Flaccid Syndrome?

What does hard flaccid syndrome look like? Patients tend to report strange sensory changes in their penis, typically described by coldness or numbness. Paired with reduced sensitivity, mainly at the level of the glans.

According to the case series, those affected complain they don’t get as many nightly and morning erections (1). Instead, to achieve an erection, they need plenty of physical and visual stimulation. This is quite tricky to maintain. The hard flaccid symptoms get worse when the person is in a standing position.

Some of the recorded HFS symptoms include:

  • Loss in erectile rigidity
  • Feeling “semi-rigid” or “hard” even when the penis isn’t erect 
  • Penile sensory changes (ex: hard flaccid numbness, clenching, or cramping)
  • Urinary symptoms (like weak urine stream or pain when urinating)
  • Erectile dysfunction (mainly getting or keeping an erection)
  • Pain in the perineal region
  • Pain when ejaculating 
  • Issues with masturbation
  • Contraction of the pelvic floor muscles
  • Emotional distress (such as depression, anxiety, and stress)

The symptoms of hard flaccid syndrome, however, can vary from person to person. It’s important to have a discussion with a specialist to identify the problem and manage the erectile dysfunction, a recent publication shows. (2)

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What Causes Hard Flaccid Syndrome?

Patients want to know what causes a semi-hard syndrome. Most of those affected are in their 20s and 30s, stated the National Institutes of Health. And more data is necessary to figure out the exact cause. Researchers believe there could be multiple hard flaccid syndrome causes. 

Different factors can play a role. Such as lifestyle, psychological, biological, and environmental factors. Trauma or injury at the base of the penis while the organ is still erect can be seen as a trigger. Patients can unintentionally hurt themselves when masturbating or having sex. 

The damage to the nerves can lead to these hard flaccid syndrome symptoms. The initial event is a traumatic injury at the base of the penis while the organ is still erect. After the injury, the patient suffers structural damage to the nerves. Another probable cause is a penile nervous system imbalance. 

The parasympathetic nervous system supports erections. It increases blood flow and slows the heart rate. While sympathetic components slow erections. In a healthy individual, the body is capable of maintaining the right balance of parasympathetic tone and sympathetic tone. 

With hard flaccid syndrome, that may not be the case. There is an increase in sympathetic tone, which is weakening people’s erections.

Being extremely stressed, depressed, or anxious could worsen these symptoms. If men have serious mental unrest, then this can very well reflect on their performance. They can have bigger odds of experiencing erectile dysfunction and sexual dysfunction.

Risk Factors

The actual set of causes and risk factors for hard flaccid syndrome is unknown. But, stress can be a major risk factor. It causes prolonged contraction of the pelvic floor muscles. The stress could be psychological and physical in nature. 

Psychological stress causes a spike in adrenalin, prompting the “fight or flight” response. The body goes on high alert.

This has a direct impact on the blood that’s supposed to be going to some visceral organs. Like the pelvis, limbs, and stomach. Instead, some of the flow of blood is directed away from these organs.

The penis is the most sensitive organ in the male body. The fact that the adrenaline and cortisol levels pose a problem for normal blood flow, can unequivocally lead to erectile dysfunction, making it a probable risk factor for HFS.

Physical stress is triggered by an injury. Injuries can be minor or major. To reduce the risk of injuries, apply enough lubrication to the penis. And take extra precautions when having hard (vigorous) penetrative intercourse. Lubrication is also necessary when masturbating, as it causes less friction and enables smooth rubbing.  


Diagnosing Hard Flaccid Syndrome

Diagnosing HFS can revolve around multiple factors. Patients are expected to provide a full medical history to get checked for risk factors. Such as a history of penile trauma, the current state of their pelvic floor muscles, urinary tract infections, etc. 

Experts will use various techniques to identify the problem, which could include transperineal ultrasounds and perineal palpitation.

Transperineal ultrasound is a practical tool for investigating multiple pelvic floor muscles in men. This imaging can help evaluate the structure of the pelvic floor muscles.

While perineal palpitation testing can help measure the electrical activity of the heart. But, what do heart palpitations have to do with HFS?

There is a close link between heart problems and erectile dysfunction. Men with ED have higher odds of getting diagnosed with an irregular heartbeat. 

To top it all off, stress can lead to heart rhythm disorders. Particularly atrial fibrillation. That’s why it may be necessary to take a closer look at the quivering or irregular heartbeat when diagnosing hard flaccid syndrome.

Overall, the hard flaccid syndrome is evaluated with a diagnosis of exclusion. Meaning that the medical condition is reached by a process of elimination.

So, most men might have to see multiple doctors and could get misdiagnosed with other similar conditions before they get a correct diagnosis. A similar condition can be penile curvature (Peyronie’s disease). 

Many patients may also be encouraged to do an intensive investigation before they get a diagnosis. Such as doing PSA testing, blood tests, and hormone profiling. As well as a screen for STIs (sexually transmitted infections), urine culture and urinalysis, and flexible cystoscopy. 

Depending on how the penis is affected, a penis/pelvis MRI can also help. The goal may be to get as many examinations as possible to reach a proper diagnosis.

Some experts estimate that the key signs of hard flaccid syndrome could be shortening of the penis. However, this is highly subjective. The chronic aches could also slump in the supine position. That’s why some patients describe their penis as “feeling hollow”.

How Do You Get Rid of Hard Flaccid Syndrome?

How to treat hard flaccid syndrome? HFS is hard to treat. Also, it isn’t widely recognized as a condition by many urologists. But, there can be ways to manage it.

The core of hard flaccid treatment is to get to the root of the problem. Patients may need to alleviate their depression, stress, and anxiety, all of which are known to make the ailment worse.

Educating patients on how to take better care of their penile health can also come in handy. Like what foods to eat and finding ways how to avoid injuries to the penis.

Ideally, doctors should unpack all the probable trigger points that could have led to the syndrome. These can be some practical steps on how to fix hard flaccid syndrome.

Medical Treatment

HFS treatment is typically carried out by a qualified physiotherapist in a clinic. Patients do various physical activities that can get their pelvic floor function back on track. The goal isn’t to make these muscles stronger but to down-regulate them. 

For mild HFS cases, pelvic yoga may help. Pelvic yoga aids in bringing mobility to the muscles around and in the pelvis. It can help re-establish better coordination of muscle contractions in this particular area. It is used to curb the aches that have resulted from pelvic floor dysfunction. 

Currently, focused shockwave (FSW) therapy is the go-to choice for treating this condition. It relies on a wand to release gentle and targeted shockwave pulses at the penile tissue. The therapy lasts for roughly 15 minutes. This non-invasive treatment is meant to promote circulation. As well as help with healthy erections.

The low-intensity shockwaves could also be used to grow new blood vessels and increase blood flow to the penis, which are a fundamental component in healthy erections. The procedure isn’t painful at all. It feels more like sensations rather than pain.


Home Remedies & Lifestyle Changes

Some home-based physical activities could work in your favor and may beat hard flaccid penile pain syndrome.

Pelvic floor relaxation

In between doctor visits, it’s crucial that you use pelvic floor relaxation & stretching exercises. But, talk to your physiotherapist to figure out the nuts and bolts of your exercising strategy. Such as the intensity and frequency of the physical activity.

Going overboard could create the opposite effect. You will be taking the movements to the point of tension without experiencing any pain. The idea is to loosen the muscles and stretch on a daily basis. 

Stretching exercises

Some of the hard flaccid exercises for men might include:

  • Knee to chest stretches by lying on the back and bending one knee to the chest. Then repeat with the other leg.
  • Child pose stretch. You will kneel and sit on the knees, then lean forward to rest the forehead on the floor by stretching the back and muscles around the hips.
  • Knee to opposite shoulder stretch. You can lie down on the floor and bring the right knee to the chest and diagonally to the opposite shoulder. Hold, stretch, and repeat with the other leg.

Reduce stress

Other than the treatment methods, men might also have to incorporate some practical lifestyle changes and healthy eating strategies. To mitigate the syndrome, it’s important to keep the stress at bay. Alleviating any stressors in your life can reduce the strain on erectile function and HFS.

Physical activity

If you are living a sedentary lifestyle, then it may be best to incorporate at least 20 to 30 minutes of moderate physical activity a day. Anything from swimming, and walking, to cycling and jogging can offer notable benefits. Being active can improve your sexual health.

That’s because your circulation gets a solid boost. When you are doing any physical activity, you increase blood flow. This promotes normal circulatory system function. And the stronger the blood flow, the better the arousal. 

Manage sexual performance anxiety

In men, blood flow has a lot to do with erections, and it’s instrumental in enjoying intercourse. If you want to know how to stay erect when nervous, it’s best to talk openly with your partner about your sexual performance anxiety. You can also try to distract yourself with a sexy movie or let romantic music play in the background. 


For those in need of penile exercise for hardness, Kegels can help. Ask a specialist for advice on how to do penile exercises for hardness the right way. They can help you pick out the best exercise for a harder erection to up your game.

Can Hard Flaccid Syndrome Be Cured?

How to get rid of penile numbness with HFS? Many people want to know how to cure hard flaccid syndrome. But, there isn’t any data that talks about a hard flaccid cure. For now, there is some effective treatment that could mitigate the symptoms. 

When physical therapy like stretching, penile rehab exercises, and trigger point therapy is not enough, it’s important to focus on mental therapy. This condition isn’t purely physical.

It is also poorly understood and a difficult problem to treat. Mainly because hard flaccid recovery can take a long time.

Managing the stress, anxiety, and depression triggers could offer ample results. However, right now there is no definite hard flaccid syndrome cure.


Sexual dysfunctions are a well-known complaint among men. All kinds of treatments and medications are being used to help improve sexual performance.

Hard flaccid syndrome only recently gained a notable online presence. Especially on online forums and health sites.

Although more research and scientific materials are necessary to understand the various HFS disturbances, there are some treatment methods that could help.

If your penis feels numb or you need erection exercises to keep erect, talk to a specialist and visit a sexual health clinic. They can help assess the development of this condition and may offer some practical guidelines on how to boost the quality of your sex life.

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  1. Abdessater M, Kanbar A, Akakpo W, Beley S. Hard flaccid syndrome: state of current knowledge. Basic Clin Androl. 2020;30:7. Published 2020 Jun 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271516/
  2. Gul M, Huynh LM, El-Khatib FM, Yafi FA, Serefoglu EC. A qualitative analysis of Internet forum discussions on hard flaccid syndrome. Int J Impot Res. 2020 Sep;32(5):503-509. https://pubmed.ncbi.nlm.nih.gov/31175339/

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