Association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome: A scoping review

Abstract

Aim:To describe the association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome.Methods: A scoping review was performed according to the recommendations of the Joanna Briggs Institute. Moreover, we performed a search strategy using the MED-LINE, EMBASE, and CENTRAL databases. We included the available information, evaluating the conditions of partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome, and their molecular and physiological mechanisms and clinical presentation. Results:We identified 207 articles and chose eight studies published between 2001 and 2021. The total number of patients was 34, and their mean age was 28.2 years.Moreover, in 84% of the studies, the pathophysiology of the events was related to microtrauma or prolonged perineal compression. Additionally, 94.2% of the patients had some degree of erectile dysfunction. In addition, out of all patients, 94% underwent magnetic resonance imaging (MRI). However, patients with hard flaccid syndrome did not show relevant findings in these studies. Conversely, MRI showed asymmetry in the proximal corpora cavernosa, thrombosed corpus cavernosum segments, and mainly cavernous fibrous septum in patients with partial cavernous thrombosis and partial priapism. Conclusion:Partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome occurred more frequently in young patients, possibly related to microtraumas that generate cavernous fibrosis and trigger alterations in the erection of the distal portion of the penis. Additionally, they cause proximal hardening of the pelvis, perineal pain, painful ejaculations, and cavernous asymmetry. Moreover, the imaging characteristics are similar in patients with partial priapism and partial cavernous thrombosis.

Hard Flaccid Syndrome: A Biopsychosocial Management Approach with Emphasis on Pain Management, Exercise Therapy and Education

“…This case report presents a multimodal management approach for HFS. Although diagnostic and pathophysiological mechanisms are still not fully acknowledged, understood, or established [2,25], and despite the scarcity of research in HFS, the clinical presentation and overall symptomatology of the patient were in accordance with current published literature on the syndrome [1][2][3][4]26]. In addition, the patient's clinical presentation revealed similarities with various other pelvic syndromes and chronic pain states, which do not affect only the somatosensory and motor components of the patient, but also the psychological, social, relationship and sexual dimensions of the patient; thus, requiring a biopsychosocial management approach.…”

“…Although pathophysiological mechanisms are not well defined or understood, symptom onset is suggested to be related to penile trauma via incident(s) of vigorous sexual intercourse or masturbation, including jelqing (a set of penis stretching exercises that some believe can enlarge the size of the penis) among other activities, traumatizing the base of the erect penis and its associated neurovascular structures, which provide nerve and blood supply to the pelvic floor muscles and the penis itself; thus, explaining the somatosensory changes described by patients in this area [1,4]. These presentations in turn, cause emotional distress and/or anxiety, initiating a sympathetic reaction, which is suggested to induce a series of adverse effects, such as prolonged pelvic floor muscle spasms, further obstructing the skin, musculature and neurovascular supply to this area.…”

Hard-Flaccid syndrome: a survey of sexual medicine practitioners’ knowledge and experience

“…The pathophysiologic process is thought to be an emotional reaction following injury and noticing the sensory changes on the penis which then causes a feedback loop where this reaction triggers a hypersympathetic response leading to extensive pelvic floor muscle spasms which ultimately causes additional extrinsic damage to the penile neurovascular bundles [1,4]. Work-up including cross-sectional imaging, penile ultrasound doppler, and labs tests tend to be completely normal [1,5]. Regarding the treatment of HFS, there have been combinations utilized with pelvic physical therapy, lifestyle and behavioral modifications, antidepressants, and phosphodiesterase 5 (PDE5) inhibitors.…”

Bilateral partial thrombosis of the corpus cavernosum associated with the use of a stationary bike. Case report and literature review

“… 2 The presence of priapism can be associated with this condition, being considered within the spectrum of erectile dysfunction pathologies with hard flaccidity syndrome and partial priapism. 3 The chronic bilateral form of a presentation not associated with priapism is rare and reveals the importance of its early suspicion. 1 …”