Idiopathic Penile Pain: When We Can't See the Problem at the 25th SMSNA Annual Fall Scientific Meeting
On the third day of the 25th SMSNA Annual Fall Scientific Meeting, Dr. Sherita King discussed the challenges of diagnosing and treating idiopathic penile pain, particularly for conditions like hard flaccid syndrome. This type of pain, with no clear underlying cause, can be difficult to address, but Dr. King outlined an approach to guide practitioners.
The diagnostic process includes a thorough workup: detailed history-taking with “pain mapping,” physical exams, lab work, penile ultrasound, pelvic MRI, and possibly other imaging like spine and hip scans. Nerve conduction studies may also be considered. Differential diagnoses cover infectious causes, structural issues such as Peyronie's disease and penile trauma, neuropathic pain, and psychological factors.
Hard flaccid syndrome presents as a semi-rigid penis in a flaccid state, accompanied by numbness, reduced sensation, erectile dysfunction, and pain during urination or ejaculation. This condition often causes emotional distress, particularly in younger men, most commonly between ages 20-30.
Dr. King stressed the need for multimodal treatment, including behavioral modifications, medications such as NSAIDs and topical lidocaine, physical therapy, psychotherapy, PDE5 inhibitors, antidepressants, and potentially nerve blocks. Penile nerve decompression may be considered in some cases.
The key takeaway from Dr. King’s talk is that treating conditions like hard flaccid syndrome requires a holistic, patient-centered approach. Patients are often frustrated and simply want to be heard, making empathetic care and the use of multiple treatment modalities essential for their management.
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