(264) HARD-FLACCID SYNDROME: A SURVEY OF SEXUAL MEDICINE PRACTITIONERS’ KNOWLEDGE AND EXPERIENCE
Authors: Gryzinski G , Hammad MA , Alzweri L , Azad B , Barham D , Lumbiganon S , Serefoglu E , Yafi F 
Published: December 2024

Abstract

Introduction
Hard-flaccid syndrome (HFS) is a condition of male sexual dysfunction (MSD) that has become a relatively new focus in online forums and urologic conferences. It is a poorly understood syndrome characterized by chronic pain, a partially rigid penis while in a flaccid state, and erectile dysfunction. HFS primarily affects men in their second and third decade of life, but its exact pathophysiology remains uncertain, with hypotheses suggesting a combination of physical and psychological factors. Consequently, an evidence-based understanding of HFS is lacking within the sexual medicine community.

Objective
Identify and quantify the current level of understanding of HFS in the sexual medicine academic society.

Methods
A survey was provided to sexual medicine practitioners at the 2023 American Urological Association (AUA) Annual Meeting who attended a plenary focusing on sexual medicine. Each survey form included a screening question to determine familiarity with HFS. If they were familiar with HFS, there were multiple additional questions querying experience with HFS in their patients, modalities of diagnosis, preferred therapy options, in addition to others. These answers were then extracted onto a spreadsheet and analyzed.

Results
According to the registration reports from the 2023 AUA conference, there were 37 attendees at the sexual medicine plenary. A total of 36 survey responses were submitted. Of these, 35 were urologists and 1 responder was a mental health professional. 23 of the 36 respondents (64%) had seen patients with HFS in their practice. Practitioners who had not seen HFS did not complete the rest of the survey. Among the respondents, 8 (35%) acquired knowledge about HFS through colleagues, 6 (26%) mentioned medical journals, 4 (17%) mentioned conferences, 4 (17%) mentioned patients, and 1 (5%) stated that they first heard about it from an online pelvic floor therapist. Regarding the diagnostic approach for HFS in their practice, 17 responders considered clinical history, 16 relied on patient self-diagnosis, and 1 utilized imaging, although the specific imaging modality was not specified. Most respondents (74%) indicated that they had seen 1-10 patients with HFS, with 4 and 2 respondents reporting 11-20 and 21-50 patients, respectively. In terms of their beliefs about HFS as a legitimate condition, 12 responders expressed confidence in its existence, while 7 remained uncertain. Most respondents (11) suggested pelvic floor therapy as the optimal approach, with 10 recommending combination therapy.

Conclusions
This analysis highlights the ongoing lack of familiarity with HFS among professionals. This project provides valuable insights into the current understanding of this complex condition. The outcome emphasizes the critical need for continued education and research on HFS to improve diagnostic accuracy, enhance patient care, and develop effective treatment strategies.

Disclosure
No.