Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

A qualitative analysis of Internet forum discussions on hard flaccid syndrome

International Journal of Impotence Research volume 32, pages 503–509 (2020)Cite this article

Subjects

A Comment to this article was published on 02 September 2019

Abstract

Hard flaccid (HF) syndrome is a complex symptom that significantly impacts a man’s sexual and social life. Since there is currently only one case series available in the literature regarding HF syndrome, it has not been recognized as a real medical condition. HF syndrome has mostly been reported in several patient forums and its exact definition, prevalence, etiology, and treatment are unknown. We hereby, aimed to understand the nature of HF syndrome and how it is perceived among men. Online forum sites in the English language were systematically evaluated to perform a descriptive qualitative assessment. “Hard flaccid; forum” term was searched in Google® and data were collected from forum posts. Datasets were analyzed using thematic analysis within a three-month period (September 2018–November 2018) and were combined to triangulate analysis. A total of 12 forum discussions, containing 6150 comments, were analyzed. Themes that arose included: “I would like to ensure that I have HF”; “How did I end up like this?”; “Seeking support for treatment choices – who will help me?”; “How can I cope with this condition?”. Thematic analysis revealed that most HF cases began after a traumatic event. The reported incidence of HF-related symptoms varies considerably. The most commonly associated symptoms of HF are penile semi-hardness in the flaccid state, penile sensory changes, erectile dysfunction, and emotional distress. Although it is not recognized by major medical authorities, many men appear to suffer from symptoms related to HF syndrome. Future basic science and clinical studies must be conducted to understand the exact pathophysiology of HF syndrome and to develop effective therapies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17:39–57.

    Article  CAS  Google Scholar 

  2. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res. 2000;12:305–11.

    Article  CAS  Google Scholar 

  3. Porst H, Montorsi F, Rosen RC, Gaynor L, Grupe S, Alexander J. The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking. Eur Urol. 2007;51:816–23.

    Article  Google Scholar 

  4. Balon R. Burden of sexual dysfunction. J Sex Marital Ther. 2017;43:49–55.

    Article  Google Scholar 

  5. Gül M, Towe M, Yafi F, Serefoglu EC. Hard flaccid syndrome: initial report of four cases. Int J Impot Res. 2019. https://doi.org/10.1038/s41443-019-0133-z.

  6. Hughes K, Parnham A, Lucky M. Hard flaccid syndrome. Urology News. 2018. https://www.urologynews.uk.com/features/synopsis/post/hard-flaccid-syndrome. Accessed 9 Mar 2019.

  7. Jamison J, Sutton S, Mant J, De Simoni A. Online stroke forum as source of data for qualitative research: insights from a comparison with patients’ interviews. BMJ Open. 2018. https://doi.org/10.1136/bmjopen-2017-020133.

  8. Eysenbach G, Wyatt J. Using the Internet for surveys and health research. J Med Internet Res. 2002;4:E13.

    Article  Google Scholar 

  9. Im E-O, Chee W. An online forum as a qualitative research method: practical issues. Nurs Res. 2006;55:267–73.

    Article  Google Scholar 

  10. Mays N, Pope C. Rigour and qualitative research. BMJ. 1995;311:109–12.

    Article  CAS  Google Scholar 

  11. Im E-O, Chee W. Practical guidelines for qualitative research using online forums. Comput Inf Nurs. 2012;30:604–11.

    Google Scholar 

  12. Alinia H, Moradi Tuchayi S, Farhangian ME, Huang KE, Taylor SL, Kuo S, et al. Rosacea patients seeking advice: qualitative analysis of patients’ posts on a rosacea support forum. J Dermatol Treat. 2016;27:99–102.

    Article  Google Scholar 

  13. McKechnie V, Barker C, Stott J. The effectiveness of an Internet support forum for carers of people with dementia: a pre-post cohort study. J Med Internet Res. 2014;16:e68.

    Article  Google Scholar 

  14. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:334–40.

    Article  CAS  Google Scholar 

  15. Im E-O, Lee BI, Chee W, Dormire S, Brown A. A national multiethnic online forum study on menopausal symptom experience. Nurs Res. 2010;59:26–33.

    Article  Google Scholar 

  16. Beck CT. Routledge international handbook of qualitative nursing research. Abingdon: Routledge; 2013.

  17. Petrovska K, Sheehan A, Homer CSE. The fact and the fiction: a prospective study of Internet forum discussions on vaginal breech birth. Women Birth. 2017;30:e96–102.

    Article  Google Scholar 

  18. Eastham LA. Research using blogs for data: public documents or private musings? Res Nurs Health. 2011;34:353–61.

    Article  Google Scholar 

  19. Wang L, Wang J, Wang M, Li Y, Liang Y, Xu D. Using Internet search engines to obtain medical information: a comparative study. J Med Internet Res. 2012. https://doi.org/10.2196/jmir.1943.

  20. Maguire M, Delahunt B. Doing a thematic analysis: a practical, step-by-step guide for learning and teaching scholars. AISHE J. 2017;9:3351–33514. http://ojs.aishe.org/index.php/aishe-j/article/view/335/553.

    Google Scholar 

  21. Dahlen HG, Homer CSE. ‘Motherbirth or childbirth’? A prospective analysis of vaginal birth after caesarean blogs. Midwifery. 2013;29:167–73.

    Article  Google Scholar 

  22. Hanna E, Gough B. Emoting infertility online: a qualitative analysis of men’s forum posts. Health (Lond). 2016;20:363–82.

    Article  Google Scholar 

  23. Okolokulak E, Volchkevich D. Vascularization of the male penis. Rocz Akad Med Bialymst. 2004;49:285–91.

    CAS  PubMed  Google Scholar 

  24. Shoskes DA. The challenge of erectile dysfunction in the man with chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2012;13:263–7.

    Article  Google Scholar 

  25. Sommer F, König D, Graft C, Schwarzer U, Bertram C, Klotz T, et al. Impotence and genital numbness in cyclists. Int J Sports Med. 2001;22:410–3.

    Article  CAS  Google Scholar 

  26. Wu AK, Lue TF. Commentary on high flow, non-ischemic, priapism. Transl Androl Urol. 2012;1:109–12.

    PubMed  PubMed Central  Google Scholar 

  27. Oberpenning F, Roth S, Leusmann DB, van Ahlen H, Hertle L. The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal. J Urol. 1994;151:423–5.

    Article  CAS  Google Scholar 

  28. Silbert PL, Dunne JW, Edis RH, Stewart-Wynne EG. Bicycling induced pudendal nerve pressure neuropathy. Clin Exp Neurol. 1991;28:191–6.

    CAS  PubMed  Google Scholar 

  29. Awad MA, Gaither TW, Murphy GP, Chumnarnsongkhroh T, Metzler I, Sanford T, et al. Cycling, and male sexual and urinary function: results from a large, multinational, cross-sectional study. J Urol. 2018;199:798–804.

    Article  Google Scholar 

  30. Gerstenberg TC, Levin RJ, Wagner G. Erection and ejaculation in man. Assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles. Br J Urol. 1990;65:395–402.

    Article  CAS  Google Scholar 

  31. Lavoisier P, Courtois F, Barres D, Blanchard M. Correlation between intracavernous pressure and contraction of the ischiocavernosus muscle in man. J Urol. 1986;136:936–9.

    Article  CAS  Google Scholar 

  32. Krieger JN, Nyberg L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282:236–7.

    Article  CAS  Google Scholar 

  33. Engeler D, Baranowski AP, Borovicka J, Cottrell AM, Dinis-Oliveira P, Elneil S, et al. European Association of Urology Guidelines. 2018 Edition. European Association of Urology Guidelines Office, 2018. http://uroweb.org/guideline/chronic-pelvic-pain/.

Download references

Acknowledgements

The authors acknowledge the participants for their cooperation.

Author information

Authors and Affiliations

  1. Department of Urology, Aksaray University School of Medicine, Aksaray, Turkey

    Murat Gul

  2. Laboratory of Reproductive Biology, University of Copenhagen, Copenhagen, Denmark

    Murat Gul

  3. Department of Urology, University of California Irvine, Irvine, CA, USA

    Linda M. Huynh, Farouk M. El-Khatib & Faysal A. Yafi

  4. Department of Urology, Bahceci Health Group, Istanbul, Turkey

    Ege Can Serefoglu

Authors
  1. Murat Gul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda M. Huynh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farouk M. El-Khatib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faysal A. Yafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ege Can Serefoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ege Can Serefoglu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gul, M., Huynh, L.M., El-Khatib, F.M. et al. A qualitative analysis of Internet forum discussions on hard flaccid syndrome. Int J Impot Res 32, 503–509 (2020). https://doi.org/10.1038/s41443-019-0151-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-019-0151-x

This article is cited by

Search

Advanced search

Quick links