Multimodal rehabilitation for hard flaccid syndrome in a retrospective case series.

Introduction: Hard flaccid syndrome (HFS) is an emerging condition of male sexual dysfunction characterized by a persistent semi-rigid penis in the flaccid state, altered penile sensation, erectile dysfunction, and pelvic or perineal pain. Single-modality treatments have shown limited success, and multimodal protocols have been reported only in single-patient case studies. Aim: To describe clinical outcomes associated with completion of an integrative multimodal rehabilitation protocol in a retrospective case series of men with HFS. Methods: Thirty-two men with HFS completed a comprehensive protocol combining class IV laser therapy, dry needling, radial pressure wave shockwave therapy, therapeutic ultrasound, biofeedback training, manual therapy, therapeutic exercise, behavioral coaching, and daily oral tadalafil. Patient-reported outcomes were collected at treatment initiation and completion. Outcomes: Erection Hardness Scale (EHS), penile function satisfaction, PROMIS Interest in Sexual Activity, and PROMIS Global Health Physical and Mental Component scores. Results: Median EHS increased from 2 to 4 and median penile satisfaction increased from 2 to 5 (both Discussion: In this retrospective case series, completion of a multimodal rehabilitation program was associated with improvements in erection hardness, penile satisfaction, sexual interest, and global health in men with HFS. These hypothesis-generating findings warrant prospective controlled studies evaluating efficacy, durability, and component-specific effects.