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  • Hard Flaccid-Hypothesis

    I posted this deep within another thread, but I would be interested in comment so I am reposting it with advance request for indulgence for a re-post.

    From the descriptions of the hard flaccid syndrome, I think that if it is a real separate entity , then it would be a vascular injury, rather than neurologic or urologic. Essentially engorged blood causes erections through a very complex process involving neurological, emotional, vascular, and urological functions. A true hard flaccid would mean that the blood never really leaves the chambers. I could hypothesize that vigorous PE could damage small blood vessels and interfere with the vascular functions and leave excess blood in the chambers ("corpora cavernosa"). If that is true, then the "cure" would be complete rest until the blood vessels repair themselves. If you keep pushing through this, then in all likelihood, you can cause chronic injury which would require even longer to repair. In contrast to some of the very specious neurological injuries that are sometimes alleged in this and other forum, but not really well defined, it is very easy to cause vascular injuries, and they need rest and time to repair. In other words, I think venous leak is a real problem and this may be a less severe subset of that type of injury.

    Basically, when erection occurs, arteries swell and veins constrict within the corpora cavernosa. In a non-erect state, the arteries that bring b*lood into the corpora cavernosa are somewhat constricted, while the veins that drain the blood from the penis are open. There is no way for pressure to build inside the penis. In this state, the penis is limp. If you damage the veins during PE, it can cause the blood to not drain fully and cause what could be described as a "hard flaccid" or partially pressurized corpora cavernosa.

    And the other problem is that many PE exercises are essentially an effort to force excess blood into the vascular system so that growth occurs, which in turn requires that the veins continue to restrict an ever increasing blood flow. So, if you are prone to this problem, then you may need to redirect your efforts into exercises that do not do this, i.e. stretching, hanging, or extending. Otherwise, you will injure yourself. And remember, that even with hanging, stretching, and extending, you are still stretching various blood vessels so injury is possible. I just think that the more pressing problem with those prone to this condition, is increasing the internal pressure of the vessels (veins). And remember you are increasing pressure both before and after the "ligature" point, so it is unclear whether the point of injury occurs within the penis, or somewhere a bit further along.

    Again, this is a theory, but it appears consistent with basic penile anatomy. My hypothesis is that folks who have experienced "hard flaccid" syndrome have either overworked pressure building exercises, or have weak vessels to begin with.
    dsmall
    Senior Member
    Last edited by dsmall; 12-27-2010, 09:43 AM.

  • #2
    So If that's the case the cure would be not getting a single erection until it heals?

    Sounds impossible to me. nocturnal and morning wood wood make it impossible to heal.

    Comment


    • #3
      Originally posted by Newbert_zero View Post
      So If that's the case the cure would be not getting a single erection until it heals?

      Sounds impossible to me. nocturnal and morning wood wood make it impossible to heal.
      No, naturally occurring erections are part of the healing process and good indications that you are healing. If your veins were very damaged, they could lose their total ability to constrict and relax. Remember, they open during a total flaccid, and constrict during an erection. A hard flaccid condition would indicate that the veins are partially constricted and lost some of their ability to open or carry a full blood supply and drain the corpora cavernosa ("CC") fully. A full erection means that the veins constricted and if you return to even a partial flaccid state, that means that some of the veins are opening, and the pressure from a naturally occurring erection is probably helpful.

      But jelquing, ULIs, etc, and clamping is an attempt to increase arterial pressure within the CC beyond what normally occurs during the erection process and place greater pressure than normal on the constricted veins.

      I think people will eventually heal, but veins can be permanently damaged. An imperfect example is varicose veins. Again, if you are prone to this condition, I would take it easy on exercises designed to increase internal pressure and focus on stretching etc.

      Comment


      • #4
        The vaso-occlusive mechanism of erection is not completely understood, but it is felt to be the result of the venous channels (not true veins) that penetrate the tunica of the corpora becoming blocked off by the walls of the sinusoids within the corpora, as those sinusoids become distended with blood as a result of dilation of the corporal arteries. The arteries themselves do not actually expand. The smooth muscle in the artery wall relaxes, so that the channel or "lumen" within the artery enlarges.

        People keep talking about valves in the veins. The veins in the penis and pelvis do, in fact, have one-way valves, but these valves are oriented to prevent back flow of blood from the pelvic veins into the penis. They do not restrict blood flow from the penis toward the pelvis. In effect, the veins are always open. The "valve effect" takes place at the inner aspect of the tunica lining the corpora.

        I have always suspected that the "hard-flaccid" syndrome is a result of thrombosis (blood clotting) within the sinusoids of the corpora. Trauma is a potent stimulant for blood coagulation, and many PE maneuvers result in some constriction of the penis, which can impede venous outflow from the penis through physical constriction and flattening of the thin-walled veins.

        Thrombosis within the corpora would explain the persistent firm consistency of the penis when flaccid. The clotted blood would also interfere with expansion of the corpora with liquid blood. It would also explain the discoloration some men have described. Some individuals have a natural or acquired tendency towards hyper-coagulability, i.e, blood that clots too easily, and they would be predisposed to this.

        Blood clots can be naturally dissolved by the body over time through the process of thrombolysis, but it takes time. Repeated injury tends to have the effect of extending any existing clot and could make the process worse. Even though clots may eventually completely lyse (dissolve) they usually result in some degree of permanent tissue damage in the area that was deprived of normal blood flow by the clot, and this could account for some degree of permanent size loss and ED.

        I have no proof for this hypothesis, but I have made it a tendency to take a short break after jelqing every 50 reps or so, and I do not usually keep the penis constricted at the base with one hand while I jelq with the other.

        Comment


        • #5
          So if it was a blood clot how would I dissolve it?

          Also can anyone explain why my balls don't hang sometimes even when it's warm? I'm not the only one alot of people with hard flaccid have this problem.

          Comment


          • #6
            Have you ever seen a urologist for this? Sorry if you have said before, but I don't recall your previous posts. If you have, did you have any kind of imaging study of the penis done, like an ultrasound?

            It seems that most people who feel they have this syndrome have diagnosed themselves and not sought medical attention, or if they did, they didn't have an imaging study done. Thrombosed blood can usually be distinguished from liquid blood by ultrasound. I must admit, that I don't remember anyone who thought they had this syndrome having an ultrasound that demonstrated clot within the corpora, so I may be all wrong.

            It is hard to imagine another mechanism by which the flaccid penis would actually become firm unless there was major thrombosis and obstruction of the veins in the pelvis draining the penis, or clot within it. Ordinarily the venous pressure in the pelvic veins is quite low, so venous drainage of the penis is unimpeded in the flaccid state. The size of the flaccid penis is dictated by the physical size of the tunica and the degree of vasodilation of the penile arteries, and probably by the tone of the smooth muscle within the walls of the sinusoids in the corpora.

            If you did have clot in the venous drainage of the penis within the pelvis, or within the penis, it would likely dissolve over time. So-called blood thinners do not actually dissolve clot, but they prevent new clot from forming, and prevent existing clots from growing, so they assist the body's natural thrombolytic (clot dissolving) process. There are potent clot dissolving drugs called thrombolytic agents, but their use involves potential serious complications. Those drugs, or even conventional blood thinners, would only be recommended and used under a physician's supervision, and only after confirming that a clot did actually exist somewhere.
            redbear52
            Senior Member
            Last edited by redbear52; 12-27-2010, 11:45 AM.

            Comment


            • #7
              Originally posted by redbear52 View Post
              The vaso-occlusive mechanism of erection is not completely understood, but it is felt to be the result of the venous channels (not true veins) that penetrate the tunica of the corpora becoming blocked off by the walls of the sinusoids within the corpora, as those sinusoids become distended with blood as a result of dilation of the corporal arteries. The arteries themselves do not actually expand. The smooth muscle in the artery wall relaxes, so that the channel or "lumen" within the artery enlarges.

              People keep talking about valves in the veins. The veins in the penis and pelvis do, in fact, have one-way valves, but these valves are oriented to prevent back flow of blood from the pelvic veins into the penis. They do not restrict blood flow from the penis toward the pelvis. In effect, the veins are always open. The "valve effect" takes place at the inner aspect of the tunica lining the corpora.]
              Actually, my discussion was a bit oversimplistic but you are absolutely correct that the mechanism for constriction and opening blood flow involves a a relaxation or constriction of smooth muscle tissues that are part of the veins and arteries, as opposed to particular valves opening or closing. As to how the "valve" operates that increases blood flow to the penis, it is basically a chemical reaction: "When the brain gets aroused, it sends a signal to the penis. Nerve cells in the penis' corpora cavernosa start producing nitric oxide, which leads to the creation of cGMP. The cGMP causes arteries in the corpora cavernosa to dilate, causing lots of blood to flow into the penis. The extra blood flowing in causes the penis to inflate like a balloon. An erection occurs. "

              I have always suspected that the "hard-flaccid" syndrome is a result of thrombosis (blood clotting) within the sinusoids of the corpora. Trauma is a potent stimulant for blood coagulation, and many PE maneuvers result in some constriction of the penis, which can impede venous outflow from the penis through physical constriction and flattening of the thin-walled veins.

              Thrombosis within the corpora would explain the persistent firm consistency of the penis when flaccid. The clotted blood would also interfere with expansion of the corpora with liquid blood. It would also explain the discoloration some men have described. Some individuals have a natural or acquired tendency towards hyper-coagulability, i.e, blood that clots too easily, and they would be predisposed to this.
              Sounds logical. But it could also be related to the either the smooth muscle in either the veins or arteries of the penis failing to respond properly to the the chemical signal to end erection cycle. In other words, that the smooth muscle in the arteries continues to be partially dilated or the veins stay somewhat constricted. A blood clot in the veins could certainly restrict back flow and lead to a hard flaccid state. Its also possible that damage to the smooth muscle itself causes them not to dilate fully after the erection cycle

              Blood clots can be naturally dissolved by the body over time through the process of thrombolysis, but it takes time. Repeated injury tends to have the effect of extending any existing clot and could make the process worse. Even though clots may eventually completely lyse (dissolve) they usually result in some degree of permanent tissue damage in the area that was deprived of normal blood flow by the clot, and this could account for some degree of permanent size loss and ED.

              I have no proof for this hypothesis, but I have made it a tendency to take a short break after jelqing every 50 reps or so, and I do not usually keep the penis constricted at the base with one hand while I jelq with the other.
              Again, I think we both share the opinion that "hard flaccid" is essentially a vascular injury from overuse. Whether it is a blood clotting issue or damage to smooth muscle tissue is an open question which cannot be answered without some sort of testing. Either way, the suggested recovery and treatment would be the same, which is to avoid specific exercises designed to increase pressure within the CC. In other words, rest until either the blood clots or smooth muscle fully heal.

              Newbert_zero= Also can anyone explain why my balls don't hang sometimes even when it's warm? I'm not the only one alot of people with hard flaccid have this problem.
              Again, an erection should cut off the low of urine into the urinary tract; and the loss of an erection should cut off the flow or leakage of seminal fluids. if you remain in a "hard flaccid" state, I wonder whether that doesn't also cause irritation of the epidydimitis or other vessels, because the "valves" that cut off the flow between these dual purpose functions don't close completely or there is seepage.

              Personally, I think you should see a urologist and give him (or her) an accurate history or what it is precisely that you are doing--despite any potential embarrassment. If you don't give the dr. an accurate history, he can't help you.

              Comment


              • #8
                Your theory that the firm flaccid syndrome is the result of persistent, inappropriate vasodilation of the corporal arteries is interesting, and something I hadn't considered. The argument against it is that vasodialation is only part of the mechanism of tumescence. The other requirement is the veno-occlusive mechanism. It seems to me that any degree of erection that could be considered "flaccid" would not be enough to occlude the venous channels penetrating the tunica.

                Persistent arterial vasodilation in the absence of veno-occlusion would be the equivalent of "venous-leak". If this was in fact the mechanism of the firm flaccid syndrome, it could be diagnosed in the same way. That would be a doppler ultrasound study demonstrating both high flow in both the intra-corporeal arteries and the dorsal vein of the penis along with an inadequate erection.

                But I agree that this syndrome, as described by those who believe they have it, smacks of some sort of vascular injury or derangement.

                Comment


                • #9
                  redbear, dmsall,

                  what are your stances on the fact that many people on here believe hard flaccid to be a pelvic floor disorder?

                  Comment


                  • #10
                    for example, people don't have the firm flaccid when they are relaxed or layign down, but it returns when stressed or performing physical activity?

                    Comment


                    • #11
                      Originally posted by redbear52 View Post

                      Persistent arterial vasodilation in the absence of veno-occlusion would be the equivalent of "venous-leak". If this was in fact the mechanism of the firm flaccid syndrome, it could be diagnosed in the same way. That would be a doppler ultrasound study demonstrating both high flow in both the intra-corporeal arteries and the dorsal vein of the penis along with an inadequate erection.

                      But I agree that this syndrome, as described by those who believe they have it, smacks of some sort of vascular injury or derangement.
                      Again, this syndrome and its descriptions, with all due deference to the sufferers, appears to have a very inconsistent history and vague presentation. I agree that it should be easily diagnosed by a urologist if presented with a good history and I am not familiar with a sufferer undegoing doppler ultrasound and the findings.

                      My problem with a clot based theory is that thrombosis in a vein is almost always associated with phlebitis and most of these folks are not reporting frank descriptions of phlebitis or visible inflammation of a vein. Given the proximity of the veins of the penis to the surface skin, you would think that they would be readily visible?

                      So, assuming that this syndrome exists, and its persistent feature is a "hard flaccid" state without any outward appearance that would suggest thrombosis, you have to start exploring possible causes of partial engorgement of the CC. And that leads to the inference that a condition has occurred because either too much blood is flowing in through dilated arteries, or not enough blood is flowing out through constricted veins. And given that one of the primary functions of jelquing and other pressure building exercises is to increase the capacity of the CC for engorgement, I don't think it is a huge leap, but it certainly is an unproven hypothesis.

                      The other alternative would be some sort of edema, but I'm not sure that this could be confused with 'hard" flaccid, and I would think that pumping would be the chief cause of an edema related condition, and it is my understanding that most suffers report the condition due to jelquing and its related activities.

                      Comment


                      • #12
                        By what mechanism would a disorder of the muscles of the pelvic floor cause the flaccid penis to remain physically firm?

                        Comment


                        • #13
                          Originally posted by ronjohn812 View Post
                          redbear, dmsall,

                          what are your stances on the fact that many people on here believe hard flaccid to be a pelvic floor disorder?
                          I would be more convinced it was related if it was accompanied with incontinence or other conditions that are typically affected by pelvic floor disorders.

                          Comment


                          • #14
                            Originally posted by redbear52 View Post
                            By what mechanism would a disorder of the muscles of the pelvic floor cause the flaccid penis to remain physically firm?
                            Without other symptoms consistent with pelvic floor disorder, beats me???

                            Comment


                            • #15
                              Originally posted by dsmall View Post
                              Without other symptoms consistent with pelvic floor disorder, beats me???
                              well guys in a few threads on medhelp.org many sufferers describe left side vein prminence in their hard flaccid, or even when the hard flaccid softens up a bit. So yea, that may be something to do with thrombosis.
                              Secondly, guys on this forum will talk of lowered libido and an odd hang to the balls due to this condition. All I know is I got a doppler in which there were lines and crap.... but I think this was different from an ultrasound. By the way would alpha blockers help this if any of your theories hold true. It seems many have obtained partial relief from their symptoms when taking alpha blockers.
                              Continuation of 'Penis hard when flaccid' thread... - Men's Health - MedHelp if you guys ever take the time to read this whole thing, I think there are even more theories to be had

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