A great deal of a man’s confidence lies in sexual prowess. Problems affecting the genital area are considered taboo among men.
Most men don’t like talking about these problems, so they often believe other guys don’t experience them. However, the more you learn about issues in the genital area, the easier it will be to overcome them.
One of these issues is penile mondor’s disease. Scroll down to learn more about this condition.
What is penile mondor’s disease?
Penile mondor’s disease (PMD) is a rare, self-limiting, benign condition affecting superficial dorsal penile veins near pubic symphysis in sexually active men. The superficial dorsal vein is located near the skin’s surface on top of a man’s penis and extends lengthwise down the penis.
In PMD, the affected vein develops superficial vein thrombosis or superficial thrombophlebitis, i.e., blood clots. The condition can also affect smaller tributary subcutaneous veins that branch off the above-mentioned vein in the dorsal aspect.
Penile mondor’s disease is a manifestation of mondor’s disease, named after a French physician Henri Mondor. He was the first one to describe the condition in 1939.
Basically, mondor’s disease is a rare condition indicated by thrombophlebitis of the superficial veins in the breast and anterior chest wall. The disease can also affect the abdominal wall, upper arm, and other parts of the body. Thrombophlebitis is defined as an inflammatory process that causes blood clotting and blocking one or more veins.
Although rare, penile mondor’ disease is an under-recognized condition too. For that reason, the prevalence of PMD could be higher than currently believed. For example, at this point, less than 400 cases of penile mondor disease were reported in the medical literature, but that number could be higher.
Symptoms
Not all cases of PMD have symptoms as the condition can be asymptomatic too.
Most patients, however, experience the following symptoms:
- Hardened vein, like a rope, at the dorsum of the penis
- Continuous or episodic throbbing and pain
- Pain with erection
- Erythema (skin rash) and edema (swelling) on the penile skin
- Distention (enlargement, dilation) on the site of penile thrombosis
- Irritative voiding symptoms such as difficulty urinating
Some patients may only notice the hardening of the vein while other symptoms are absent. It is also worth mentioning symptoms of PMD may occur together with the formation of similar lesions on other areas such as the arm or chest.
Causes
The exact cause of penile mondor’s disease remains unclear. The main cause of penile mondor’s disease is mechanical penile trauma. A vast majority of patients report increased sexual activity right before the formation of the lesion on their manhood. In most cases, the lesions occur within 24 to 48 hours after prolonged sexual intercourse.
Abstinence from sex makes these lesions go away, but as a patient engages in sexual activities again, these lesions reappear. Most patients have a history of sexual abstinence due to sexually transmitted diseases.
Indeed, sexually transmitted diseases such as syphilis and candida infections may also be associated with the development of PMD. However, the primary etiological cause of penile mondor’s disease is trauma like penile fracture and rupture of tunica albuginea caused by rough and vigorous sexual intercourse.
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Risk Factors
Any man can develop penile mondor’s disease, but most of them do not. Certain risk factors make you more likely to have PMD and venous stasis of a vein in the penis.
These risk factors include:
- Frequent and vigorous sexual intercourse
- Trauma to the penis
- Local or distant infections
- History of sexually transmitted diseases
- Penile candidiasis or thrush
- Thrombophilia (condition wherein blood tends to form clots)
- Inguinal hernia repair
- Orchiopexy (surgery to remove an undescended testicle into the scrotum and fix it there permanently)
- Varicocelectomy (surgery that removes swollen veins, called varicoceles, inside the scrotum)
- Use of intracavernous drugs (injection into the base of the penis to treat erectile dysfunction)
- Use of penile vacuum pumps
- Behcet’s disease (a rare disorder characterized by inflammation of blood vessels throughout the body)
- Bodybuilding exercises
- Cancer affecting the pelvic area, e.g., bladder cancer and prostate cancer
- Pancreas cancer in metastatic stages
- Migratory phelibitides caused by paraneoplastic syndromes (rare disorders triggered by an abnormal response of the immune system to a cancerous tumor called neoplasm)
- Venous occlusion induced by filled bladder
- Intracavernous drugs abuse
- Thrombosis tendency or excessive clotting
As you can see, risk factors for PMD are numerous. More research is necessary to uncover all mechanisms of action linked to this disease and confirm the connection between these risk factors and PMD.
Keep in mind that not every person with the abovementioned risk factors will develop penile mondor’s disease. For that reason, it is theorized genetics also plays a role. Some genetic mutations can put you in a hypercoagulative state, i.e., make you prone to excessive blood clotting.
When to see a doctor
Men are generally reluctant to see the doctor for problems affecting their genital area. However, being proactive is the best way to manage certain conditions, improve sexual performance, or protect reproductive health.
Make sure to schedule an appointment to see a doctor if you experience symptoms described above, especially pain with erection. Instead of waiting for it to go away on its own, you should see the doctor, who will carry out a physical exam to uncover the culprit.
Swelling of the penis and reddening of the skin are also signs something is wrong, and you should see the doctor. If you don’t have these symptoms but do have a hardened vein on top of the penis, schedule an appointment to see your healthcare provider as well.
Diagnosis
The disease can be diagnosed with a medical history and physical exam. During the physical exam, the doctor can spot the telltale signs of PMD, such as a hardened, rope-like vein. In some cases, the lesion can extend and go beyond the pubic bone.
Medical history, on the other hand, enables the doctor to evaluate the presence of potential risk factors connected to this disease, including the history of sexually transmitted infections and intracavernous drugs.
To rule out other potential conditions, a doctor may order a color Doppler ultrasound. These potential conditions for which differential diagnosis is necessary include Peyronie’s disease and sclerosing lymphangitis.
Color Doppler ultrasound is a noninvasive test that doctors order to analyze blood flow through blood vessels. It works by bouncing ultrasound off circulating red blood cells. A healthcare professional orders a color Doppler ultrasonography test in cases when the clinical picture is not definitive.
If a doctor believes PMD is secondary to some health problem or an underlying disease, they may order other tests such as:
- STI screening if they suspect a patient has syphilis
- Checking for enlarged lymph nodes in the groin as a preliminary investigation of cancer
- Prostate-specific antigen (PSA) test to detect prostate cancer
- Genetic test to screen for hypocoagulative disorders
Treatment
Penile mondor’s disease is a benign condition that usually goes away on its own. Many patients don’t need medical treatment. Generally speaking, the treatment for PMD revolves around alleviating inflammation and pain with anti-inflammatory agents.
The doctor may recommend non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or Voltaren to reduce inflammation. Topical creams containing heparin, an anticoagulant, to break down blood clots may be prescribed in some cases.
If the condition doesn’t resolve in six weeks, a doctor may prescribe oral heparin, which has various side effects such as liver toxicity and easy bleeding.
A patient diagnosed with PMD should avoid sexual intercourse until symptoms resolve. The same applies to masturbation, too. It is important to avoid these activities even if you don’t experience pain and discomfort. Sex and masturbation could contribute to a lesion and slow down the healing process.
Severe and persistent penile mondor’s disease requires a more advanced approach. In this case, the doctor may recommend surgery such as thrombectomy to remove the blood clot. Thrombectomy is accompanied by affected dorsal vein resection or removal. Thrombectomy with resection is carried out in an outpatient setting. The process of healing and recovery lasts about eight weeks on average.
Outlook
Penile mondor’s disease is a self-limiting condition. Most cases of PMD resolve within four to eight weeks. While some episodes of recurrence have been documented, they are associated with sexual intercourse.
Like with any other thromboembolic disease, there is a slight chance of developing deep venous thrombosis, but in most cases, it limits itself to superficial venous thrombosis. While research on PMD is relatively scarce, there are no reports of permanent deformity to the penis or erectile dysfunction.
Penile mondor’s disease is unlikely to induce permanent problems. For that reason, it’s important to be proactive, see a doctor, and adhere to the treatment.
Conclusion
Penile mondor’s disease is a rare but under-recognized condition that affects veins on the surface of the penis. The self-limiting condition tends to go away on its own, but some patients may require specific treatment.
Symptoms of PMD can be uncomfortable and often require abstaining from masturbation and sexual intercourse. If you experience pain with an erection, make sure to see your doctor.
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