Penile Mondor's disease is a rare benign condition involving thrombosis of the superficial dorsal vein of the penis, typically presenting as a palpable cord-like structure along the penile shaft. Whilst the condition can cause considerable anxiety, particularly regarding sexual function, it does not directly affect the deeper erectile tissues responsible for erections. Many men presenting with this condition understandably worry whether it causes erectile dysfunction. This article examines the relationship between penile Mondor's disease and erectile function, exploring the symptoms, diagnosis, treatment options, and long-term outlook for this self-limiting condition.

What Is Penile Mondor's Disease?

Penile Mondor's disease, also known as superficial dorsal vein thrombophlebitis of the penis, is a rare benign condition characterised by thrombosis (clot formation) and inflammation of the superficial dorsal vein of the penis. First described by Henri Mondor in 1939 in relation to chest wall veins, the penile variant was subsequently recognised as a distinct clinical entity affecting the superficial venous system of the male genitalia.

The condition typically presents as a palpable, cord-like structure along the dorsal aspect of the penile shaft. The exact cause remains incompletely understood, though several precipitating factors have been reported in case series. These include:

• Vigorous or prolonged sexual activity — the most commonly reported trigger

• Trauma to the penis from physical injury or instrumentation

• Underlying thrombophilic disorders (rare)

Other factors such as prolonged abstinence followed by sexual activity or genitourinary infection have been suggested in isolated reports, but the evidence base is limited and causation is not established.

Penile Mondor's disease can affect sexually active men of any age, though many reported cases involve men aged 20–40 years. The condition is considered self-limiting in the majority of cases, though it can cause considerable anxiety and distress due to its sudden onset and the sensitive anatomical location. Whilst the thrombosed vein may be visibly prominent and tender, the condition does not typically affect the deeper erectile tissues directly. However, patients frequently present with concerns about sexual function, including questions about whether the condition causes erectile dysfunction.

It is important to distinguish penile Mondor's disease from other conditions that may present with similar symptoms, including sclerosing lymphangitis of the penis (a benign cord-like swelling after sexual activity), Peyronie's disease (which causes penile curvature and plaques), and, in cases of acute severe pain and swelling, penile fracture. Understanding the pathophysiology and natural history of this condition is essential for appropriate patient counselling and management.

Symptoms and Diagnosis of Penile Mondor's Disease

The clinical presentation of penile Mondor's disease is usually distinctive, enabling diagnosis based primarily on history and physical examination. The cardinal symptom is the sudden appearance of a palpable, cord-like induration along the dorsal surface of the penis, typically extending from the base towards the glans. This represents the thrombosed superficial dorsal vein.

Patients commonly report:

• Pain or discomfort ranging from mild to moderate, often described as a pulling or stretching sensation

• Visible prominence of a vein-like structure beneath the skin

• Tenderness on palpation of the affected area

• Anxiety about sexual function, though true erectile dysfunction is uncommon

Some patients may notice bruising or discolouration along the affected vein. Penile curvature during erection is uncommon but may occur; if present, it is important to differentiate this from Peyronie's disease, which typically presents with palpable plaques, progressive curvature, and a different natural history. Importantly, there is usually no fever, systemic illness, urethral discharge, or genital ulceration, which helps distinguish this condition from infectious or sexually transmitted causes.

The onset typically follows sexual activity or trauma, with symptoms developing within 24–48 hours.

Diagnosis is predominantly clinical. Physical examination reveals a non-compressible, cord-like structure along the dorsal penis that does not empty with elevation. The surrounding tissue is typically normal, and testicular examination is unremarkable. In most cases, no further investigation is required. However, Doppler ultrasound may be performed if the diagnosis is uncertain, demonstrating absent flow in the affected vein and confirming thrombosis.

Blood tests, including thrombophilia screening, are not routinely recommended. According to British Society for Haematology (BSH) guidance, thrombophilia testing should not be performed routinely for superficial thrombophlebitis and should be considered only in selected cases—such as those with a strong personal or family history of venous thromboembolism, recurrent unprovoked events, or unusual sites—and only after specialist haematology or urology input.

When to seek further assessment:

• Urethral discharge, genital ulcers, or high risk of sexually transmitted infection (STI): refer to or attend a sexual health (genitourinary medicine) clinic for assessment and testing.

• Severe acute pain, swelling, or deformity: consider urgent urology referral to exclude penile fracture or other acute pathology.

• Diagnostic uncertainty or failure to improve: consider urology referral for specialist assessment.

NICE Clinical Knowledge Summaries (CKS) on superficial thrombophlebitis provide general principles for assessment and conservative management that can be applied to this condition.

Treatment Options for Penile Mondor's Disease

Management of penile Mondor's disease is primarily conservative, as the condition is self-limiting in the vast majority of cases. The cornerstone of treatment involves reassurance, symptomatic relief, and advice on activity modification. Patients should be counselled that whilst the condition can be alarming, it typically resolves spontaneously, often within several weeks, without long-term complications.

Conservative management includes:

• Sexual abstinence for 4–6 weeks to allow healing and reduce the risk of recurrence

• Simple analgesia: paracetamol and/or ibuprofen may be used for pain and inflammation. Use the lowest effective dose for the shortest duration. For ibuprofen, the usual adult dose is 200–400 mg three times daily (maximum 2,400 mg daily in divided doses), taken with or after food. Do not use ibuprofen if you have a history of stomach ulcers, severe heart failure, or are allergic to NSAIDs. If you are at increased risk of gastrointestinal side effects (e.g., older age, previous ulcer, taking corticosteroids or anticoagulants), discuss gastroprotection with your GP. Paracetamol is a suitable alternative if NSAIDs are not appropriate.

• Warm compresses applied to the affected area to promote comfort

• Supportive underwear to minimise movement and friction

Anticoagulation therapy is not routinely recommended for uncomplicated penile Mondor's disease, as the thrombosis is superficial and the risk of extension or embolisation is extremely low. In rare cases where there is concern about propagation into deeper venous structures, or in patients with known thrombophilic conditions, anticoagulation (e.g., low-molecular-weight heparin) may be considered. This is not a licensed indication and should be initiated only by a specialist (urology or haematology) after careful risk–benefit assessment.

Surgical intervention is rarely necessary but may be considered in cases of:

• Persistent symptoms beyond 8–12 weeks despite conservative measures

• Recurrent episodes causing significant functional impairment

• Severe penile curvature affecting sexual function

Surgical options include excision of the affected vein segment, though this is reserved for refractory cases.

When to seek medical advice:

• Fever, spreading redness, increasing pain, or swelling — these may indicate secondary infection or an alternative diagnosis requiring urgent assessment.

• Urinary symptoms, urethral discharge, or genital ulceration — attend a sexual health clinic or see your GP.

• Severe acute pain or deformity — seek urgent medical attention to exclude penile fracture.

Most patients can be managed entirely in primary care, with referral to urology reserved for diagnostic uncertainty, treatment failure, or complications.

Reporting side effects of medicines: If you experience a suspected side effect from any medicine, you can report it via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or by searching for 'Yellow Card' in the Google Play or Apple App Store.

Recovery and Long-Term Outlook

The prognosis for penile Mondor's disease is excellent, with complete resolution expected in most cases, often within 4–6 weeks of conservative management. The thrombosed vein typically undergoes gradual recanalisation or becomes a fibrotic cord that is no longer symptomatic. Patients can be reassured that the condition does not cause permanent damage to erectile function in the vast majority of cases.

Regarding erectile dysfunction specifically, there is no established direct causal link between penile Mondor's disease and long-term erectile problems. The superficial dorsal vein is not essential for erectile function, which depends primarily on arterial inflow and corporal veno-occlusive mechanisms involving the deep dorsal vein and cavernosal tissues. However, patients may experience temporary erectile difficulties during the acute phase due to:

• Pain and discomfort during erection

• Psychological factors including anxiety and fear of worsening the condition

• Voluntary abstinence as part of treatment

These issues typically resolve as the physical condition improves. If erectile dysfunction persists beyond the resolution of the thrombophlebitis, alternative causes should be investigated, as this would not be attributable to the Mondor's disease itself. NICE CKS guidance on erectile dysfunction provides a framework for assessment and management, including lifestyle factors, cardiovascular risk review, and consideration of underlying causes.

Recurrence is uncommon. To support recovery and reduce the risk of recurrence, patients are advised to:

• Avoid vigorous sexual activity during the healing phase

• Use adequate lubrication during intercourse (pragmatic advice, though evidence is limited)

• Maintain good hydration (pragmatic advice, though evidence is limited)

• Address any underlying risk factors if identified

Follow-up is typically arranged at 4–6 weeks in primary care to assess resolution, though this should be tailored to the individual patient's symptom course and diagnostic certainty. Patients should be encouraged to resume normal sexual activity gradually once symptoms have completely resolved. Long-term complications are exceptionally rare, and most men return to full, normal sexual function without residual effects. Patient education and reassurance remain paramount throughout the recovery period.

Frequently Asked Questions