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Key Takeaways
- Penile Mondor’s disease is a rare condition that causes inflammation and blood clots in the veins of the penis.
- The symptoms usually resolve on their own, but applying anti-inflammatory creams can help with pain.
Penile Mondor’s disease is a rare, non-threatening condition that causes temporary pain and swelling due to clots in the penile veins, often triggered by sexual activity or trauma. It often goes away on its own, but a healthcare provider can discuss diagnosis and treatment.
What Is Penile Mondor’s Disease?
Penile Mondor’s disease is a form of Mondor’s disease, first described by French physician Henri Mondor in 1939. It involves thrombophlebitis—inflammation and clotting—of veins in the chest wall, breast, and sometimes the arm and penis.
The first known case affecting only the penis was identified in 1958 and later named Penile Mondor’s Disease (PMD).
Thrombophlebitis refers to vein inflammation that leads to blood clot formation, often triggered by conditions that increase blood clotting, such as certain genetic disorders like hereditary antithrombin III deficiency, linked to deep vein thrombosis (DVT).
In PMD, superficial thrombophlebitis typically affects the dorsal vein on the top of the penis, and smaller veins branching from it may also be involved.
Mondor’s disease is rare, with fewer than 400 cases reported worldwide.
Many PMD cases likely go undiagnosed because individuals may feel embarrassed to consult a healthcare provider. When they do, symptoms may have already started to improve or fully resolve.
Recognizing Penile Mondor’s Disease Symptoms
PMD often occurs after events like prolonged, vigorous sex. The first sign is usually the hardening of part of the dorsal vein on the penis within 24 to 48 hours. This feels like a rope-like mass under the skin, measuring 1 to 4 inches long.
Symptoms of PMD, aside from the hardened vein, may include:
In some cases, PMD may only cause a hardened vein on the penis without other symptoms. Occasionally, it may involve similar thrombotic lesions on the breast, chest, or arm.
PMD is generally self-limiting, meaning it will resolve on its own as the body’s natural anticoagulants (blood thinners) break down the clot. Most cases will return to normal within four to six weeks.
Some cases of PMD occur once and do not recur. Others may come back, triggered by similar events.
What Can Cause Penile Mondor’s Disease?
The exact cause of PMD is unclear as it is rarely diagnosed. However, reports suggest it often results from mechanical trauma to the penis.
PMD may also occur due to diseases, infections, or surgeries affecting the penis. Possible causes include:
Genetics
Clearly, not everyone with the risk factors listed above will develop PMD. Because of this, many scientists believe that certain people have a genetic predisposition for PMD.
There are several gene mutations linked to PMD that can place a person in a hypercoagulative state (meaning prone to excessive blood clotting). This includes the aforementioned antithrombin III deficiency as well as protein S deficiency, protein C deficiency, factor V Leiden mutation, and PT 20210 mutation.
What all these disorders share is an autosomal dominant pattern of inheritance, meaning that only one gene mutation from one parent is needed for the child to develop the disease (in this case, hypercoagulation). Moreover, the parent with the gene mutation will also have the disorder.
Despite the association, not everyone with PMD will have these or any other gene mutation linked to hypercoagulation. As such, it is still unclear how much genetics influences the likelihood of PMD in relation to other known risk factors.
Diagnostic Steps
Express your concerns to a primary care physician or make an appointment with a specialist called a urologist who specializes in diseases of the urinary tract and male reproductive system.
PMD can often be diagnosed with a physical exam and a review of the person’s medical history. An ultrasound and other tests may be used to confirm the diagnosis.
Physical Exam
The physical examination will usually reveal classic signs of PMD, most predominately the hardened, rope-like vein along the top of the penis. It is not uncommon for the lesion to extend above the pubic bone.
PMD has certain telltale signs. Among them, the skin overlying the lesion will not be loose; rather, it will adhere to the lesion and be immovable.
When reviewing your medical history, your healthcare provider will check for risk factors associated with PMD, like a history of STIs or use of intracavernous drugs.
Often, lesions appear 24 to 48 hours after prolonged or vigorous sex. In other cases, they may be idiopathic, with no known cause, possibly resulting from an old penile injury.
Ultrasound
To confirm PMD as the cause of your symptoms, your provider may order a color Doppler ultrasound. This helps differentiate PMD from nonvenereal sclerosing lymphangitis (NVSL), which is also caused by vigorous sex but involves lymph vessels.
A color Doppler ultrasound is an imaging test that uses sound waves to show blood moving through blood vessels. It shows the flow in the arteries into and the veins out of the penis. (A traditional ultrasound also uses sound waves to create images, but it can’t show blood flow.) Changes in color correspond to the speed and direction of the blood flow.
On a color Doppler ultrasound, the blood flow in the dorsal vein will be slowed in someone with PMD but not in someone with NVSL.
A color Doppler ultrasound is also useful for differentiating PMD from Peyronie’s disease, a far more common condition that causes the abnormal curvature of the penis.
In addition to the abnormal curve (which typically does not occur with PMD), Peyronie’s disease is characterized by scarring not in the blood vessels but in the membrane surrounding the spongy interior of the penis (called the tunica albuginea). On a color Doppler ultrasound, there will be no evidence of restricted blood flow in the dorsal vein.
Other Tests
Other tests may be ordered if PMD is believed to be secondary to an underlying disease. This may include an STI screen if syphilis is suspected. Enlarged lymph nodes in the groin may warrant a preliminary investigation of cancer, including the use of the prostate-specific antigen (PSA) test to help detect prostate cancer.
On rare occasions, genetic tests may be ordered to screen for hypocoagulative disorders. Even so, they are not commonly used, as a positive result would do little, if anything, to alter the treatment plan.
Treatment and Management
PMD is typically a self-limiting, benign condition that will resolve on its own without treatment. The treatment of PMD is generally supportive to relieve pain and inflammation.
If diagnosed with PMD, you should abstain from sex (including masturbation) until the symptoms resolve. Even if there is no pain, sex could worsen the lesion and slow the healing process.
Topical and Oral Therapies
Topical preparations containing nonsteroidal anti-inflammatory drugs (NSAIDs) like Voltaren (diclofenac) are sometimes used to reduce inflammation in people with PMD. Topical creams containing the anticoagulant heparin may also be prescribed to help break down the blood clot. Neither preparation is known to be consistently beneficial.
More controversial is the use of oral heparin to treat refractory (treatment-resistant) PMD. Although it may be considered if the condition is severe and doesn’t resolve after six weeks, the side effects of oral heparin (including easy bleeding and liver toxicity) tend to outweigh the possible benefits.
Surgery
If PMD is persistent and severe, surgery may be a more reasonable—albeit invasive—option. This would typically involve a thrombectomy to surgically remove the blood clot, accompanied by the resection (removal) of the affected dorsal vein.
Penile thrombectomy with resection can usually be performed on an outpatient basis. The healing and recovery time takes around eight weeks.