Glans insufficiency syndrome

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Glans insufficiency syndrome
Other namesSoft glans, cold glans, isolated glans insufficiency, glans insufficiency, floppy glans syndrome (FGS)
Erect penis shaved pubic hair (cropped).JPG
Erect human penis with partial glanular engorgement
Specialty Andrology
Symptoms Soft glans penis
Frequency4 - 60% (following anterior urethroplasty) [1]

Glans insufficiency syndrome, also known as the soft glans, cold glans, or glans insufficiency, is a medical condition that affects male individuals. This condition is characterized by the persistent inability of the glans penis to achieve and maintain an erect or turgid state during sexual arousal, remaining soft and cold. This condition can have an impact on a person's sexual function, including decreased sensitivity, difficulty in maintaining an erection, and overall quality of life. [2] [3]

Contents

This condition is typically diagnosed among individuals who have undergone penile implant surgery, and is often underdiagnosed in the general population due to its complexity and the lack of clear nomenclature.

Pathophysiology

Most commonly three distinct pathophysiologies have been hypothesized: [2]

Corpus spongiosum of a human penis An atlas of human anatomy for students and physicians (1903) (14760462886) (cropped).jpg
Corpus spongiosum of a human penis

Causes

The exact causes of soft glans syndrome remain complex and multifactorial, potentially involving issues related to blood flow, nervous system function, hormonal imbalances, medication side effects, or trauma.

Possible explanation of lack of glanular engorgement is that the pressure within the glans penis during an erection is consistently lower than that within the corpora cavernosa. Glans engorgement does not typically occur in response to intracavernous injections of vasoactive agents, and it is frequently absent following the implantation of a penile prosthesis. [4]

Prevalence

Patients who have undergone urethroplasty and penile implantation may encounter the glans remaining soft and cold despite the expected response to sexual stimulation. [5] It has been reported that from 4 to 60% of people who underwent anterior urethroplasty surgery had a glans insufficiency syndrome. [6]

Treatment

Treatment options may include mechanical, pharmacologic, or surgical approaches. Surgical interventions may involve ligation of veins and closure of iatrogenic shunts, but their effectiveness remains a subject of limited research.

In people who had received penile implantation, the problem was addressed through a combination of penile implant revision and a glanular enhancement procedure, which improved the outcome by alleviating cold glans syndrome. The method included venous stripping procedure of the retrocoronal plexus, followed by ligation of the dorsal deep vein (DDV) and circumflex veins (CVs) at the penile hilum. [7]

In a 1990 study, a treatment approach was used to repair isolated glans insufficiency due to venous leakage. The diagnosis was established by observing the rapid drainage of a contrast agent through the deep dorsal vein while conducting pharmacodynamic ultrasonography. The treatment involved the surgical resection and ligation of a segment of the deep dorsal vein, a procedure that aimed to reduce pathologic venous outflow from the glans during erections. This treatment effectively restored normal glans tumescence. [8]

Veins and arteries of a human penis in cross section Penis cross section.svg
Veins and arteries of a human penis in cross section

See also

Related Research Articles

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.

<span class="mw-page-title-main">Glans penis</span> End of the penis

In male human anatomy, the glans penis or penile glans, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and primary anatomical source of sexual pleasure. The glans penis is present in the male reproductive organs of humans and most other mammals where it may appear smooth, spiny, elongated or divided. It is externally lined with mucosal tissue, which creates a smooth texture and glossy appearance. In humans, the glans is located over the distal ends of the corpora cavernosa and is a continuation of the corpus spongiosum of the penis. At the summit appears the urinary meatus and at the base forms the corona glandis. An elastic band of tissue, known as the frenulum, runs on its ventral surface. In men who are not circumcised, it is completely or partially covered by a fold of skin called the foreskin. In adults, the foreskin can generally be retracted over and past the glans manually or sometimes automatically during an erection.

<span class="mw-page-title-main">Priapism</span> Medical condition where an erection lasts excessively long

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases are ischemic. Ischemic priapism is generally painful while nonischemic priapism is not. In ischemic priapism, most of the penis is hard; however, the glans penis is not. In nonischemic priapism, the entire penis is only somewhat hard. Very rarely, clitoral priapism occurs in women.

<span class="mw-page-title-main">Penis enlargement</span> Technique aimed to increase the size of a human penis

Penis enlargement, or male enhancement, is any technique aimed to increase the size of a human penis. Some methods aim to increase total length, others the shaft's girth, and yet others the glans size. Techniques include surgery, supplements, ointments, patches, and physical methods like pumping, jelqing, and traction.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

<span class="mw-page-title-main">Dorsal artery of the penis</span> Artery of the penis

The dorsal artery of the penis is a bilaterally paired terminal branch of the internal pudendal artery which passes upon the dorsum of the penis to the base of the glans penis, where it unites with its contralateral partner and supply the glans and foreskin.

<span class="mw-page-title-main">Dorsal veins of the penis</span>

In human male anatomy, the dorsal veins of the penis are blood vessels that drain the shaft, the skin and the glans of the human penis. They are typically located in the midline on the dorsal aspect of the penis and they comprise the superficial dorsal veinof the penis, that lies in the subcutaneous tissue of the shaft, and the deep dorsal veinof the penis, that lies beneath the deep fascia.

Venous leak, also called venogenic erectile dysfunction and penile venous insufficiency, is one category of vasculogenic impotence — a cause of erectile dysfunction in males. It affects all ages, being particularly awkward in young men. Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male sex organ that additionally serves as the urinary duct. The main parts are the root, body, the epithelium of the penis including the shaft skin, and the foreskin covering the glans. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra goes across the corpus spongiosum and ends at the tip of the glans as the opening, the urinary meatus. It is a passage both for excretion of urine and the ejaculation of semen.

Urethroplasty is the surgical repair of an injury or defect within the walls of the urethra. Trauma, iatrogenic injury and infections are the most common causes of urethral injury/defect requiring repair. Urethroplasty is regarded as the gold standard treatment for urethral strictures and offers better outcomes in terms of recurrence rates than dilatations and urethrotomies. It is probably the only useful modality of treatment for long and complex strictures though recurrence rates are higher for this difficult treatment group.

<span class="mw-page-title-main">Body of penis</span> Part of the penis located outside of the pelvic cavity

The body or shaft of the penis is the free portion of the human penis that is located outside of the pelvic cavity. It is the continuation of the internal root, which is embedded in the pelvis and extends to the glans. It is made up of the two corpora cavernosa and the corpus spongiosum on the underside. The corpora cavernosa are intimately bound to one another with a dorsally fenestrated septum, which becomes a complete one before the penile crura. The body of the penis is homologous to the female clitoral body.

<span class="mw-page-title-main">Corona of glans penis</span> Flare above the sulcus of the human penis

The corona of glans penis or penis crown refers to the rounded projecting border or flare that forms at the base of the glans in human males. The corona overhangs a mucosal surface, known as the neck of the penis, which separates the shaft and the glans. The deep retro-glandular coronal sulcus forms between the corona and the neck of the penis. The two sides of the corona merge on the ventral midline forming the septum glandis. The circumference of the corona is richly innervated and is described as a highly erogenous area of the glans.

<span class="mw-page-title-main">Erection</span> Physiological phenomenon involving the hardening and enlargement of the penis

An erection is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, and endocrine factors, and is often associated with sexual arousal, sexual attraction or libido, although erections can also be spontaneous. The shape, angle, and direction of an erection vary considerably between humans.

<span class="mw-page-title-main">Clitoral erection</span> Physiological phenomenon involving the engorgement of the clitoris

Clitoral erection is a physiological phenomenon where the clitoris becomes enlarged and firm.

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<span class="mw-page-title-main">Penile artery shunt syndrome</span> Medical condition

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Penile ulltrasonography is medical ultrasonography of the penis. Ultrasound is an excellent method for the study of the penis, such as indicated in trauma, priapism, erectile dysfunction or suspected Peyronie's disease.

<span class="mw-page-title-main">Hard flaccid syndrome</span> Medical condition

Hard flaccid syndrome (HFS), also known as hard flaccid (HF), is a chronic painful condition characterized by a semi-rigid penis at the flaccid state, a soft glans at the erect state (cold glans syndrome), pelvic pain, low libido, erectile dysfunction, erectile pain, pain on ejaculation, penile sensory changes (numbness or coldness), lower urinary tract symptoms, contraction of the pelvic floor muscles, and psychological distress. Other complaints include rectal and perineal discomfort, cold hands and feet, and a hollow or detached feeling inside the penile shaft. The majority of HFS patients are in their 20s–30s and symptoms significantly affect one's quality of life.

References

  1. Winter, A.; Rubin, R.; Goldstein, I. (2018). "209 Self- Administered Intraspongiosal (IS) Injection Therapy for the Management of Cold Glans Syndrome". The Journal of Sexual Medicine. 15: S68–S69. doi:10.1016/j.jsxm.2017.11.168 . Retrieved 2023-09-06.
  2. 1 2 Goldstein, Irvin. "Soft Glans / Cold Glans / Glans Insufficiency Syndrome". www.sdsm.info. Retrieved 2023-09-06.
  3. Winter, A.; Rubin, R.; Goldstein, I. (2018). "209 Self- Administered Intraspongiosal (IS) Injection Therapy for the Management of Cold Glans Syndrome". The Journal of Sexual Medicine. 15: S68–S69. doi:10.1016/j.jsxm.2017.11.168 . Retrieved 2023-09-06.
  4. Christopher, Nim; Pryor, John P. (May 2002). "Abnormalities of penile shape and function". Sexual and Relationship Therapy. 17 (2): 199–205. doi:10.1080/14681990220144667. ISSN   1468-1994. S2CID   144443284.
  5. Moncada, Ignacio; Martinez-Salamanca, Juan Ignacio; Allona, Antonio; Hernandez, Carlos (November 2004). "Current role of penile implants for erectile dysfunction". Current Opinion in Urology. 14 (6): 375–380. doi:10.1097/00042307-200411000-00014. ISSN   0963-0643. PMID   15626882. S2CID   4832280.
  6. Winter, A.; Rubin, R.; Goldstein, I. (2018). "209 Self- Administered Intraspongiosal (IS) Injection Therapy for the Management of Cold Glans Syndrome". The Journal of Sexual Medicine. 15: S68–S69. doi:10.1016/j.jsxm.2017.11.168 . Retrieved 2023-09-06.
  7. Hsu, Geng-Long; Hill, James W.; Hsieh, Cheng-Hsing; Liu, Shih-Ping; Hsu, Chih-Yuan (2014-08-07). "Venous Ligation: A Novel Strategy for Glans Enhancement in Penile Prosthesis Implantation". BioMed Research International. 2014: e923171. doi: 10.1155/2014/923171 . ISSN   2314-6133. PMC   4140147 . PMID   25165719.
  8. Schramek, P.; Waldhauser, M. (April 1990). "Isolated glans insufficiency due to venous leakage". Urology. 35 (4): 307–309. doi:10.1016/0090-4295(90)80151-c. ISSN   0090-4295. PMID   2181770.