Sex is a double-edged sword: its virtues don’t need to be extolled; its negatives–aside from the possibility of sexually transmitted infections–include the rare occurrence of genital injuries. For the male, acute sex-induced penile trauma may run the gamut from chafing, bruising, and swelling to clotting of penile veins and penile fracture. Chronic sex-induced penile trauma is thought to be the underlying cause of Peyronie’s disease. Today’s entry provides information on thrombosis of the superficial dorsal penile vein, the writing of which was prompted by a recent patient’s diagnosis and my lack of a credible written resource to offer him.
Mondor’s disease is a relatively rare, benign, and self-limited process characterized by clotting of superficial veins that cause firm linear bands just under the skin in different areas of the body. This was first described in 1939 by a French physician, Dr. Henri Mondor, who diagnosed thrombosis (local coagulation or clotting) of a superficial chest vein, hence the eponym Mondor’s phlebitis (inflammation of a vein). Superficial venous clotting was thereafter found to occur in different body locales, including the chest, abdomen, arms and genitals. In 1955, Braun-Falco described the first case of penile superficial venous thrombosis within the context of generalized phlebitis and in 1958 Helm and Hodge described the first isolated case of penile superficial venous thrombosis.
Penile Mondor’s Disease
The superficial dorsal vein is situated atop the penis and runs the length of the penis. See image of the superficial veins below:
The Superficial Penile Veins (Note the superficial dorsal vein situated atop the penis and running its length) from Henry Gray’s Anatomy of the Human Body, 1918, Public Domain
Mechanical trauma from prolonged, vigorous, or rough sexual intercourse or masturbation is the most common cause of clotting of the superficial dorsal vein or its tributaries. Venous trauma occurs from repetitive stretching, compression and torquing of the penis. This trauma causes clotting, which typically appears 24-48 hours following the sexual activity. The clotting creates hardening of the vein, sometimes accompanied by a throbbing discomfort, but at times it occurs with no associated pain whatsoever. Despite the occlusion of the vein, there are no serious issues with venous return because of the vast penile collateral veins (alternative veins).
The patient with penile Mondor’s disease discovers a firm cord or band on the dorsum (top part of the penis—think dorsal fin). He typically becomes anxious over fears of the possibility of cancer, sexually transmitted infections, and future sexual dysfunction. Many patients are too embarrassed or fearful to seek medical help. On physical examination, the superficial dorsal vein or one of its tributaries, such as the retro-glanular (behind the head of the penis) circumferential veins that run perpendicular to the dorsal vein just behind the head of the penis, are found to be thrombosed with a cord-like induration (a localized hardening of a soft tissue of the body). The overlying skin is sometimes found to be erythematous (red) and tethered to the vein and not loosely attached as is typical of penile skin.
The other diagnostic possibilities that may be confused with Mondor’s are non-venereal sclerosing lymphangitis (distinguished with a color Doppler ultrasound) and Peyronie’s disease.
The good news is that penile Mondor’s disease is a benign and self-limited condition. Management is with non-steroidal anti-inflammatories such as ibuprofen in conjunction with warm compresses. Sexual abstinence is a must, and typically the situation will resolve within 6-8 weeks or so. Nature, time and patience are the 3 great physicians!