Mondor’s Disease of the Penis: Clinical Presentation, Diagnosis, and Conservative Management

Abstract

Mondor’s disease of the penis is a rare, benign thrombophlebitis of the superficial dorsal vein, often presenting as a painful, cord-like induration along the penile shaft. Though alarming to patients, it is a self-limiting condition that responds well to conservative management. A 54-year-old male presented with pain and swelling over the dorsal shaft of the penis for 15 days. Examination revealed a tender, cord-like induration without ulceration or discharge. Laboratory parameters were normal. Doppler ultrasonography demonstrated a dilated, thrombosed superficial dorsal vein with loss of venous flow, confirming the diagnosis of penile Mondor’s disease. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs, fractionated flavonoids, warm compresses, vitamin supplements, and temporary sexual abstinence. Marked symptomatic relief was observed within 2 weeks, with complete resolution of induration by 6 weeks. Penile Mondor’s disease is an uncommon but self-limiting condition that can be effectively managed with conservative therapy. Early recognition, reassurance, and avoidance of unnecessary interventions are essential. Fractionated flavonoids may provide additional benefit in symptom resolution and recovery.

INTRODUCTION

Mondor’s disease, first described in 1939, is a rare, benign, and self-limiting condition characterized by superficial thrombophlebitis of the subcutaneous veins.[1,2] Although it was originally described in the thoracoabdominal wall, penile Mondor’s disease involving the superficial dorsal vein of the penis is uncommon and often underdiagnosed.[1] The condition typically presents with an acute onset of pain, cord-like induration, and localized swelling along the dorsal penile shaft, which can be alarming for patients.[2,3] The etiology is multifactorial, including trauma, vigorous sexual activity, prolonged abstinence, pelvic surgery, infections, or hypercoagulable states, though in many cases, it remains idiopathic.[4]

Diagnosis is primarily clinical, with Doppler ultrasonography playing a key role in confirming the absence of venous flow and ruling out differential diagnoses such as sclerosing lymphangitis or Peyronie’s disease.[5] Conservative management remains the mainstay of therapy, with nonsteroidal anti-inflammatory drugs (NSAIDs), supportive measures, and, in recent years, the adjunctive use of fractionated flavonoids due to their venoactive and anti-inflammatory properties.[1,6,7] We report a case of penile Mondor’s disease managed successfully with fractionated flavonoids, NSAIDs, and supportive therapy, with complete resolution of symptoms.

CASE REPORT

A 54-year-old male presented to the surgery department with complaints of pain and swelling over the shaft of the penis for the past 15 days. The pain was insidious in onset, gradually progressive, and aggravated by movements and sexual activity. He denied any history of trauma, fever, dysuria, hematuria, sexually transmitted infections, constipation, or recent surgical procedures. There was no history of prolonged immobilization, pelvic surgery, or any systemic illness. His past medical and surgical history was unremarkable.

On local examination, there was redness and swelling over the shaft of the penis with a palpable cord-like induration along the dorsal aspect. The swelling was tender on palpation, and the overlying skin showed erythema but no ulceration or discharge. There was no evidence of inguinal lymphadenopathy. Systemic examination findings were within normal limits.

Laboratory investigations, including complete blood counts and coagulation profiles, were normal. Ultrasonography of the penis with Doppler revealed a dilated [Figure 1], thrombosed superficial dorsal vein with loss of compressibility and absence of venous flow, findings consistent with Mondor’s disease (superficial thrombophlebitis of the dorsal penile vein). An abdominal ultrasound was also performed, which showed no associated intra-abdominal pathology.

Figure 1.

Doppler image showing no blood flow in the superficial dorsal vein. Yellow box shows the dopper blood flow where there is no flow in the dorsal penile vein

The patient was managed conservatively with oral NSAIDs, fractionated flavonoids, warm compresses, vitamin supplements, and advice for sexual abstinence. Supportive therapy with anxiolytics was provided for symptomatic relief. He showed gradual improvement with a significant reduction in pain and swelling within 2 weeks. At follow-up after 6 weeks, the induration had completely resolved, and the patient remained asymptomatic.

DISCUSSION

Penile Mondor’s disease is a rare clinical entity characterized by superficial thrombophlebitis of the dorsal vein of the penis. Since its first description by Helm and Hodge in 1958 as a penile variant of Mondor’s disease, fewer than a few hundred cases have been reported in the literature, underscoring its rarity.[8,9] The estimated incidence is low, with some studies suggesting a prevalence of <1.4% among men presenting with penile pain or swelling, though the true incidence may be underreported due to spontaneous resolution and under-recognition by clinicians.[10,11]

The condition most commonly affects men in the third to fifth decade of life, consistent with our patient, who was 54 years of age.[5,12] Risk factors include vigorous or prolonged sexual activity, local trauma, infections, pelvic surgery, prolonged immobilization, or systemic hypercoagulable states.[4] However, in many cases – including ours – no clear etiology can be identified, and the disease is considered idiopathic.

Comparison with previously reported cases reveals a similar clinical course. Patients typically present with acute or subacute penile pain, cord-like induration, and swelling along the dorsal shaft, often causing significant anxiety due to concerns about sexually transmitted diseases or malignancy.[2,13] Like prior reports, our case was diagnosed with the aid of Doppler ultrasonography, which is the investigation of choice, reliably demonstrating thrombosis and absence of venous flow.[14,15]

Most reported cases, including ours, respond well to conservative management with nonsteroidal anti-inflammatory drugs, warm compresses, and advice for temporary sexual abstinence. A review of published literature suggests that spontaneous resolution usually occurs within 4–8 weeks, with rare need for anticoagulation or surgical intervention. Long-term outcomes are excellent, and recurrences are uncommon.[16]

Thus, our case adds to the growing body of evidence that penile Mondor’s disease is a benign, self-limiting condition. Early recognition, appropriate counseling, and reassurance are critical to reduce patient distress and avoid unnecessary invasive interventions.

CONCLUSION

Mondor’s disease of the penis is a rare but benign condition that should be considered in the differential diagnosis of painful penile swelling. Timely recognition and reassurance are crucial to alleviate patient anxiety and prevent unnecessary interventions. Conservative management remains the mainstay, with excellent outcomes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.