Penile Mondor's Disease Management
Penile Mondor's disease is a benign, self-limiting superficial thrombophlebitis of the dorsal penile vein that requires only conservative management with NSAIDs, sexual abstinence, and patient reassurance, with complete resolution expected within 6-8 weeks. 1, 2
Clinical Presentation and Diagnosis
The condition presents with a characteristic cord-like or string-like induration along the superficial dorsal vein of the penis, often painful with localized inflammatory changes. 1 The diagnosis is primarily clinical, based on the palpable thrombosed vein on physical examination. 2, 3
Doppler ultrasonography can confirm the diagnosis when there is clinical uncertainty, though it is not required for typical presentations. 1, 2, 3 The imaging helps visualize the thrombosed vein and can be valuable for patient reassurance by demonstrating the benign nature of the condition. 1
Etiological Factors to Identify
Common precipitating factors include:
- Prolonged or vigorous sexual intercourse (most common) 2, 4
- Recent inguinal surgery (hernia repair) 2
- Penile trauma or use of sexual devices 4
- Excessive physical exercise 3
- Deep vein thrombosis history 2
- Rarely, underlying malignancy 3
First-Line Conservative Treatment
The standard treatment approach consists of:
- NSAIDs: Nimesulide 100 mg orally twice daily for 3 weeks or equivalent NSAID 1, 2
- Complete sexual abstinence until thrombosis resolves 1, 4
- Patient reassurance about the benign, self-limiting nature 1, 3, 4
- Consider antiplatelet agents in select cases 2
The mean interval to complete symptom resolution is approximately 3 weeks with medical therapy, though full resolution typically occurs within 6-8 weeks. 1, 2
Surgical Intervention
Surgery (dorsal vein resection) is reserved only for patients who fail conservative management or have chronic, severe local pain. 1, 2 This represents a minority of cases, as approximately 80% of patients respond to medical therapy alone. 2
Critical Management Points
The most important aspect of management is proper diagnosis and patient reassurance to prevent anxiety-induced erectile dysfunction. 1, 3 Many patients present with significant psychological distress about the penile abnormality, and clear explanation of the benign prognosis is therapeutic. 3, 4
Atypical presentations may involve circumflex veins rather than the dorsal vein, but management remains identical. 5 If no clear etiology is identified despite thorough history, idiopathic cases still follow the same benign course. 5
Follow-Up
Patients should be re-evaluated at 3-4 weeks to confirm resolution. 1 Complete resolution with restoration of normal sexual function is expected in the vast majority of cases. 1, 2 If symptoms persist beyond 8 weeks despite appropriate conservative management, surgical consultation for vein resection should be considered. 2