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MISCELLANEOUS

Penile Mondor’s Disease: Primum Non Nocere!*

Purpose: Penile Mondor’s disease (superficial thrombophlebitis of the dorsal vein of the penis) is a rare clinical di-
agnosis. It is an easily diagnosed and treated disease. Nevertheless, when reviewing the literature, we considered that 
unnecessary tests are carried out for diagnosis. In this study, we aimed to indicate the redundancy of Doppler ultra-
sonography for diagnosis of penile Mondor’s disease.

Materials and Methods: Seven patients with the clinical presentation of penile Mondor’s disease were included in the 
study. In the first two patients, penile Doppler ultrasonography was performed for diagnostic purposes by applying a 
vasoactive intracavernosal agent. This diagnostic procedure was not implemented in the next five patients.

Results: Physical examinations revealed cord-like thickening lesions on dorsal and dorsolateral penis. In the first two 
patients, who penile Doppler ultrasonography with an intracavernosal vasoactive agent was used for diagnostic pur-
poses, was developed priapism. We did not use penile Doppler for more patients as this would be unethical according 
to us.

Conclusion: Recovery from penile Mondor’s disease is usually spontaneous and smooth. A simple physical examina-
tion is sufficient for diagnosis, and palliative treatment is effective. For the diagnosis of this disease, unnecessary tests 
should be avoided so that patients are not harmed.

Keywords: penis; blood supply; thrombophlebitis; physiopathology; thrombosis; diagnosis, differential; penile dis-
eases; ultrasonography.

INTRODUCTION 

Superficial vein thrombosis was initially described by Mondor in 1939 in the subcutaneous veins of the anterolateral thoracoabdominal wall.(1) Penile Mondor’s 
disease was first described by Braun-Falco in the 1950s. 
The incidence of this disease has recently been estimated 
to be 1.39%.(2) Penile Mondor’s disease is characterized 
by thrombosis in the superficial dorsal penile vein. 
Patients complain of a generally painful or painless cord-
like induration on the dorsal and dorsolateral aspect of 
the penis. The etiology of penile Mondor’s disease is not 
completely understood, but various causes have been 
reported, including penile trauma, prolonged sexual 
abstinence, vigorous and prolonged sexual intercourse, 
infection, constrictive elements used during certain 
sexual practices, pelvic tumors and pelvic surgery.(3-
5) In the literature the most common cause is stated as 
prolonged sexual intercourse.(3,4) On physical examination 
of the dorsum and dorsolateral surface of the penis, a 
hard, spermatic cord-like structure is palpated. From 
the literature, it is clear that Doppler ultrasonography 
is often carried out for diagnostic purposes as a further 
investigation (with or without an intracavernosal 
vasoactive agent).(6-13) 

MATERIALS AND METHODS
After study was approved by the local institutional 
review board seven patients with the clinical presentation 
of penile Mondor's disease were included in this study. 

Between June 2012 and April 2014, seven patients 
with preliminary diagnoses of penile Mondor’s disease 
were prospectively evaluated, treated and followed up. 
Detailed history was taken from all patients. All patients 
had complained of swelling on the dorsum of the penis. 
There were also three patients who complained of pain. A 
patient without having pain in the dorsal aspect of the penis 
had mild dysuria complaint. On physical examination, all 
patients presented subcutaneous cord-like indurations on 
the penis’ dorsal/dorsolateral surface. A mean of 3.6 days 
(2-10 days) elapsed between the onset of symptoms and 
seeking medical attention at the outpatient clinic. 

In the first two patients, advanced examination was 
performed using diagnostic color Doppler ultrasonography 
with an intracavernosal vasoactive agent (60 mg 
papaverine hydrochloride) injection after obtaining their 
informed consent. Further investigation was not carried 
out in the next five patients. For the three patients who 
had pain, dexketoprofen trometamol (25 mg) pills were 
administered twice daily. Clinical improvement was 
judged by improvement in the induration and pain. To 
resolve their anxiety, the patients were informed about 
the benign nature of the disease. It was recommended that 
they refrain from sexual activity during treatment.
 
RESULTS 
The mean age of patients was 34.2 years (range, 22-45). 
None of the patients had specific anamnesis before the 
development of painful or painless superficial thrombosis 

1 Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
2 Department of Radiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
* Primum non nocere is a Latin phrase that means "first, do no harm."
**Correspondence: Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
Tel: +90 416 216 1015-3317. E-mail: mozyucel@yahoo.com.
Received September 2014 & Accepted February 2015

Haci Polat,1 Mehmet Ozgur Yucel,1** Alper Gok,1 Can Benlioglu,1 Ali Cift,1 Mehmet Akif Sarica2

Miscellaneous   2096



of the penis. Physical examination in four patients showed 
cord-like indurations parallel to the coronal sulcus. Three 
patients had cord-like induration in the dorsal aspect of 
the proximal penis. Color Doppler ultrasonography was 
carried out on the first two patients. The ultrasonography 
findings were similar for these patients, including an 
increase in the diameter of superficial dorsal vein, 
non-compressibility and intraluminal thrombus in the 
superficial dorsal vein (Figure). The venous current 
spectrum in this vein was not observed via color Doppler 
examination. 
After intracavernosal vasoactive agent injection (60 mg 
papaverine hydrochloride), Doppler ultrasonography did 
not show any disorder in the cavernosal arteries. Following 
intracavernosal vasoactive agent administration, the first 
patient’s average cavernosal artery diameter was 0.7 mm, 
peak systolic velocity was 47 cm/sec on the right and 49 
cm/sec on the left; moreover, end diastolic velocity was 
-3 cm/sec on the right and -2 cm/sec on the left. In the 
second patient, the mean artery diameter was 0.6 mm; 
peak systolic velocity was 34 cm/sec on the right and 
32 cm/sec on the left; and end diastolic velocity was -5 
cm/sec on the right and -2 cm/sec on the left (Table). 
Both of these patients developed priapism after Doppler 
ultrasonography. Fortunately, the patients, taking our 
suggestions into consideration pre-procedure, applied 
to the hospital when an erection maintained six hours 
after the procedure. Patients were treated without any 
problems by applying corpus cavernosum drainage with 
a 21 gauge butterfly needle. The next five patients did 
not undergo diagnostic examination except for the patient 

history and physical examination. All patients who were 
invited to the weekly follow-up, improved completely 
within 3–5 weeks of the onset of symptoms, as indicated 
in the literature.

DISCUSSION 
Penile Mondor’s disease is a benign condition that is 
spontaneously resolved. However, it can sometimes create 
anxiety in patients. Patients almost always complain of 
cord-like induration on the penis; this can sometimes 
be painful. In terms of etiology, various reasons for 
this condition are given, particularly prolonged sexual 
activity, but the exact cause is not known. Our patients 
had no specific medical history. In our region, patients 
with a conservative sociocultural background may be 
reluctant to provide accurate medical history regarding 
sexual activity. On physical examination of patients with 
penile Mondor’s disease, the subcutaneous cord-like 
mobile induration is easily palpable. 
In the literature, diagnostic penile Doppler ultrasonography 
with an intracavernosal vasoactive agent injection has 
been reported.(11-13) Such examination was carried out in 
our first two patients; these patients developed priapism. 
We decided that although the priapism was corrected with 
proper treatment, ultrasonography was an unnecessary 
examination. Thus, we concluded that this type of imaging 
for diagnosis to be harmful because penile Mondor’s 
disease is considered to have a benign course. As a result, 
we decided that Doppler examination was unethical and 
we did not want to use it for our next patients, and it was 

Penile Mondor’s Disease-Yucel et al.

Figure. Ultrasound showing thrombosis of the superficial dorsal vein of the penis (arrows). When there was current flow in the other veins of 
the penis, this was not monitored in the superficial dorsal vein.

Patients  Mean Cavernosal  Peak Systolic   Peak Systolic Velocity End Diastolic Velocity  End Diastolic Velocity 
  Artery Diameters (mm) Velocity on the Right (cm/sec)  on the Left (cm/sec) on the Right (cm/sec) on the Left (cm/sec)

1  0.7  47   49  -3  -2

2  0.6  34   32  -5  -2

Table. The first two patients’ Doppler ultrasonography results with application of an intracavernosal agent.

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not employed for the next five patients. 
All of the patients were improved within 3–5 weeks, as 
expected. Dexketoprofen trometamol (25 mg) pills were 
given twice daily to patients experiencing pain. Penile 
Mondor’s disease patients are usually young and sexually 
active. In these patients, erectile function is generally 
normal and the risk of developing priapism is higher than 
in patients with erectile dysfunction after penile Doppler 
ultrasonography with intracavernosal vasoactive agent 
injection. We think that priapism is a much more serious 
condition than penile Mondor’s disease when considering 
the possible consequences.
Penile Mondor’s disease is easily recognizable with 
medical history taking and physical examination. The 
patient consistently presents with a mobile, cord-like 
induration on the dorsum and dorsolateral aspects of 
the penis which has become thickened and adherent to 
the overlying skin. We do not consider that additional 
scrutiny is required. To arrive at these results, we do not 
consider that more patients need to be examined.
Sclerosing lymphangitis and Peyronie’s disease have been 
emphasized in differential diagnosis of penile Mondor’s 
disease.(10) The morphology of sclerosing lymphangitis 
is serpiginous and it is characterized by thickened and 
dilated lymphatic vessels. Peyronie’s disease results from 
a thickening of the tunica albuginea and presents as a 
well-defined immobile fibrotic plaque on the penis.

CONCLUSION 
Although penile Mondor’s disease is fairly uncommon, 
it is easily diagnosed. It improves with conservative 
treatment or spontaneously, but the diagnosis is important 
because the condition may create fear in patients. In 
our view, patients should not be exposed to diagnostic 
penile Doppler ultrasonography with an intracavernosal 
vasoactive agent injection, as this is unnecessary and 
has the potential to cause serious harm. As noted in the 
literature, if the greatest cause of this disease is prolonged 
sexual intercourse, these investigations should be 
contraindicated. Primum non nocere!

CONFLICT OF INTEREST.
None declared.

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