Mondor’s Disease of Penis

The importance of optimal penile health cannot be ignored in the maintenance of male reproductive as well as sexual functions. Unfortunately, it has been observed that the clinical diagnosis of diseases involving the genital organs is often delayed because most males find it embarrassing to see a doctor for such indications.
Mondor’s disease is a rare condition of penis that is usually overlooked by both patient as well as the physician.  Additionally, due to similarities in the symptomatology, Mondor’s disease is often confused with peyronie’s disease or sclerotizing lymphangitis of penis. The peak age of incidence is 20 – 40 years. Based on the latest estimates, the incidence of Mondor’s disease is 1.39%.
 

What is Mondor’s Disease?

The pathophysiology of Mondor’s disease revolves around the thrombosis of dorsal vein of the penis. It is logical to assume that penis is richly supplied with an extensive network of blood vessels (also referred to as venous plexuses) that are responsible for the maintenance of normal erectile functions in males. However, certain condition (such as traumatic injury to penile tissue) can lead to acute or chronic inflammatory reaction in the penis. This can significantly affect the integrity of blood flow to the penis and may lead to superficial thrombophlebitis or inflammation of the dorsal vein.
Patients suffering from Mondor’s disease are usually asymptomatic. According to study reported in Journal of Ultrasound in Medicine (3), only 33% (or 1/3^rd) patients present with symptoms; whereas in other patients the condition is usually diagnosed incidentally during general physical examination.
Classic symptoms of Mondor’s disease are:

• Localized pain on the dorsal aspect of the penis (mostly aching or throbbing in character)
• Signs of visible induration due to thrombophlebitis (inflammation of the vein)

Most patients lack other disturbing symptoms of infection/ inflammation such as penile discharge, fever, abdominal pain, itching, hematuria, dysuria, painful penile erection or sexual dysfunction.
 

What Causes Mondor’s Disease?

Based on research and clinical analysis, common causes of Mondor’s disease are:

• History of acute or persistent trauma to the penis
• Malignant or benign growth on the penis
• Vigorous or aggressive sexual activity
• Healthcare providers believe that prolong abstinence can also cause Mondor’s disease

In addition certain high risk conditions like hypercoagulable conditions (such as disseminated pancreatic adenocarcinoma, pelvic tumors) or prolong use of intravenous drugs can aggravate the risk of Mondor’s disease.
 

How to Manage Mondor’s Disease?

The management rests largely on the accurate diagnosis of Mondor’s disease. Although clinical findings and history is sufficient to make the diagnosis; yet clinicians also use sophisticated modalities like doppler ultrasound to detect Mondor’s disease.
Most common therapeutic interventions include:

• Anticoagulation (use of aspirin or other anti-coagulant agents like heparin)
• Antibiotics (localized injection) especially in situations where clinicians expect cellulitis

Study reported in peer reviewed journal Urology (4) suggested that conservative treatments (such as antibiotics and anticoagulant therapy) is effective in over 92% cases to achieve complete resolution of symptoms. In advanced cases when the penile tissue is fibrosed, venous stripping or surgical intervention may be needed.
 
References:

1. Nazir, S. S., & Khan, M. (2010). Thrombosis of the dorsal vein of the penis (Mondor’s Disease): A case report and review of the literature. Indian journal of urology: IJU: journal of the Urological Society of India, 26(3), 431.
2. Griger, D. T., Angelo, T. E., & Grisier, D. B. (2001). Penile Mondor’s disease in a 22-year-old man. JAOA: Journal of the American Osteopathic Association, 101(4), 235-237.
3. Conkbayır, I., Yanik, B., Keyik, B., & Hekimoğlu, B. (2010). Superficial Dorsal Penile Vein Thrombosis (Mondor Disease of the Penis) Involving the Superficial External Pudendal Vein Color Doppler Sonographic Findings. Journal of Ultrasound in Medicine, 29(8), 1243-1245.
4. Al-Mwalad, M., Loertzer, H., Wicht, A., & Fornara, P. (2006). Subcutaneous penile vein thrombosis (Penile Mondor’s Disease): pathogenesis, diagnosis, and therapy. Urology, 67(3), 586-588.