Sclerosing lymphangitis, or lymphangiosclerosis, is a rare skin condition in which a lymph vessel in the penis becomes swollen and hard. It occurs below the head of the penis and has the appearance of a rope- or cord-like swelling that runs the circumference of this area.

In this article, we define sclerosing lymphangitis and explore its symptoms, diagnosis, and treatment. We also cover the potential complications of this condition and explain when to see a doctor.

Sclerosing lymphangitis is a skin condition that typically presents between the ages of 20 and 40 years. However, there are case reports of sclerosing lymphangitis occurring in people up to 66 years of age.

The condition presents as a cord-like swelling below the head of the penis. It usually forms in an area of the penis known as the coronal sulcus and encircles this area. This area is the groove between the head of the penis and the penile shaft.

Although it may look alarming, sclerosing lymphangitis is usually not a cause for concern and will likely heal without medical intervention.

The exact causes of sclerosing lymphangitis are unknown. However, it seems that repeated trauma through vigorous sexual activity is the most likely reason for it to develop.

The repeated trauma seems to block a lymph vessel, which results in swelling. Lymph vessels are thin tubes that transport lymphatic fluid and white blood cells around the lymphatic system.

Circumcision may also be a causal factor, but further research is necessary to understand whether it has an association with the condition.

Older research suggests that sclerosing lymphangitis may also arise due to sexually transmitted infections (STIs) — for example, syphilis.

The main symptom of sclerosing lymphangitis is a hard, cord-like swelling on the coronal sulcus of the penis.

A person may mistake this for a swollen vein, but a swollen vein will appear red or purple. In cases of sclerosing lymphangitis, the color of the affected area is often the same as a person’s normal skin tone.

According to a 2014 case study, the hard and swollen lymph vessel is usually about 3 millimeters in width.

The associated swelling is hard to the touch but often painless. It is visible in both an erect and flaccid penis.

If the cause of sclerosing lymphangitis is an STI, a person may experience other symptoms associated with the infection.

The diagnosis of sclerosing lymphangitis will typically involve a physical examination. A doctor will ask about sexual history and any frequent or vigorous sexual activity or masturbation a few days prior to the appearance of the swelling.

To understand the underlying cause of the condition and rule out other causes, a doctor may also conduct the following tests:

  • Swab test: To check for STIs, a doctor may insert a swab into the tip of the penis.
  • Urine test: A doctor may ask for a urine sample as another way to check for STIs.
  • Blood test: This test can identify whether a person has a high white blood cell count, which is indicative of an infection.
  • Biopsy: This procedure involves taking a small sample of tissue from the area. The doctor will send the sample to a laboratory to rule out any other potential causes of the swelling.
  • Doppler ultrasound: This test may play an important role in determining whether the swelling is due to sclerosing lymphangitis rather than other conditions that may present with similar symptoms, such as penile Mondor’s disease.

Sclerosing lymphangitis is not serious and usually goes away on its own within 4–6 weeks.

Before it resolves, a person with sclerosing lymphangitis may find getting an erection uncomfortable. While waiting for the swelling to go, they should avoid any sexual activity, including masturbation. Continuing to engage in sexual activity may slow down healing or irritate the area.

Although a doctor will not usually prescribe medication for sclerosing lymphangitis, they may prescribe nonsteroidal anti-inflammatory drugs. In one case study, a person took oral tiaprofenic acid to help reduce swelling and pain.

If the cause of sclerosing lymphangitis is an STI, a person may require a course of antibiotics. To avoid the STI spreading to sexual partners, a person should abstain from intercourse until the STI has gone.

As sclerosing lymphangitis is a rare condition, there is a lack of research exploring its long-term effects.

In the short term, sclerosing lymphangitis is not associated with any major complications. However, the swelling may make a person feel self-conscious, and it might be uncomfortable for them to engage in sexual activities.

Once the swelling goes, there do not seem to be any further short-term complications.

If the swelling is painful, discolored, or still there after 6 weeks, a person should consider visiting a doctor or urologist. These may be signs that they have a different condition.

A person should also consider seeing a urologist if they frequently experience sclerosing lymphangitis.

If a person believes that they have sclerosing lymphangitis due to an STI, they will need to see a doctor who can prescribe them the necessary treatment.

Sclerosing lymphangitis is a cord-like swelling under the head of the penis, which may occur due to trauma from vigorous sexual activity or an STI. The swelling goes around the circumference of the affected area.

Usually, sclerosing lymphangitis is not a cause for concern. In most cases, it resolves by itself. However, if the underlying cause is an STI, a person will require medical attention.