A persistent painful penile fissure is an exquisitely painful horizontal crack on the shaft of the penis of unknown etiology. This condition appears suddenly in young adults or at early midlife for no obvious reason. There is no history of a precipitating trauma or the local application of steroid or other creams. It may be seen in circumcised and in uncircumcised individuals.

A very painful, horizontal crack appears on the shaft of the penis or in the mucosal aspect of the foreskin, which makes intercourse very painful, to the extent that the patient becomes reluctant to have normal sexual relations. The lesion may be surrounded by redness secondary to inflammation. The lesion tends to heal, but attempts to have sexual intercourse causes it to split open again. Histology shows only a nonspecific inflammation. Treatment with antibiotic or steroid creams has not been helpful.