The ads for all the erectile dysfunction pills (like Viagra, Cialis, and Levitra) say “seek medical attention if you have an erection lasting for more than 4 hours”. Called priapism, this is a potentially serious medical condition. Often occurring in men with Sickle Cell Anaemia (of the trait) due to the abnormal shape of the red blood cells, it can result in impotence, thrombosis and in some rare cases, gangrene (shudder). There are several ways medical professionals can deal with this condition. Going from the mild to the extreme. The other day we had a man (with sickle trait) come in with a painful erection lasting about 6 hours. He had experienced some milder cases in the past but this time was the most serious. He was miserable. The concept of this condition is that blood enters the penis but can’t get out. So what you need to do is mostly restrict blood flow in. If that is not effective, more distressing measures are required to remove the blood. First we gave him an injection of terbutaline (a drug used to arrest labour and occasionally in asthma) which can sometimes restrict inflow enough to resolve the problem. It did not work, so onto step two. This is a bit more disturbing to watch but still better than the subsequent steps as you will see. We injected a very small amount of phenylepherine into the spongy tissue of the penis itself (being careful to avoid the penile artery or urethra) with an insulin syringe. This is a powerful vaso-constrictor that causing the spongy, blood filled tissue to clamp down and prevent more blood from coming in. He got three injections and luckily for him , the third time was a charm. He detumesced. Now, if we had had to go onto step three, he would have been a much less happy camper. This is where you have to stick a very large needle into the corpus cavernosum (14 gauge) and aspirate the blood out. I have seen this done and it sends shudders down my spine. But is it still better than step four which is in my opinion, akin to a mediaeval torture. It is called Winter’s Procedure. What is done is that a very large needle or surgical blade is inserted through the glans (tip) of the penis on either side of the urethra and multiple punctures are made to create a shunt between the cavernosum and the spongiosum (more spongy tissue on the underside of the penis which contains the urethra, and is composed of slightly different tissue - where blood returns back out of the penis). There are variants of this procedure done more proximately if it fails. A urologist I spoke with told me this was a procedure that when performed (under anaethesia of course), causes all the other males in the room to turn away or leave (including first time urology residents!). This guy can count himself lucky that he never made it past step two!
Uh, as a chick all I have to say is, “AUUUUGGGGGHHHHHH!”
I wonder if that guy is going to use Viagra again.
Are men with sickle trait subject to priapism “simply” by virtue of their misshapen blood cells — that is, are there necessarily ED medications involved in that population?
Oh, and yes, how glad I am for your patient that the relatively less horrid treatment worked!
I wish I had something more constructive to say than “OWW!!!!” but… I’m at a loss of words right now…
Reason #16,423 why I am glad I am female!
Okay…explain then how men who claim they are into Tantic sex and can have erections for hours do not have any of the risks associated with priapism?
I guess in that case they can shut it down if it gets to painful…still…the claim to me seems unlikely…
Oops..typo in my info..allow me to repost…
Okay…explain then how men who claim they are into Tantic sex and can have erections for hours do not have any of the risks associated with priapism?
I guess in that case they can shut it down if it gets to painful…still…the claim to me seems unlikely…
Men with sickle cell anemia (homozygotes) can have priapism without ever taking Viagra. I would suppose that men with sickle cell trait (heterozygotes) could have priapism without taking Viagra as well, providing the conditions were right (dehydration, extreme heat, altitude–any thing that can put a person with sickle trait into a sickle crisis). Erectile dysfunction drugs are only one way to get this condition. A commonly used sleep medication, trazodone, carries a very small but significant risk of priapism, also.
In other words, I’m guessing from the way the post is written that this patient did not actually take any medication, but due to his blood condition had a priapism anyway. I liked this post because I hear a lot of guys laugh at that comment on the Viagra commercials–”Hey, I’d be HAPPY if it lasted four hours!” Obviously, they don’t know the consequences, or how painful priapism actually is.
He had taken no meds. He was just + for Sickle trait.
4 hours — as the commerical says — that’s not a medical emergency it’s a scheduling conflict.
I love your website, but I keep forgetting not to read it before going to bed
*shudder*
Albinoblackbear: With the control necessary to perform Tantric sex correctly, one can actually go to a sort of ‘halfway there’ state. This permits blood to move in and out as required for health. It’s only ‘unlikely’ if you’re insisting on rock-hard, maximal erection. That’s not necessary, of course.
Large amounts of IV fluid and pain medicine (and some oxygen) are the only treatments I’m used to for sickle cell crises. Would this be a contraindication for giving a lot of fluids?
Loving the blog. Been reading bits of it over the last week or so. It truly scares me to read about some of the things my fellow human beings get up to.
I have just seen this story on an IT news website (No idea about the technical angle?) about a 23 year old guy with priapism for five days.
More here for those interested in reading it:
http://www.theregister.co.uk/2009/02/26/hardened_dominican/