A four-hour erection, also known as priapism, on the surface, may sound like the height of masculinity, but in reality, it is an emergency that requires immediate hospital care. Priapism has many causes which we will discuss briefly, but for this article, we will focus on medical interventions for erectile dysfunction or ED and whether they increase the risk. The patient must be aware of this risk, but it is also important to understand why it occurs and when to be on guard. Before addressing the various ED interventions and whether they caused priapism, it is necessary to understand why priapism is problematic.
The tissues in the penis are specially made to absorb and eventually fill with blood. This is what causes a firm erection. However, if the blood remains in these tissues for too long (usually more than 4 hours), it can lead to oxygen deprivation of the erectile tissue, causing cell death, scarring and permanent disability in the form of reduced erectile function.
The two types of priapism
Ischemic or low-flow priapism results from blood not leaving the penile tissue through the veins, often due to problems with the erectile smooth muscle in the penis. This is by far the most common type of priapism, requiring an emergency room visit. Blood trapped in the penis is eventually depleted of oxygen, which deprives the penile tissue of this vital nourishment. Over time, this causes penile tissue to die. The main symptoms of ischemic priapism are an erection that lasts more than four hours, an erection that remains without sexual stimulation, a soft glans penis with a rigid shaft, and pain that worsens over time.
There is a subtype of ischemic priapism known as stuttering priapism. This includes prolonged erections that happen over and over again. This is rare and is of particular concern to men with sickle cell disease. Priapism stuttering often begins in childhood and worsens over time.
Non-ischemic or high-flow priapism is a condition in which the arterial blood flow does not work normally. This is often caused by trauma and the penile tissue continues to receive oxygen, making it somewhat less emergent than ischemic priapism. Although not an immediate emergency like ischemic priapism, only a qualified doctor can diagnose which form of priapism you have. Therefore, it is important that if you have an erection that lasts longer than four hours or an erection that is not caused by sexual interest or arousal, you get immediate care.
Causes of Priapism
Priapism has many possible causes, including blood disorders such as leukemia or sickle cell disease. Patients with these diseases often receive instructions from their hematologist about what to do if they develop priapism. Medications can also cause priapism. This is especially true of antidepressants, alpha-blockers such as Flomax for BPH, anxiety medications, blood thinners, hormone replacement therapy, and other psychiatric medications related to mental health, including those that treat ADHD . Alcohol and drug use, trauma to the penis or pelvic area, and even certain neurological and metabolic disorders can cause priapism.
However, priapism can also be caused by the injections we use to treat erectile dysfunction. This drug is known as a trimix or quadmix, so named for the number of drugs that are mixed for maximum effect. These drugs are best described as rocket fuel for an erection. Men who are no longer receiving sufficient benefit from drug therapy such as sildenafil/Viagra or tadalafil/Cialis often turn to these injections as they produce almost immediate and very stable erections, at least for some time. That said, the main concern, although rare, is priapism. Therefore, patients should be aware of any erection that lasts longer than four hours or occurs without sexual stimulation – physical or mental.
Can Ed’s meds cause priapism?
In general, priapism is not a common side effect of ED medications, although there is a small risk with continued use of Viagra/sildenafil. There are, however, confounding factors that have not been well studied because of the rarity of the event. Is the patient taking too much sildenafil? What other medications or injections is the patient taking that could have increased the risk of priapism? There are many variables.
That said, ED medications are extremely safe and effective in early-stage erectile dysfunction. Most patients continue to take these medications until they are no longer effective without significant side effects. Indeed, while Cialis and Viagra have their differences, one of their common features is safety and effectiveness.
The bottom line
Priapism is a major concern and emergency for patients who experience it. Despite the relatively rare nature of the condition, patients using Trimix or Quadmix for erectile function are at greater risk. Primary ED interventions, such as medications, are usually not associated with priapism, although there is a minimal risk.
The next step is to visit a specialist men’s health urologist like Dr. Natale to understand more about your erectile dysfunction treatment options. We look forward to a consultation where we can decide together what the best next step is, be it medication, injections or even penile implants for severe erectile dysfunction.
