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Urgent men's health
An erection that lasts four hours or more without sexual stimulation is a medical emergency. Treated early, it almost always resolves with simple measures; treated late, it can permanently damage erectile tissue.
If you have had an erection for more than four hours, call our office during office hours at (212) 991-9991 or go to the nearest emergency room. Do not wait for it to go away on its own. Time matters because the risk of lasting damage climbs steadily after about four to six hours.
Low-flow, or ischemic, priapism is the common and dangerous type. The mechanism that traps blood to maintain an erection locks in place, fresh arterial blood can no longer enter, and the tissue is starved of oxygen. It is usually painful and rigid.
High-flow priapism is rare, typically follows an injury to the groin or penis, is often painless, and does not destroy tissue in the same way. It is managed differently, sometimes with observation or embolization.
The most common cause we see is injection therapy for erectile dysfunction, particularly Trimix, and especially when an injection is combined with a pill such as sildenafil or tadalafil. Never stack them. Other causes include sickle cell disease and sickle cell trait, certain psychiatric and blood pressure medications, recreational drugs, and occasionally blood disorders.
The first step is an injection of phenylephrine, which constricts the blood vessels and lets blood drain. One or two rounds resolve the large majority of cases.
If injections are not enough, blood is drawn out and the tissue is rinsed under good anesthesia, which resolves many of the remaining cases.
Rarely, a small procedure creates a new drainage path. The earlier treatment starts, the less likely this is to be needed.
When we start a patient on Trimix, the first dose is given in our office so the right dose is found safely, starting low, because a small change in volume is a large change in effect. Men on injection therapy should know exactly what to do if an erection does not subside. Men with repeated, stuttering episodes can often be prevented with oral medication.
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Four hours. After that, seek care immediately; tissue damage becomes more likely after about four to six hours.
No. Stacking an injection with a PDE5 pill is the most common preventable cause of priapism we see.
When it is treated early, most men recover normal function. The longer it lasts, the higher the risk of permanent erectile dysfunction.
Yes. Both sickle cell disease and sickle cell trait increase the risk of priapism.
Get to care rather than waiting. Do not take more medication, and do not apply ice directly to the skin for long periods.
Book a men's-health visit at our Manhattan or Forest Hills office — a simple step that's easy to keep putting off.
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