What is a priapism?

Priapism is defined as a sustained erection lasting for longer than 6 hours. Damage to the penis as a result of a prolonged sustained erection usually begins to occur after it has been erect for more than 12 hours. This is variable and may occur sooner for some men. To prevent any chance of damage, I recommend that a priapism be treated well before 12 hours. There is little reason why an erection should last for more than 2 hours. It is both unnecessary and uncomfortable if this happens. I therefore recommend that remedial treatment should be started soon after 2 hours. There are some men, however, for whom 2 hours is will never be long enough!
Marty, 73 years old, retired business man
Marty has been a regular patient of mine for the last three years. He originally saw me at the age of 70, after suffering from erectile dysfunction for several years. Marty is a widower. His wife died three years previously to our first meeting. He hadn't wanted to become involved with anyone else since then, but his desire for sex had reawakened him.
A week before I saw him for the first time, Marty had an embarrassing experience with a call girl. His erection had failed him and he felt devastated. Subsequently, I treated him successfully and since then he had been to the clinic every six to nine months to replenish his medication. He was in good health each time I saw him and his body was looking younger as he got older.
Recently, he arrived for a consultation but it had been only two weeks since his last appointment.
'Hi, Marty. What brings you back so soon?'
'Doc', he said, I've been using this medication for three years now. It's been great. I use it twice a week. I give myself an injection and then I head off to the nudist beach. I lie there naked with a strong erection for three hours. Even if I go for a swim, when I come out, it's still strong, no matter how cold the water is.
'[But] this batch of medication you gave me two weeks ago is not doing the job. It comes up all right, but 30 minutes later it's getting soft. What do I do if a woman starts to follow me into the forest?'
'Women follow you into the forest?' I asked, thinking that I'd not heard him correctly.
'Yes, of course they do. They see me lying there with this hard erection for hours at a time, and eventually they just can't stop themselves.'
'How often does this happen?' I asked surprised and with renewed interest.
'Oh, maybe once a week, or once every two weeks. We walk into the forest for a bit of privacy and do the deed', he said. 'Doc, I'm 73 years old now. I'm having sex more often now, with more different women than ever before. So I need this three-hour erection. It's the best thing in the world.' This case is an exception, I might add. Three hours, to me, just seems far too long.

In experienced hands, a priapism in a patient should be a rare occurrence. If the medication is dispensed carefully, the incidence should not be higher than i in 500. Priapism is more likely to occur if the treeating doctor is inexperienced in this field (although it happens with experienced doctors). It is also more likely to occur if papaverine is used as a part of treatment. It is less likely to occur in single therapy PGE use. Priapism has even been shown to occur while using testosterone for hormone replacement therapy. This is quite rare. It is also a rare complication when using Viagra, which has only recently been documented. A priapism may even occur spontaneously, without using any treatment.
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