Danger signal: When Your Penis Plays the ‘Stand-Up’ Routine Too Long

One of the most notable characteristics of the penis is its ability to be flexible and rigid, soft and hard. However, sometimes it can become hard and stay that way for hours on end. If it remains erect for more than four hours, it's usually referred to as priapism (a similar condition can also occur with the clitoris). But don't mistake this for a convenient or manly situation. Priapism often comes with pain, swelling, and a bluish-purple hue, and it can cause difficulty in urination. If left untreated, it can even lead to erectile dysfunction. So, what causes priapism?

### The Reasons and Consequences of Stiffness

Erection relies on the engorgement of the corpora cavernosa with blood. It's important to note that an erection isn't like inflating a balloon and then sealing it until you're done. Instead, it's more like a firefighter using a hose to put out a fire. When the valve is opened, the hose fills with water as it sprays out. Similarly, an erection occurs when arterial blood flow increases and venous return decreases.

The cause of priapism, in essence, is either difficulty in blood returning from the penis or an increase in blood flowing into it. The most common reason is that blood flows into the penis easily but has trouble getting out, known as ischemic or low-flow priapism. There are many potential factors for this, such as taking certain antihypertensive or sedative medications, nerve damage or diseases, and external pressure. These can all lead to compression of the small veins beneath the tunica albuginea, causing priapism. Additionally, increased blood viscosity can also obstruct blood flow in these small veins. A common cause is blood disorders, with sickle cell anemia being the most typical. People with this condition have sickle-shaped red blood cells that are more likely to cluster in the corpora cavernosa. In fact, priapism is one of the associated symptoms of sickle cell anemia. Other diseases, such as leukemia and malaria, can also cause priapism.

Another cause of priapism is excessive blood flow into the corpora cavernosa, known as non-ischemic or high-flow priapism. This can occur due to injury to the penis or perineum, which damages the relevant arteries. However, this type of priapism is much less common than the ischemic kind.

It's crucial to note that when ischemic priapism occurs, poor blood circulation can lead to oxygen deprivation and pain in the corpora cavernosa. If left untreated for a long time, it can cause tissue death and directly affect erectile function. Therefore, it's important to see a doctor promptly to avoid any long-term damage.

### Going Soft to Get Harder

The treatment for priapism aims to relieve the erection and pain while preserving the penis's ability to achieve future erections. The main treatment methods include:

- **Applying ice to the affected area to reduce swelling and pain**: This might sound like a "cooling-off" period, but sometimes, a bit of calm can really help.

- **Ligating the damaged artery to restore normal blood flow**: If the artery is injured, the doctor might apply an "emergency brake" to get the blood flow back on track.

- **Injecting medication into the corpora cavernosa**: This method is used for ischemic priapism, where medication helps to alleviate the swelling, acting like an "emergency kit" for the corpora cavernosa.

- **Surgical shunting**: This is also used for ischemic priapism, where doctors surgically divert blood from the penis to restore normal circulation. However, surgical shunting is usually a last resort when other methods fail, as no one wants to undergo surgery if it can be avoided.

- **Aspiration**: The penis is numbed, and then a needle is inserted directly into it to drain the excess blood, reducing pressure and swelling. It might sound a bit intimidating, but sometimes it's the most direct and effective solution.

In summary, if you experience priapism, it's essential to seek medical attention immediately and avoid trying to handle it yourself. The longer priapism lasts, the greater the damage, and more invasive treatments may be necessary, which can directly affect future erectile function. Most cases treated promptly can recover erectile function, while those lasting over 36 hours are much less likely to do so. So, if this happens, don't hesitate—head straight to the hospital. After all, health is the real deal!