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Untreated, it could lead to erectile dysfunction.

By Colleen Murphy
March 08, 2021
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There are a lot of health complications that may come with COVID-19: pneumonia, acute respiratory distress syndrome, and heart problems, just to name a few. There can also be "thromboembolic" complications that occur when a blood clot breaks loose and blocks blood flow in another vessel; one such complication is priapism: a prolonged erection of the penis.

That's what recently happened to a 69-year-old man with a severe case of COVID-19 in Ohio. Doctors wrote about the man's experience in a case report that was published in the American Journal of Emergency Medicine earlier this year.

According to the case report, the man went to the emergency department after the respiratory symptoms he had been experiencing for a week, like cough and congestion, worsened. Doctors tested him for COVID-19, and the test came back positive. While in the hospital, the man's respiratory status continued to decline, and he was intubated and placed on a mechanical ventilator. To help him breathe better, he was then put in a prone position so that he was lying on his stomach. The next day, when adjusting the patient's positioning, a nurse noticed that the man had an erection. The care team put ice packs on the area, but the erection still wouldn't go down, lasting more than three hours.

His doctors determined that the prolonged erection was due to ischemic priapism. According to the Mayo Clinic, ischemic priapism (also called low-flow priapism) happens when blood isn't able to leave the penis. In this case, the man's priapism was believed to be due to an obstruction of draining venules, which are very small blood vessels. People with ischemic priapism usually have an erection that lasts more than four hours or that is unrelated to sexual interest or stimulation.

Another symptom of ischemic priapism is progressive pain in the penis. Usually, clinicians can ask patients about their pain level to determine whether they have ischemic priapism or another type of priapism, known as nonischemic or high-flow priapism. This occurs when blood flow in the penis isn't regulated appropriately, according to the Mayo Clinic. It usually hurts less than ischemic priapism. However, since the patient was sedated, doctors couldn't gauge what level of pain he would have been feeling if he were conscious. Other tests ruled that it was ischemic priapism.

The case report authors consider priapism to be a "medical emergency" because of the potential adverse effects. The Mayo Clinic described how serious complications can occur: "The blood trapped in the penis is deprived of oxygen. When an erection lasts for too long, this oxygen-poor blood can begin to damage or destroy tissues in the penis. As a result, untreated priapism can cause erectile dysfunction."

In this man's case, the blood was drained from his penis. And with the help of medication injected into the base of his penis, his erection subsided after 30 minutes of treatment. While he had no additional thromboembolic complications, and priapism didn't happen again, the man ultimately died from his other COVID-19 complications.

This is certainly not the only case of priapism in a patient with COVID-19. A 62-year-old man with COVID-19 developed priapism after he was sedated and put on a ventilator, as previously reported by Health.

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