With Valentine’s Day around the corner lots of couples, lovers, and hopeful lovers will have plans in place to make that special someone feel on top of the world for the 14th. Roses, candlelight dinners, trips, and other surprises will hopefully end with a climactic crescendo, which literally may require, in part, an adequate firmness from the male organ lasting for just the right time.

An erection for some is the epitome of manhood and is always a good thing, or is it? Lots may not know, but there is such a thing as an unwanted prolonged erection with dire consequences if not recognised and treated or averted within a reasonable time. This is known as a priapism.

The term priapism is derived from Priapus, the Greek god of fertility, gardening, and lust, who is depicted with a massive phallus, but the condition as it’s known speaks to an urgent medical condition that may have significant morbidity. Increased awareness, avoidance of precipitating drugs or environmental conditions for certain high-risk groups is essential, as is early medical intervention if it persists.

Priapism is a persistent penile (or clitoral) erection that continues hours beyond or is unrelated to sexual stimulation. There are two types: ischemic (no oxygen) and non-ischemic.

Ischemic priapism accounts for 95 per cent of cases and it is this one which will be discussed briefly. It was previously described as lasting at least four hours or more. An erection requires increased blood flow into the tissues of the penis with decreased outflow, like filling a balloon with water until its walls become tense and ensuring no leaking to maintain its inflated shape. However, tissues need oxygen to live and what happens in priapism is that there remains no outflow (or relaxation of tissues) over a prolonged time, and pressures within the penile tissue increase to a critical point to prevent inflow of oxygenated blood which is vital. Without oxygen beyond a certain point, there will be permanent damage to tissues and ultimately death if this continues. It’s accompanied with severe pain and may require hospitalisation.

There are multiple associated medical conditions and drugs that are recognised as risk factors for this condition — certain disorders of blood, such sickle cell disease and leukemia, as well as metastatic cancers involving the pelvis, such as prostate, bladder, or even colon cancer.

Its relevance to Jamaica is that sickle cell disease is relatively common in our population. As many 1 in 150 live births have sickle cell and, as shown in a local study by Morrison, et al in 2010, the prevalence amongst this group is as high as 30 per cent. Other studies have shown the prevalence of priapism as high as 42 per cent amongst men with sickle cell disease (HbSS). It has a bimodal age distribution with peaks at five to 10 years and 20 to 50 years. Unfortunately, a more recent local study showed that awareness about priapism as a medical emergency stood at only 30 per cent. Ignorance, embarrassment, and taboos surrounding this condition have possibly resulted in parents of children affected and patients not seeking necessary help in a timely fashion. Consequences can be devastating as mentioned earlier.

Lots of drugs and medications are promoted to increase the vim, vigour, and overall performance, but caution should be exercised and, ideally, medical advice sought as lots of these medications have been associated with priapism. Recreational drugs, such as cocaine, crack cocaine, marijuana, and even alcohol; some anti-hypertensives, antipsychotic, and anticoagulant medications, are amongst a relatively long list.

Treatment involves early recognition and may start with attempted home remedies such as hydration, exercise, avoiding extreme or stressful conditions, such as the cold (especially for those with sickle cell) as stressful conditions may precipitate a painful crisis including priapism. If it persists then medical help is required. Surgical procedures, which start from the least invasive, involve injecting medications into the penis and aspirating the deoxygenated blood from same. There are more invasive shunting (surgical) procedures that may be done by a urologist to allow for improved blood flow to the area. Unfortunately, the longer the duration of this unwanted erection is the greater the likelihood of permanent erectile dysfunction and, in some cases, it can be quite devastating. In some refractory cases penile implants may be even recommended on the same admission because of the expectation of severe erectile tissue damage and dysfunction. Penile implants have been done at both the University Hospital of the West Indies and in Montego Bay but, in general, are somewhat pricey and not covered by most insurance companies, even though we believe that this aspect is essential to lots of healthy relationships and overall health.

Dr Jeremy Thomas is a consultant urologist. He works privately in Montego Bay, Savanna-la-Mar, and Kingston and publicly at Cornwall Regional Hospital. He may be contacted on Facebook and Instagram: @jthomasurology or by e-mail: jthomasurology@gmail.com