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Long-lasting, painful erections send 10,000 men to the ER each year

All the erectile dysfunction drug commercials have it -- that quickie disclaimer about seeking help if you have an erection that lasts more than four hours. It makes for good joke fodder, but the condition, known as priapism, not only can be a symptom of a possibly life-threatening situation, but, says a new study published this week in the Journal of Sexual Medicine, costs patients and the health care system a significant amount of money.

Using data gathered from the Nationwide Emergency Department Sample, a large public database that monitors E.R. usage, Daniel Stein, a urology resident at Northwestern University’s Feinberg School of Medicine, and his colleagues, found that of every 100,000 E.R. visits, 8.5 were for priapism during the years 2006-2009.

That may not seem like much, but that works out to about 40,000 emergency room visits during those years, or around 10,000 cases each year during that time period.

Men treated in the ER and sent home cost $1,778 per episode. But men who came to the ER and were then admitted cost $41,909. In all, the mean annual charge for episodes that began as an E.R. visit for priapism was $123,860,432.

Stein pointed out that those numbers don’t necessarily mean that all costs directly apply to the priapism.

That more men than thought are headed for ERs with persistent erections can't automatically be blamed on all those pill commercials and the increased popularity of the drugs. “We don’t know the reason for admission,” Stein said of his data in an interview with, clarifying that we only know that patients first appeared in the E.R. complaining of an erection that was painful and/or wouldn’t go away.

In 21 percent of priapism ER episodes, the patient also had sickle cell disease. Admission could be for complications of that disease, with the priapism only one symptom.

In sickle cell disease, the blood cells are malformed into distorted sickle shapes that can lead to a “sludging” of the blood flow, Stein said. That can lead to blocked or minimal flow through small blood vessels like those in the penis. But it can also lead to dangerously high blood pressure and strokes.

So a persistent erection could be a symptom of more sickle cell trouble that requires admission.

Priapism itself, whether related to sickle cell, or due to other common causes like use of an erectile dysfunction pill, an injectable erectile dysfunction treatment, or some other cause, can seriously damage the penis.

“It’s like a heart attack,” Stein explained. “When there’s a problem with blood flow to the heart, tissue is damaged and time is critical. Same thing here. The longer it goes on, the more damage to the fibrous tissue of the penis.”

Typical treatments used in an E.R. include “irrigation,” which involves sticking a needle into the side of the penis and injecting and withdrawing saline solution, or injecting a drug like epinephrine to constrict blood vessels.

Stein was motivated to study the issue of E.R. treatment for priapism because there didn’t seem to be reliable data on just how big the issue was. “We found it interesting and eye-opening,” he said. “This shows that if we can streamline management of patients in the E.R., and not have extraneous admissions, we could save a lot of money.”

Brian Alexander is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," now on sale.