Prolonged erection is dangerous; revealing the secrets of priapism.

**Part 5**

**Prolonged "ejaculation" can be dangerous.**

**Case Study**

**Name: Liu Li (pseudonym), 32 years old**

**Region: Wuhan, Hubei Province**

**Occupation: Graphic Designer**

Liu Li, who has been married for eight years, has always been a "quick finisher" in their sex life. He always gets excited and goes into bed early, but he ejaculates in just a few minutes. Although it's not a big problem, his wife always feels unsatisfied and wishes that the duration could be longer.

But recently, his wife found the feeling she wanted with Liu Li. After returning from a business trip, Liu Li seemed like a different person; he lasted for half an hour in one go, which made his wife both happy and worried. She was happy about his virility, but also worried that he had been taking aphrodisiacs and harming his health. Liu Li confessed to his wife that he hadn't taken any aphrodisiacs, nor had he had time to exercise. This time, their "battle" in bed was probably due to "absence makes the heart grow fonder," and his "quick-draw" technique had become "unfailingly powerful."

One night, Liu Li and his wife were intimate again. After several orgasms throughout the night, Liu Li was still unable to ejaculate. At first, Liu Li was secretly pleased, but after more than ten minutes, his penis still wouldn't ejaculate. He even had great difficulty urinating and found that the skin of his penis had turned purple. He was in extreme pain, so he quickly went to the hospital for treatment.

Liu Jihong, Chief Physician of the Department of Urology at Tongji Hospital, Wuhan, affiliated with Huazhong University of Science and Technology: "Unfailing erection" is a common phrase in advertisements for many drugs treating erectile dysfunction. A penis as hard as a "golden gun," never losing its erection, may be every man's dream. However, sometimes an "unfailing erection" can not only cause discomfort but may also be a pathological condition leading to permanent erectile dysfunction.

How can we distinguish between what is normal and what is pathological?

Under sexual stimulation, the penis undergoes nerve and vasodilation regulation, causing a large amount of blood to rapidly flow into the corpora cavernosa, resulting in penile enlargement and hardening. Typically, after an orgasm, the blood vessels connecting the penis to the outside reopen, acting like drainage channels to expel the accumulated blood from the corpora cavernosa, causing the penis to shrink and soften again. Throughout this entire process, there is no discomfort felt in the penis.

Pathological "priapism," also known as a persistent erection, is characterized by the penis remaining erect for more than 4 to 6 hours without desensitization or sexual stimulation. After onset, the patient's penis remains permanently erect and does not flaccidize, often accompanied by swelling, pain, and difficulty urinating. This condition can last for hours, days, or even longer. Such "priapism" offers no sexual pleasure and is extremely painful, primarily due to prolonged penile swelling and congestion caused by various factors.

When priapism occurs, a large amount of blood accumulated in the penis cannot flow out. Over time, the oxygen-deprived red blood cells become stiff, blocking all blood vessels connecting to the outside world, turning the penis into a completely isolated cavity. The penis will gradually swell and eventually die. Some physical illnesses, such as sickle cell anemia, leukemia, spinal fractures, and paralysis, can thicken the blood or cause red blood cells to lose elasticity and fluidity, potentially leading to priapism. Some medications, such as antidepressants and antihypertensive drugs, can also cause priapism. Another situation is excessive arterial blood supply and insufficient return, leading to priapism, such as in cases of aneurysm.

If priapism occurs, don't be ashamed to seek medical attention. It's crucial to address it as soon as possible. Ideally, the erection should not last more than 4-6 hours, and definitely not more than 12 hours. Studies have found that if the corpora cavernosa of the penis experiences ischemia for more than 12 hours, the chance of tissue necrosis is over 90%.

Priapism is usually treated by injecting vasoconstrictors, such as phenylephrine, into the penis to induce flaccidity. Another common method is penile aspiration, where blood is slowly drawn from the corpora cavernosa, sometimes combined with flushing the corpora cavernosa with saline solution until the penis is completely flaccid. If these methods are ineffective, surgery should be performed as soon as possible.