Ep. 19 - The Erection That Won't Go Away

[00:12] When an Erection Becomes an Emergency

Host: Dr. Kanwal Bawa | Runtime: 16:06 | Published: April 18, 2022

Dr. Bawa: Welcome to the Dr. Sex Fairy Podcast. I am Dr. Kanwal Bawa, and I am here to transform your life. It is every man's dream to have an erection that lasts forever, until it really does. This is a condition called priapism. The term priapism comes from Priapus, the Greek god of fertility and lust, who is depicted with what else but a massive penis. Priapism is a persistent erection that lasts for over four hours without sexual stimulation or desire. To understand why an erection won't go away, we must first understand how an erection happens in the first place. An erection begins with the relaxation of the smooth muscle of the penile arteries and tissue, leading to increased inflow and decreased outflow.

Dr. Bawa: Priapism can involve either a section of or the entire penis.

[01:05] Why Priapism Happens

Dr. Bawa: So why does it happen? Unfortunately, the cause is not identified in most cases. This is called primary or idiopathic priapism. In some cases, certain medication and disease states have been implicated. This is called secondary priapism. The most common cause in adults is medication use, especially with penile injections, which account for about 25% of the cases. Black widow spider bites and scorpion stings can cause priapism too.

[01:32] Ischemic Priapism

Dr. Bawa: Now let's talk about the two main types of priapism: ischemic and non-ischemic. Ischemic priapism is the more common form. It is also called low-flow priapism. Nitric oxide has been discussed as an important mediator in the development of priapism because it leads to the relaxation of smooth muscle. Understanding of this very pathway led to the development of PDE5 inhibitors used in the treatment of erectile dysfunction. These medications are better known as Viagra and Cialis. Men are delighted, and rightly so, that they can have an erection that is good enough for penetrative sex. There are times when they find that this erection is not going away. They initially think that this is a great thing.

Dr. Bawa: After all, isn't this why they took it in the first place? They are thinking, I'm the man, and then a few hours in, they realize that there's something wrong, something very wrong. They tend to wait too long before seeking medical help. In their defense, many of them are trying to reach the prescribing physician and get stuck dealing with the answering service. The prescribing physicians are often family medicine or internal medicine doctors, and they're unable to deal with this in their office anyway and send them to the ER. When it comes to priapism, I always say, time is penis. It is a true emergency. I say this because permanent damage happens very quickly.

Dr. Bawa: A prolonged erection leads to structural damage of erectile tissue, in part due to edema or swelling in the tissue. Tissue damage can occur as early as four to six hours after the onset of the erection. Significant structural damage can happen as soon as 12 hours later, and irreversible damage can be seen after 24 to 48 hours of priapism. This includes necrosis, or cell death, in the cavernosal smooth muscle and endothelial cells. As you can see, how long priapism lasts is directly related to long-term erectile dysfunction. Ninety percent of men with an ischemic priapism lasting 24 hours will never regain the ability to have sex again.

[03:48] Stuttering Priapism and Sickle Cell Disease

Dr. Bawa: There is a form of ischemic priapism called recurrent or stuttering priapism, which tends to occur in men with sickle cell disease. This starts off with erections of short duration, usually during sleep, and then it persists upon waking up. These episodes become longer in duration as time goes on, and become more frequent as well. And these men eventually have a proper full-blown episode of priapism. It is estimated that about 42% of men with sickle cell anemia develop priapism at some point.

[04:21] Non-Ischemic Priapism

Dr. Bawa: Now let's talk about non-ischemic priapism. Non-ischemic or high-flow priapism is less common than ischemic priapism and is commonly related to trauma, penile or perineal trauma. Blunt trauma can even occur from cycling, and it may damage the cavernosal artery. This kind may take up to 72 hours after the injury to even see a priapism. Congenital arterial malformations may also cause this. Unlike ischemic priapism, like that from sickle cell disease or oral ED medications like Viagra and Cialis and the ED injection Trimix, non-ischemic priapism is not an emergency situation. In this case, the cavernous blood is well oxygenated. The other important difference between the two types is that non-ischemic cases resolve spontaneously up to 62% of the time.

[05:09] Treating Priapism in the ER

Dr. Bawa: As an emergency medicine physician, I personally saw and treated many men suffering from priapism. These men were usually taking Viagra, Cialis, and in some cases were also injecting their penises with medications such as Trimix to get erections. The men who were using the oral medications in conjunction with the injectable drug were the ones being seen most often for priapism. These men were traumatized because they had taken the medication to fix a problem, but were now in an emergency room with an erection that was not going away. Now they were faced with the possibility of long-term impotence. As I said earlier, time is penis. In an ideal world, these men will be seen by a urologist immediately.

Dr. Bawa: However, the real-world situation is that the urologist may not be able to come in quickly enough, or these men go to an ER which does not even have a urologist on call. The blood in the penis must be aspirated or removed immediately. After this, phenylephrine is diluted and injected into the penis every three to five minutes for up to an hour. If this does not take away the erection, surgery is the next step. And in some cases, an actual penile implant has to be inserted during this initial surgery to prevent fibrosis and further damage. The goal is to minimize the chance of long-term erectile dysfunction and to preserve penile length.

Dr. Bawa: I am quite certain that you did not think that a smaller penis is a possible side effect of the little blue pill.

[06:51] Why I Moved Into Sexual Wellness

Dr. Bawa: One of the main reasons why I began my career in sexual wellness was my experience with sexual dysfunction in the ER. I could see that there was a lot of suffering in the world when it comes to sexual function. Men were suffering from erectile dysfunction and, ironically enough, due to the treatments for it. I knew that there had to be a better way. At my Boca Raton, Florida, rejuvenation practice, Bawa Medical, I help men and women treat sexual dysfunction and, in many cases, avoid it altogether. Men suffering from various forms of erectile dysfunction are an important part of my practice.

Dr. Bawa: Word has spread that I do not believe in Band-Aids and that I help my patients get better from the inside out. This is not just about better sexual function; it is also about better intimate health.

[07:47] Erectile Dysfunction Is a Blood-Flow Problem

Dr. Bawa: Erections, or lack thereof, are a matter of flow. There must be sufficient blood flow to the penis and maintain an erection. As we get older, our blood vessels tend to develop plaques. This happens in the heart, the groin, and all over. In the heart, these plaques are causing heart attacks. In the pelvic area, these plaques are causing sexual problems.

[08:11] What Viagra and Cialis Actually Do

Dr. Bawa: Let's talk about Viagra and Cialis again for a minute. These PDE5 inhibitors are called vasodilators. This means that they are dilating or stretching the blood vessels. They do nothing for the plaques. They make the blood vessels wider so that there can be more blood flow around the plaques. I cannot imagine that any man would want a Band-Aid if he knew that he could have a more long-term solution to the problem itself. And I cannot imagine that any man would want a dangerous treatment over a benign one. Let me explain to you what I'm talking about. Since much of erectile dysfunction is a flow-related issue, I seek to improve that flow by removing the plaque itself.

Dr. Bawa: I do not like to fool my patients into thinking that they are improving by simply giving them a medication that is masking the symptoms. This is not my way. Instead, I use a combination approach to make real change happen under the surface.

[09:16] Acoustic Wave Therapy

Dr. Bawa: Most of my patients begin with acoustic wave therapy. This is a treatment where I use the power of sound waves to break down the plaques we just discussed. Think of it as something similar to kidney stones that don't pass. Again, I will reference my days as an ER doctor. I often saw patients with kidney stones larger than five millimeters, the magic number above which stones don't seem to like to pass in the urine spontaneously. These patients would often have to see a kidney specialist and do a procedure called a lithotripsy that also uses shock waves. This procedure breaks the stones down into smaller fragments so that they can pass through the urine more easily.

Dr. Bawa: In much the same way, we help our patients break down the plaques so that they can have better blood flow and therefore better erections. The beauty of acoustic wave therapy is that it is completely painless. We do not use any numbing, and you need absolutely no pain medication afterward. The other important feature of this treatment is that it involves absolutely no downtime. You can have sex immediately prior to and immediately after the treatment. You can exercise. You can get in a hot tub. You can do pretty much whatever you want. I recommend at least six treatments to start, and then maintenance as needed.

[10:46] Preservation Before Restoration

Dr. Bawa: An important point that I stress to my patients is the fact that they need to start thinking about their body and life in terms of preservation, more so than just restoration. We are talking about sexual function here, but this applies as much to skin, hair, and overall vitality. Why wait till you have a major problem? Why not maintain health while you are still blessed with it? Blockages start forming early in life. Twenty percent of men in their twenties suffer from erectile dysfunction. There is a large number of men suffering even at a young age. I'm sure that you cannot wrap your head around that information. Men in their twenties are supposed to be having the sex of their dreams.

Dr. Bawa: However, there are enough men suffering even at that age. It's easy to assume that it must be a psychological issue at that age, but that would be incorrect. And so, acoustic wave therapy can be used to maintain good erectile function. It is not just for people who have a problem. It is also for people who don't want to develop a problem. By the way, I use acoustic wave therapy in my female patients as well, but we'll discuss that in an upcoming episode. Today, we are focusing on male issues.

[12:11] PRP, PRFM and the P-Shot

Dr. Bawa: Next, let's talk about how I improve penile function by using your own blood. Many of you have heard the term PRP, but may not know what exactly that even means. PRP is platelet-rich plasma. It contains growth factor and helps stimulate your stem cells. Your body helps rejuvenate itself. What a concept. In my book, anything worth doing is worth overdoing. Why use PRP when you can use PRFM? What is PRFM, you ask? PRFM is platelet-rich fibrin matrix. It is a more concentrated form of PRP that is more gel-like, stays in the area longer, and works better. I inject PRFM painlessly into the penis as what is called the P-Shot. Yes, you heard right. I did say that my P-Shot is painless.

Dr. Bawa: My Boca Raton, Florida practice, Bawa Medical, is a center of excellence for this, and I have perfected this into an art form. My patients feel no pain with the P-Shot. This treatment basically gives you a younger, newer penis. Men have better erections that are quick to develop, harder, and last longer. There is also a shorter lag time between erections. While one P-Shot may help my patients, I do believe that two P-shots have a much stronger effect.

[13:32] Penis Size and Blood Flow

Dr. Bawa: And since we're on the topic of male sexuality, we cannot overlook the topic of penis size. When penises have inadequate blood flow, they have a clearly visible decrease in size. As discussed early in this very episode, the lack of blood flow due to priapism can make a penis shrink in size. The same problem happens when there is a decrease in blood flow. I hear from people all the time that penis size does not matter, and that what matters is how you use it. The majority of women beg to differ.

Dr. Bawa: A study by King's College in London studied 15,521 men and found that their average flaccid length was 3.6 inches, or 9.16 centimeters, and an erect length of 5.2 inches, or 13.12 centimeters. A study showed that women prefer penises that are about 6.3 inches long. So there's a bit of a disconnect there. I highly recommend maintaining good blood flow long term, not just for better erections, but for better size as well. And for those of you who are interested in increasing your penis size or just hearing more on the issue, listen to episode five titled How to Get a Porn Star Penis and episode nine titled Mr. Big: Let's Talk Penis Enlargement.

[14:55] Protecting Sexual Function Long Term

Dr. Bawa: So, what else can a man do to maintain good sexual function? Don't smoke. Don't do drugs. Limit your alcohol intake. Exercise. Maintain a healthy weight. Make sure that your blood pressure, cholesterol, and blood sugar are under control. Nothing will kill your ability to have sex like hypertension, high cholesterol, and diabetes. I know that it sounds so boring, but you'll have to treat your body like the temple it is. You do your part, and I will do mine. It's a team effort. As long as you are putting in the effort, I can help you have the intimate health and sex of your dreams. As I always say, I am here to transform your life. Until next time.

[15:43] Recorded Outro

Dr. Bawa: I hope you enjoyed the Dr. Sex Fairy Podcast today. I would love to continue this conversation with you. If you would like my top three secrets for amazing sex, send me an email at askme@drsexfairy.com, and I will share them with you. Don't forget to follow this podcast and leave me a five-star review. Until next time.