# I'm afraid to ask but: How do they treat an erection that lasts for more than 4 hours?
**URL:** https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211
**Category:** Factual Questions
**Created:** [November 28, 2010, 10:22pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211 "2010-11-28T22:22:10Z")
**Posts on this page:** 20
**Page:** 2
### Author:  [@HeyHomie](https://boards.straightdope.com/u/HeyHomie)
#### Post date: [November 29, 2010, 1:23pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/21 "2010-11-29T13:23:16Z")
> [@carnut](#):
>
> Of course, if they guy is only age 14, four hours might be normal. đ
Kidding aside, is a four-hour erection in an adolescent to be expected and thus not cause for concern?
Any pediatric urologists in the house? Is pediatric urology even a specialty? đ
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### Author:  [@WhyNot](https://boards.straightdope.com/u/WhyNot)
#### Post date: [November 29, 2010, 2:02pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/22 "2010-11-29T14:02:59Z")
> [@HeyHomie](#):
>
> Kidding aside, is a four-hour erection in an adolescent to be expected and thus not cause for concern?
Not, it is not expected and is still a cause for concern. The most common causes of priaprism in adolescents (and children) are sickle cell and perineal trauma.
Adolescents may get more \*frequent \*erections than adults (although Iâm not entirely sure about that, thatâs based on water cooler talk rather than research), but they still shouldnât be unremitting.
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### Author:  [@RoniaBorkason](https://boards.straightdope.com/u/RoniaBorkason)
#### Post date: [November 29, 2010, 2:25pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/23 "2010-11-29T14:25:11Z")
> [@HeyHomie](#):
>
> Any pediatric urologists in the house? Is pediatric urology even a specialty? đ
Yup, and just like regular ones, you donât want to have to meet them. My baby son had posterior urethral valves, we have his 6 month follow up visit with, no joke, Dr. Huang, next week.
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### Author:  [@Leaffan](https://boards.straightdope.com/u/Leaffan)
#### Post date: [November 29, 2010, 3:03pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/24 "2010-11-29T15:03:36Z")
> [@WhyNot](#):
>
> I think you mean the corpus cavernosum, the spongy erectile tissue that fills with blood to produce an erection. That is a treatment, about in the middle of the list of things theyâre likely to try.
>
> First of all, there are two kinds of priaprism - ones where the blood canât get out (vaso-occlusive or âlow flowâ) and ones where the blood wonât stop coming in (arterial, or âhigh flowâ) Obviously, theyâre treated differently, if the docs can figure out which yours is.
>
> High flow are often just observed to see what happens. This kind of priaprism isnât so likely to cause lasting injury, and often time is all thatâs needed to reduce the erection. Compression therapy (which is just about what it sounds like) can often resolve high flow priaprism, especially in little boys (yes, it happens). Sometimes, thereâs a fistula (opening) where it shouldnât be thatâs causing the blood to keep coming into the penis, and a simple procedure is needed to close the fistula, either with angiography or surgical incision.
>
> Low flow priaprism is more common, more dangerous, and the one the ED drugs may cause. With low flow priaprism, the least invasive interventions are ice to the groin and perineum, pressure on the perineum and having the man walk up some stairs. These can all be tried at home before the 4 hours are up, by the way.
>
> If four hours pass, an ER visit really is called for. Low flow priaprism can cause pretty hellacious long term effects on your penis. If ice, pressure and stairs donât do it, theyâll probably give you one or more drugs which may make the erection go away - terbutaline taken orally resolves about one third of the cases. Some docs will use oral pseudoephedrine, but Iâm not sure how widely thatâs accepted yet. If that doesnât work within 30 minutes, an injection of an alpha-adrenergic blocker will be attempted. Third line of intervention is the aforementioned aspiration of the blood in the corpus carvernosum with a needle. If this doesnât work theyâll also inject alpha-adrenegeric blockers or methyline blue into the cavernosum itself
I love it when you talk nerdy to us.
Iâll be in my bunk.
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### Author:  [@WhyNot](https://boards.straightdope.com/u/WhyNot)
#### Post date: [November 29, 2010, 3:14pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/25 "2010-11-29T15:14:19Z")
> [@Leaffan](#):
>
> I love it when you talk nerdy to us.
>
> Iâll be in my bunk.
lol
Ok, see you in 3 hours and 59 minutes, or weâre sending a urologist in there with a needle!
(Sorry if my nerdiness is too much. I actually use this site (and a couple of others) to practice my 'splaining skills. Someday I may actually need to nerd out at a patient or his wife in real life, and having some things rehearsed in layspeak like âblood canât get outâ will, I hope, make me a better nurse!)
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### Author:  [@cwthree](https://boards.straightdope.com/u/cwthree)
#### Post date: [November 29, 2010, 4:11pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/26 "2010-11-29T16:11:25Z")
> [@WhyNot](#):
>
> High flow are often just observed to see what happens. This kind of priaprism isnât so likely to cause lasting injury, and often time is all thatâs needed to reduce the erection. Compression therapy (which is just about what it sounds like) can often resolve high flow priaprism, especially in little boys (yes, it happens). Sometimes, thereâs a fistula (opening) where it shouldnât be thatâs causing the blood to keep coming into the penis, and a simple procedure is needed to close the fistula, either with angiography or surgical incision.
This may also be treated with drugs that cause the blood vessels of the penis to constrict, thereby reducing the amount of blood that can flow into the penis. Said drugs may be administered intravenously or by injection directly into the penis.
If the urologist suspects that ischemic (low flow) priapism is caused by a blood clot, anti-clotting drugs may be used.
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### Author:  [@WhyNot](https://boards.straightdope.com/u/WhyNot)
#### Post date: [November 29, 2010, 4:23pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/27 "2010-11-29T16:23:11Z")
> [@cwthree](#):
>
> If the urologist suspects that ischemic (low flow) priapism is caused by a blood clot, anti-clotting drugs may be used.
Do they use thrombolytics to actually break up the clot, or things like heparin to prevent more? Or both? Do you have any more information on clots and priapism? We didnât cover that cause in class, except tangentially r/t sickle cell.
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### Author:  [@Diogenes\_the\_Cynic](https://boards.straightdope.com/u/Diogenes_the_Cynic)
#### Post date: [November 29, 2010, 4:25pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/28 "2010-11-29T16:25:30Z")
They show you naked pictures of Dick Cheney.
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### Author:  [@Kevbo](https://boards.straightdope.com/u/Kevbo)
#### Post date: [November 29, 2010, 4:44pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/29 "2010-11-29T16:44:52Z")
\ Like a god!\
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### Author:  [@Morgenstern](https://boards.straightdope.com/u/Morgenstern)
#### Post date: [November 29, 2010, 4:54pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/30 "2010-11-29T16:54:01Z")
> [@Khadaji](#):
>
> So Iâm watching NFL and I see lots of adverts for Viagra - and one thing that is always stated is that you should see an doctor if your erection lasts more than 4 hours.
>
> Iâm sure I donât want to know but - so what \*do \*they do?
Obligatory TSA witty comment here.
The last âUntold Stories of the ERâ had just such a patient, as well as the dudes wife rushing to the ER only to discover her hubby holding hands with his mistress waiting the Urologist exam.
They took him to surgery and attacked his warrior with a needle.
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### Author:  [@purplehorseshoe](https://boards.straightdope.com/u/purplehorseshoe)
#### Post date: [November 29, 2010, 5:50pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/31 "2010-11-29T17:50:45Z")
> [@RoniaBorkason](#):
>
> Yup, and just like regular ones, you donât want to have to meet them. My baby son had posterior urethral valves, we have his 6 month follow up visit with, no joke, Dr. Huang, next week.
Iâm 30 going on 12. This made my morning, after I sat for a moment sounding it out. (Hope your sonâs okay, of course. But still, thanks for the lol.)
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### Author:  [@cwthree](https://boards.straightdope.com/u/cwthree)
#### Post date: [November 29, 2010, 6:33pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/32 "2010-11-29T18:33:40Z")
> [@WhyNot](#):
>
> Do they use thrombolytics to actually break up the clot, or things like heparin to prevent more? Or both? Do you have any more information on clots and priapism? We didnât cover that cause in class, except tangentially r/t sickle cell.
Looks like both approaches have been tried - I found references to the use of streptokinase, heparin, and warfarin.
This seems to associated with sickle-cell disorder more than anything else. Sickling can make the blood more liable to clot anywhere in the body. The penis, or the blood vessels associated with it, are no exception.
I believe our \*\*Qadgop \*\*has treated a couple of men with priapism related to sickle cell disease.
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### Author:  [@limegreen](https://boards.straightdope.com/u/limegreen)
#### Post date: [November 29, 2010, 9:11pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/33 "2010-11-29T21:11:28Z")
You could watch that episode of True Blood where the brother drinks all the vamp blood⌠It describes the needle thing pretty squickishly.
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### Author:  [@KlondikeGeoff](https://boards.straightdope.com/u/KlondikeGeoff)
#### Post date: [November 29, 2010, 9:58pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/34 "2010-11-29T21:58:54Z")
I am soooo relieved that the answer is not, âamputation.â
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### Author:  [@Washoe](https://boards.straightdope.com/u/Washoe)
#### Post date: [November 29, 2010, 10:08pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/35 "2010-11-29T22:08:23Z")
Thatâs reserved as an option of last resort for intractable cases of ârobot arm grasping a manâs penis.â
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### Author:  [@ShibbOleth](https://boards.straightdope.com/u/ShibbOleth)
#### Post date: [November 29, 2010, 11:16pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/36 "2010-11-29T23:16:27Z")
A sharp âthwackâ with a ruler usually does the trick.
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### Author:  [@Clothahump](https://boards.straightdope.com/u/Clothahump)
#### Post date: [November 29, 2010, 11:23pm UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/37 "2010-11-29T23:23:16Z")
I think [one of these](http://en.wikipedia.org/wiki/File:Ball-peen_hammer_380mm.JPG) is involved.
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### Author:  [@fumster](https://boards.straightdope.com/u/fumster)
#### Post date: [November 30, 2010, 12:56am UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/38 "2010-11-30T00:56:50Z")
> [@Washoe](#):
>
> Thatâs reserved as an option of last resort for intractable cases of ârobot arm grasping a manâs penis.â
What a turn-off.
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### Author:  [@Rysdad](https://boards.straightdope.com/u/Rysdad)
#### Post date: [November 30, 2010, 1:01am UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/39 "2010-11-30T01:01:35Z")
> [@Diogenes\_the\_Cynic](#):
>
> They show you naked pictures of Dick Cheney.
Bea Arthur.
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### Author:  [@jayjay](https://boards.straightdope.com/u/jayjay)
#### Post date: [November 30, 2010, 1:03am UTC](https://boards.straightdope.com/t/im-afraid-to-ask-but-how-do-they-treat-an-erection-that-lasts-for-more-than-4-hours/562211/40 "2010-11-30T01:03:09Z")
> [@sh1bu1](#):
>
> What a turn-off.
Youâre gonna hurt **Robot Arm** âs feelingsâŚ
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