Man suffers 4-hour erection with Covid-19 coronavirus infection

This is not one of the twelve symptoms of Covid-19 listed on the website of the Centers for Disease Control and Prevention (CDC). But American Journal of Emergency Medicine published a case report of a 62-year-old man with a Covid-19 coronavirus infection who had an erection that lasted four hours.

If you’ve ever heard a commercial for Viagra, you know that an erection that lasts more than four hours is not a good thing. It is well beyond the “this is exciting” stage. After all, nothing is so exciting for more than four hours.

Instead, it is a condition called priapism, which the Mayo Clinic defines as a “prolonged erection of the penis,” rather than a prolonged erection of the armpit. As the American Urological Association describes, there are two general types of priapism: ischemic priapism, in which blood cannot flow out of the penis, and non-ischemic priapism, in which blood flow to the penis is not very well regulated.

The blood in the blood vessels of the penis is not like the horse and the stable. You want blood to continue to flow out of the penis to maintain blood flow and therefore oxygen supply to the penis. Therefore, ischemic priapism is a medical emergency because your penis cannot endure being erect for that long and can cause tissue damage.

A team (Myriam Lamamri, Ala Chebbi, Jordan Mamane, Sofía Abbad, Milena Munuzzolini, Florence Sarfati and Stéphane Legriel) from the Versailles Hospital Center in Le Chesnay, France, near Paris, wrote the case report. They described how the man first saw his doctor for fever, dry cough, diarrhea, and a feeling of disgust. He had apparently been in good health. The doctor prescribed some antibiotics, but two days later, the man began to have severe shortness of breath. Eventually he had respiratory failure and had to be admitted to the hospital and placed on a ventilator. The man’s blood pressure also plummeted, requiring intravenous fluids and medications to maintain adequate blood pressure.

Notably, a computed tomography (CT) scan of his chest showed what was described as a “crazy paving pattern” in his lungs, which is an interesting description. Your doctor should never utter the phrase, “Your chest CT is normal except for the crazy paving pattern.” In fact, the “crazy paving pattern” tends to be a bad thing, either in the driveway or in the lungs. By analyzing a sample of fluid from the patient’s lungs, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), the cause of Covid-19, was discovered.

According to the case report, “the physical examination revealed previously unidentified priapism.” Basically, this meant that no one had noticed an erection before the physical exam. Of course, when someone is having trouble breathing, that person’s penis may not be the first thing to look at, unless they are doing something very unusual to make it difficult to breathe. Therefore, it is unclear how long the erection may have been occurring prior to the physical examination.

Doctors tried to put an ice pack on his penis, but that did not bring down the problem. When the problem was close to four hours, the doctors decided to put together a plan. Fortunately, it was not too difficult a problem to solve. They inserted a needle into the blood vessels in his penis. This was not done for fun because penile needles and fun go together like sewage and sheets. Rather, they wanted to take blood samples to analyze.

Priapism can be a very painful condition. You may also have needles stuck in your penis. But the patient was on the respirator and therefore sedated throughout the test.

The blood sample had dark blood clots and high carbon dioxide and low oxygen content. This was consistent with ischemic or low-flow priapism. Ischemia basically means not getting enough blood for certain parts of the body. Probably no blood was coming out of her penis due to blood clots blocking the exit. When the blood remains in the same place and cannot return to the lungs, it is depleted of oxygen and increasingly loaded with carbon dioxide.

The doctors injected a drug, ethylephrine, yes, into his penis. This medication can stimulate the sympathetic nerves in that area, which in turn can relax the blood vessels in the penis. (The sympathetic nerves are part of your sympathetic nervous system and not nerves that sympathize with an erection for four hours.)

Things calmed down, so to speak. They also gave him 40 mg of a blood thinner, enoxaparin, twice a day to help prevent more blood clots. Finally, after 14 days, the doctors were able to remove it from the ventilator.

Why did the man have blood clots, since he had no history of blood clots before having Covid-19? Well, there are still more and more reports of patients with Covid-19 coronavirus infections suffering from blood clots. This phenomenon was already noticed in April, as this CBS Evening News report described:

Covid-19 can cause blood clots for three reasons. One is hyperviscosity of the blood, which means that the blood becomes essentially stickier and prevents it from flowing evenly. When your immune system reacts to the virus, it can make more white blood cells and chemicals in your blood, making your blood thicker and stickier. Pushing stickier blood through the glasses can be like pushing peanut butter up your nose. It can get stuck. Another is hypercoagulability. Chemicals produced by your immune system’s response can also make blood clot more easily. The third is endothelial dysfunction. The endothelium is the layer of cells that lines the inside of blood vessels. The chemicals produced by your immune reaction can also cause damage to these cells. Such damage can facilitate the formation of blood clots.

Therefore, there is a decent chance that Covid-19 would lead to this man’s permanent problem. This case report showed another potential complication that may further contribute to making Covid-19 a tough uphill battle. Do you still think that Covid-19 is not a big problem?