Covid-19 may cause priapism ― an erection lasting longer than four hours, doctors have warned.
An unidentified 62-year-old man from France suffered the painful condition while receiving care in hospital for a severe bout of the coronavirus.
His erection was caused by trapped blood in the penis, which was found to be full of blood clots when it was drained by medics.
Blood clotting, or thrombosis, has been reported as a dangerous complication in up to a third of coronavirus-infected patients.
When clots block arteries or veins, the blockages can trigger fatal heart attacks and strokes. They can also lead to pripiasm.
But this is believed to be the first time priapism has been seen as a side effect of the coronavirus, which has killed 500,000 people worldwide.
The patient left intensive care after spending two weeks on a ventilator, suggesting he has now recovered from Covid-19.
A 62-year-old man in France suffered priapism ― an erection lasting longer than four hours ― while receiving care in hospital for severe Covid-19
Doctors at Centre Hospitalier de Versailles in Le Chesnay, an area near Paris, wrote about the man in The American Journal of Emergency Medicine.
Myriam Lamamri, an intensive care doctor, explained how blood clotting caused by Covid-19 has been extensively reported during the pandemic.
Normally, blood clotting occurs when someone injures themselves. The clot stops a wound, such as a paper cut, from bleeding.
This process can happen at the wrong time, causing thrombosis – when blood clots develop in the arteries and veins. These clots block the heart, brain and lungs.
Hospital patients with Covid-19 are suffering blood clots but doctors are mystified as to why.
THIRD OF HOSPITALISED COVID-19 PATIENTS DEVELOP CLOTS
As many as 30 per cent of people in hospital with the coronavirus develop blood clots, according to doctors.
Experts say they have seen rising numbers of people with tiny clots in their lungs as well as larger ones in the veins as hospitals have filled up with Covid-19 patients.
Clots are dangerous because they can damage the tissue around them and also break off, travelling to the brain or heart to trigger a stroke or heart attack.
Professor Roopen Arya, from King’s College London, said in May: ‘I think it has become apparent that thrombosis is a major problem,’ the BBC reported.
‘Particularly in severely affected Covid patients in critical care, where some of the more recent studies show that nearly half the patients have pulmonary embolism or blood clot on the lungs.’
Professor Arya said he thinks rates of blood clots among people who are severely ill with Covid-19 could be 30 per cent or higher.
The reason patients are developing clots is because the virus makes their blood stickier, he observed, by triggering the release of certain hormones in the lungs.
Professor Arya added: ‘In severely affected patients we are seeing an outpouring of chemicals in the blood and this has a knock-on effect of activating the blood clotting.’
Blood thinners, which are usually used to prevent or shrink clots, are dangerous in high doses because they can lead to uncontrollable bleeding in the event of an injury.
Larger numbers of clots is likely increasing the virus’s death rates, Professor Arya said.
Some say the virus is directly causing their blood to change. Another theory is that the virus’s effects on the immune system could also ramp up clotting through a variety of pathways.
Dr Lamamri said this is the first time ‘penile thrombosis’ has been reported in a patient with Covid-19.
The patient to his doctor with a fever, dry cough, difficulty breathing and diarrhoea, and two days later was rushed to hospital where a test confirmed the coronavirus.
On arrival he was mechanically ventilated because he was showing signs of respiratory failure, called ARDS.
A physical examination found ‘previously unidentified priapism’, suggesting it had been there for some time.
The two corpora cavernosa ― the chambers of tissue inside the penis ― were rigid. But the tip was flaccid.
The man suffered low-flow priapism ― when blood becomes trapped in the erection chambers ― as opposed to high-flow priapism, caused by injury.
It can often occur without a known cause in men who are otherwise healthy. It also affects men with sickle-cell disease, leukemia (cancer of the blood), or malaria.
The man was sedated and so he was unable to answer questions about how much pain he was suffering ― but the condition is known to become excruciating.
An ice pack was applied to the penile area. After four hours of a persistent erection, doctors sucked out the blood from his penis using a needle.
They found ‘dark blood clots’ which they said were the result of thrombosis induced by the coronavirus.
The doctors came to this conclusion because no other alternative cause of priapism was found and the virus is known to cause blood clotting complications.
They wrote: ‘Although the arguments supporting a causal link between COVID-19 and priapism are very strong in our case, reports of further cases would strengthen the evidence.
‘The clinical and laboratory presentation in our patient strongly suggests priapism related to SARS-CoV-2 infection.’
Any form of priapism can cause long-term damage, and therefore needs to be treated as quickly as possible.
As well as draining the blood from the penis, the doctors injected the man with drugs to normalise his nervous system and he was given medication to prevent blood clotting.
He hasn’t suffered priapism since leaving hospital, the report said.
Dr Richard Viney, a consultant urological surgeon at the Queen Elizabeth Hospital in Birmingham, said this case was ‘interesting’ and he hadn’t come across any Covid-19 patients with priapism himself.
He told MailOnline: ‘We haven’t seen any cases of Covid-related priapism like this and we have dealt with more Covid patients than any other European hospital as far as I’m aware, so this is clearly a rare but explainable manifestation of Covid.
‘Although the article doesn’t go into detail on his follow up I would suspect a high likelihood of profound erectile failure after this event which is unlikely to respond to medication. He would likely require a penile prosthesis insertion should he want to maintain his potency.
‘In this patient, he has low flow priapism which would certainly fit with microemboli (little clots forming in smaller blood vessels) and this is one of the complications of Covid we see in many other organ systems.’
Dr Viney said an alternative explanation might be profound hypoxia – deprivation of oxygen.
This is seen in males who die by hanging, who have erections after their death, attributed to pressure on the cerebellum at the base of the brain created by the noose.
It has been given the nicknames ‘Angels Lust’ or the ‘Terminal Erection’.
WHAT IS PRIAPISM?
Priapism is a long-lasting painful erection which can cause permanent damage to your penis if not treated quickly, including scarring and permanent erectile dysfunction.
Priapism can occur in all age groups, including newborns. However, it usually affects men in two different age groups: between the ages of 5 and 10, and 20 and 50.
The condition develops when blood in the penis becomes trapped and is unable to drain.
There are two types of priapism: low-flow and high-flow.
Low-flow priapism: This is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but it also affects men with sickle-cell disease, leukemia (cancer of the blood), or malaria.
High-flow priapism: This is more rare and is usually not painful. It is the result of a ruptured artery from an injury to the penis or the perineum (the area between the scrotum and anus), which prevents blood in the penis from circulating normally.
Priapism most commonly affects people with sickle cell disease.
Less common causes include blood-thinning medicines, like warfarin, some antidepressants, recreational drugs – like cannabis and cocaine – some medicines for high blood pressure, other blood disorders, like thalassaemia and leukaemia and some treatments for erection problems.
Malignant priapism, which is secondary to cancer, is rarely reported and has poor outcomes.
It occurs when the cancer causes the penis to become rigid and can only be relieved when the cancer is treated.
An erection that lasts longer than four hours is known as priapism and is a medical emergency.
- try to urinate
- have a warm bath or shower
- drink lots of water
- go for a gentle walk
- try exercises such as squats or running on the spot
- take painkillers like paracetemol if you need to
- do not apply ice packs or cold water to your penis – this can make things worse
- do not have sex or masturbate – it won’t make your erection go away
- do not drink alcohol
- do not smoke
The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future, and may include surgical ligation, intravenous injection and surgical shunt.
Source: NHS and Cleveland Clinic