Be alert to the causes of acute male erectile dysfunction.

"Priapism" is a condition that many people are unfamiliar with. It is an acute condition that occurs in men, also known as "priapism" or "abnormal erection." In this condition, the penis remains in a persistent erection that can last for hours, tens of hours, days, or even weeks. It is most common in married adult men. Its characteristics include: the penis remains erect and hard, but there is no sexual arousal or libido, accompanied by pain and discomfort, sometimes unbearable. The main causes of priapism are as follows: (1) Blood diseases: such as sickle cell disease, leukemia, polycythemia vera, and thrombocytopenia. These diseases can cause blood to accumulate in the corpora cavernosa of the penis, leading to abnormal erection. (2) Neurological diseases: often seen in spinal cord injuries or inflammation, brainstem lesions, and also in some patients after craniotomy. Excessive excitation of the spinal cord center leads to persistent erection. (3) Mechanical lesions: such as genital trauma, late-stage pelvic tumors, etc. These diseases can continuously compress the root of the penis, affecting blood return and causing erectile dysfunction. (4) Drug-induced: Common drugs that cause erectile dysfunction include thiazides, guanethidine, reserpine, heparin, testosterone, hydralazine, compound antihypertensive capsules, etc. Hemostatic drugs such as glycine can also cause erectile dysfunction; in addition, there are cases of erectile dysfunction caused by penile injection of papaverine. (5) Inflammation: such as prostatitis, which can cause thrombosis of the prostatic venous plexus, affecting deep venous return and causing penile erection. (6) Others: Some cases may be secondary to vigorous intercourse or intercourse after prolonged abstinence. There are also nearly 1/3 of patients with erectile dysfunction whose cause cannot be identified at present.

If erectile dysfunction occurs, seek medical attention promptly and do not delay treatment due to embarrassment. Erectile dysfunction not only causes significant swelling and pain in the penis, but if it progresses, it often leads to blood stasis, increased viscosity, and more difficult venous return, even forming blood clots and local lumps. It is also a manifestation of many diseases and can damage erectile tissue, causing serious consequences. Therefore, if erectile dysfunction occurs, do not be careless or delay treatment. Seek medical attention as soon as possible to relieve pain promptly and avoid or reduce sequelae.

Priapism is an acute condition that must be treated as soon as possible to restore venous return in the corpora cavernosa. However, patients with priapism are often embarrassed to go to the hospital for treatment, hoping that it will subside on its own. They often delay seeking medical help for several days or even weeks, so that even after treatment, their penis may permanently lose its erectile function. Common treatment methods are as follows: (1) General treatment: Stop sexual activity, avoid all sexual stimulation, apply local cold compresses (ice packs), and use sedative drugs, such as diazepam 5-10 mg, 3 times a day or chlordiazepoxide 10-20 mg, 3 times a day, or chlorpromazine 25-50 mg, 3 times a day, orally. Vasodilators such as tolazoline 25 mg, 3 times a day or once a day, can also be used to promote the dilation of penile veins and allow the blood accumulated in the penis to return. Short-term oral estrogen, such as diethylstilbestrol 5 mg, 3 times a day, has a certain effect on reducing the body's sensitivity to sexual stimulation. Treatment of the primary disease should be carried out simultaneously with the treatment of priapism. (2) Eliminate nerve and muscle stimulation: Commonly used methods include spinal anesthesia, epidural anesthesia, and pudendal nerve block, all of which are beneficial for dilating the cavernous veins and improving blood return. They can also artificially block erectile reflexes and abnormal nerve stimulation. (3) Local treatment: Under general anesthesia and controlled hypotension, use a large needle to puncture and aspirate the penile corpus cavernosum to remove penile blood clots. Dopamine can be injected in several doses. If adrenaline crisis occurs, such as excessively high arterial blood pressure (180/80 mmHg) or tachycardia (160 beats/minute), nifedipine can be added for prevention. Repeatedly rinse with heparinized saline until fresh blood flows out. After the penis softens, apply pressure bandage and supplement with local or systemic anticoagulation therapy. (4) Anticoagulation therapy: Anticoagulants such as heparin, streptokinase, dicumarol, and dextran can be tried. (5) Traditional Chinese medicine treatment: Nourishing yin and liver, and promoting diuresis and removing blood stasis have certain effects. (6) Surgical treatment: For those who do not respond to non-surgical treatment, a corpus cavernosum incision can be performed to remove the blood clot, followed by local irrigation with diluted heparin solution. If thrombosis has already formed in the corpus cavernosum, a potentially effective approach is to perform a shunt procedure between the great saphenous vein or dorsal vein of the penis and the corpus cavernosum or corpus spongiosum to provide an alternative route for blood return. For priapism caused by excessive arterial blood flow, autologous blood clots can be injected through a catheter inserted into the artery via puncture to temporarily reduce arterial blood flow and cause the penis to flaccidize.

Penile erection is composed of a series of conditioned and unconditioned reflexes. Stimuli such as memory, fantasy, sight, hearing, and smell trigger sexual impulses via the central nervous system, reaching the sacral spinal cord center. These impulses are then innervated by sensory and motor nerves to the penis or external genitalia. Sensory nerve stimulation is transmitted via the pudendal nerve to the erection center in the spinal cord, and then along the erection nerves to the genitals. Through peripheral nerve fibers, neurotransmitters such as nitric oxide, vasoactive intestinal peptide, and prostaglandin E are released, causing relaxation of the smooth muscle in the corpora cavernosa, dilation of the penile arteries, and a continuous influx of blood into the corpora cavernosa, causing penile swelling. The tunica albuginea surrounding the corpora cavernosa also expands and thins, compressing the veins and obstructing venous return. When penile blood pressure reaches 75 mmHg, an erection occurs. The contraction of the pelvic muscles surrounding the base of the penis further reduces venous return, increasing penile firmness. This demonstrates that penile erection is regulated by a healthy nervous and endocrine system, altering the hemodynamics of the corpora cavernosa. Erectile dysfunction can result from any obstruction in any part of the process, defects in the penile structure, certain diseases, or the effects of drugs or toxins. The causes of erectile dysfunction are introduced as follows: (1) Functional causes ① Psychological factors. This is caused by physiological changes in the nervous system, such as fear, anxiety, lack of confidence in sexual life, fear of wife getting pregnant or worry that the penis is too small to complete intercourse and childbearing, fear of not being able to satisfy the wife's sexual desire, or being blamed by the wife for the first failed intercourse, or the wife's lack of sexual pleasure due to illness, aging, or disability, some women have too strong a sexual desire and are forced to cope, some are distracted during sexual life or have external interference and are mentally tense, or have too much admiration for the woman and are very reserved during sexual life. ② Lack of sexual knowledge. Believing that intercourse and ejaculation are harmful to the body and affect health, or believing that intercourse is immoral, low-class or dirty behavior. ③ Marital discord. Such as dissatisfaction with the marriage, hostility, resentment, fear of the wife, or excessive mental burden due to personality clashes, emotional breakdown, extramarital affairs or economic difficulties. ④ Irregular lifestyle. Such as alcoholism, heavy smoking, excessive sadness, fatigue, or work difficulties. (2) Organic causes ① Vascular factors. First, arterial causes: such as arteriosclerosis or other vascular diseases (such as arteritis, myocardial infarction, abdominal aortic bifurcation thrombosis, penile artery embolism, etc.) which obstruct the blood supply to the penis and affect erection. According to measurements, when the penis is flaccid, the blood flow through the corpora cavernosa is very small, only 4 ml per minute. When erect, the blood flow reaches 100 ml per minute, and the volume is 80-200 ml. Its blood pressure can be close to the blood pressure of the trunk. If arteriosclerosis occurs, the vessel wall will become fibrotic, calcified, and the lumen will be narrowed, greatly reducing the blood flow and affecting erection. Second, venous causes: can be seen in the venous leakage of the corpora cavernosa. The blood flow passes through too quickly (i.e., short-circuit return) which leads to weak or unsustainable penile erection. ② Nervous system diseases. Examples of causes of erectile dysfunction include: cerebral palsy, damage to the midbrain, pituitary gland, and temporal lobe; spinal cord tumors; lumbar sympathectomy; spina bifida; tabes dorsalis; amyotrophic lateral sclerosis; multiple sclerosis; Parkinson's disease; extensive pelvic surgery; peripheral nerve diseases; and myasthenia gravis. ③ Anatomical abnormalities and diseases of the urogenital system, such as congenital penile malformations, large inguinal hernias, hydrocele, cystectomy, perineal prostatectomy, Peyronie's disease, phimosis, prostatitis, seminal vesiculitis, urethritis, cryptorchidism, testicular hypoplasia, testicular fibrosis, and penile-scrotal elephantiasis. ④ Hematologic disorders, such as leukemia, pernicious anemia, and Hodgkin's disease. ⑤ Infectious diseases, such as genital tuberculosis, gonorrhea, syphilis, and non-gonococcal urethritis. ⑥ Endocrine factors and diseases. Abnormal changes in the mutually reinforcing and feedback relationship between the hypothalamus-pituitary-gonadal endocrine system can also cause erectile dysfunction. For example, a deficiency in luteinizing hormone secreted by the anterior pituitary gland, leading to insufficient gonadotropin secretion, can cause erectile dysfunction; hyperthyroidism or hypothyroidism, Cushing's syndrome, and certain pancreatic diseases can also cause it. ⑦ Age factors. Male sexual function is most vigorous between the ages of 20 and 29, begins to decline significantly between 35 and 50, and after age 60, libido, erectile strength, and frequency of intercourse are significantly weakened and reduced. This is due to neurovascular degeneration and hormonal changes. ⑧ Other diseases. Liver cirrhosis, chronic renal failure, obesity, rheumatic fever, and pulmonary insufficiency can also lead to erectile dysfunction. (3) Drug toxicity factors: According to the results of an analysis of 8,353 cases of drug-induced sexual dysfunction by the WHO Collaborating Centre for International Drug Surveillance, 80% of cases were male. Drugs that can cause erectile dysfunction include: guanethidine, benzylmethylguanidine, reserpine, clonidine, methyldopa, propranolol, digoxin, clofibrate, hydrochlorothiazide, spironolactone, furosemide, cyclopentylchlorothiazide; diethylstilbestrol, dimethylergonovine, cyproterone acetate, chlorpheniramine, chlorpheniramine; alcohol, chlorpyrifos, diazepam, phenytoin sodium, phenobarbital, estazolam, lithium carbonate, amphetamine; cimetidine, metoclopramide, brompheniramine, atropine; cannabis, methadone, heroin, morphine, meperidine, indomethacin, and lead poisoning, etc.