Possible link between Covid-19 and priapism

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A sexagenarian hospitalized for a Covid-19 infection, at the same time, developed priapism. He is not the first patient to present the two pathologies that could actually be linked.

The case of this 62-year-old man who has both Covid-19 infection and priapism, an erection of more than 4 hours without sexual stimulation, was reported on June 17 by The American Journal of Emergency Medicine. The patient was admitted to the emergency room after suffering from a particularly virulent acute respiratory distress. Two days before, he had consulted his doctor to complain of fever, diarrhea, and dry cough but the doctor did not suggest anything. Once in the hospital, he was put on a ventilator and had a blood pressure drop requiring intravenous injections. Medical examinations have revealed Covid-19 infection in the patient.

During these examinations, doctors also observed priapism, an erection lasting several hours without any sexual stimulation. This disease, if poorly treated or ignored, can lead to serious sequelae to the penis, or even cause its necrosis.

The erection was characterized by two rigid cavernous bodies while his glans was soft. After four hours of compression with ice, aspiration of blood revealed black blood clots, characteristic of low-flow priapism (PFR). This type of priapism is dangerous since it results from an obstruction of the venous flow and therefore from a complete stop of the blood circulation in the region. It was the stagnation of blood in the patient’s cavernous bodies and thus caused his clotting which gave penile thrombosis. Two weeks later, the patient was able to return home.

This patient is not the first case of a thromboembolic complication in people infected with Covid-19. “In fact, patients with Covid-19 present the simultaneous presence of all elements of the Virchow triad, promoting thrombosis,” said the medical team. These three elements are: hyperviscosity, hypercoagulation and endothelial dysfunction. The link between priapism and the Covid-19 could therefore make sense.

More research is needed to clarify the link between these two conditions. “While the arguments for a causal link between Covid-19 and priapism, as well as the ischemic mechanism of priapism, are very strong in our case, further narratives of this nature would help strengthen the evidence, temper the doctors. This medical emergency should be recognized by healthcare professionals and treated promptly to avoid immediate and chronic functional complications.”