De-identified Medical Question
{
"question": "Here is my patients account; I have palpated his penis and felt no oddity\n\n[PATIENT] experienced the following: Took 10mg of tadalafil in the afternoon after taking 5mg daily for two weeks prior, anticipating sexual activity. Has erectile dysfunction and reduced penile sensation likely from masturbation habits. That night at approximately 11pm, achieved initial erection that subsided during penetration. Took 30mg sildenafil and later another dose. After ejaculation, penis remained approximately 80% erect and very firm, unable to bend, with soft tip. Woke at 3am with same state, ejaculated, slight detumescence. Morning erection followed by ejaculation returned to 80% state. Shaft remained very firm at soft size throughout the day, tip was red and sensitive. No pain, possibly slight soreness. Attempted masturbation with full erection returning to firm soft state. Cardio exercise decreased girth slightly but firmness persisted. By 24 hours post-medication, tip color and sensitivity normalized. At 48 hours, shaft still firm and possibly sore, presented to emergency department. Penis not fully erect in size, would flop when lying down but remained engorged at approximately double soft size. Discharged after receiving pseudoephedrine. Saw urologist next morning who stated not ischemic priapism, described as penile trauma requiring healing time. One week later noticed discoloration at tip and below, increased numbness at tip. Abnormal erections during intimate contact - some half-size but firm, others very thick with soft tip, some with mid-shaft bend. Veins more prominent than usual. At approximately 23 days post-event, can achieve erection with masturbation but feels hotter, has purple coloration, pronounced bulging veins. Appears shorter and more difficult to attain. Becomes uncomfortable if erect too long. Recent bowel movement difficulties and urination issues including lack of urge and difficulty initiating stream. Becomes somewhat erect with straining during bowel movements. Penis becomes limp but double soft size when urinating. At smallest size, shaft remains firm. After masturbation, stays 80% erect briefly before reverting to small firm state or limp but larger than normal. Current erections have softer tip than normal. Wakes every few hours with semi-erection that only resolves with movement, sometimes returns when lying back. Notes that softer state correlates with longer length, harder state with smaller size closer to soft size. At smallest, incredibly firm. Saw original urologist again who reiterated healing takes time. Day 28: Woke 4 times overnight with partial erections resolving only when standing. Shaft feels very rubbery and dark. Numbness fluctuates. Tip color fluctuates between dark purple and red. Has not taken any medication since initial event."
}