I took tadalafil 5 mg daily for two weeks, then a single 10 mg dose, and later three 30 mg doses of sildenafil (Viagra) within a few hours because I couldn't maintain an erection. Now, 28 days later I have a persistent partially rigid, rubbery, dark‑colored penis with numbness, discoloration, prominent veins, occasional pain, and new urinary and bowel symptoms. How long until it fully heals?

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You likely experienced a prolonged non-ischemic priapism or vascular injury from the combined PDE5 inhibitor overdose, and while your urologists are correct that this wasn't classic ischemic priapism, your persistent symptoms at 28 days warrant urgent additional evaluation—specifically penile MRI and possibly vascular studies—because the ongoing partial tumescence, color changes, numbness, and new urinary/bowel symptoms suggest either incomplete resolution of vascular injury or development of secondary complications.

What Actually Happened

Your presentation does not fit classic acute ischemic priapism, which your urologists correctly identified 1. According to AUA/SMSNA guidelines, partial erections (not fully rigid) should not be counted toward the 4-hour emergency threshold, and you would have experienced severe pain with true ischemic priapism 1, 2. The fact that you maintained some erectile function throughout and could achieve detumescence with activity strongly argues against compartment syndrome of the penis.

However, you took a dangerous combination: 10mg tadalafil (on top of 14 days of daily 5mg) plus 60mg sildenafil within hours 3, 4. This created overlapping PDE5 inhibition with different half-lives—tadalafil persists 36+ hours while sildenafil peaks at 1-2 hours 3, 4. This likely caused prolonged vasodilation and venous congestion that traumatized the penile tissues.

Why 28 Days Is Too Long

The concerning red flags at day 28 are:

  • Persistent partial tumescence that won't fully resolve (the "rubbery" shaft that stays firm even at smallest size)
  • Progressive color changes (dark purple/red fluctuations suggest ongoing vascular dysfunction)
  • Worsening numbness (indicates possible nerve injury or chronic ischemia)
  • New urinary symptoms (difficulty initiating stream, loss of urge) and bowel dysfunction suggest pelvic floor involvement or autonomic dysfunction
  • Nocturnal partial erections every few hours that only resolve with standing (suggests venous drainage problems)
  • Abnormal erection quality (shorter, hotter, more purple, prominent veins, soft glans)

While the guidelines state that prolonged erections from PDE5 inhibitors can take time to heal 1, 28 days of persistent symptoms with progression (new urinary/bowel issues) is outside the expected recovery window.

What You Need Now

Immediate next steps:

  1. Penile MRI with contrast - This is critical and overdue. You need imaging to assess:

    • Corporal smooth muscle viability and fibrosis
    • Vascular integrity (arterial inflow and venous outflow)
    • Presence of thrombus or hematoma
    • Tunica albuginea integrity

  2. Penile duplex Doppler ultrasound - Should have been done earlier 2. This differentiates ischemic from non-ischemic patterns and assesses current blood flow dynamics.

  3. Formal neurological assessment - The numbness, urinary retention (loss of urge, difficulty initiating), and bowel dysfunction suggest possible pudendal nerve involvement or cauda equina-like syndrome. This requires:

    • Post-void residual measurement
    • Uroflowmetry
    • Consider pelvic MRI if penile MRI doesn't explain urinary/bowel symptoms

  4. Corporal blood gas - Even at 28 days, if you can induce an erection, checking blood gas during tumescence would confirm whether there's ongoing ischemia 2.

The Likely Diagnosis

You probably have chronic venous leak or venous occlusive dysfunction from the prolonged engorgement, possibly with:

  • Endothelial injury to corporal sinusoids
  • Partial smooth muscle damage (explaining the firmness without full erection)
  • Venous valve dysfunction (explaining why lying down causes re-engorgement)
  • Secondary neuropathy from compression or ischemia

The "rubbery firm shaft at smallest size" suggests the corpora aren't fully draining—this is NOT normal healing.

Common Pitfalls Your Doctors May Be Missing

Your urologists are partially correct that you didn't have classic ischemic priapism requiring emergency shunting 1. However, they're potentially missing:

  1. Delayed ischemic injury - Even non-ischemic priapism can cause secondary smooth muscle damage over weeks
  2. The urinary/bowel symptoms are a major red flag - These weren't present initially and suggest either:
    • Pelvic floor dysfunction from prolonged Valsalva/straining during the event
    • Neurological injury
    • Medication effect (though you stopped 28 days ago)
  3. Persistent partial tumescence at 28 days requires investigation - "Wait and see" is no longer appropriate

Timeline for Healing (If This Is Simple Trauma)

If this were simple vascular trauma without structural damage, you should see:

  • Week 1-2: Gradual reduction in firmness, return of normal flaccid state
  • Week 2-4: Improvement in color, sensation, erectile quality
  • Week 4-8: Near-complete resolution with perhaps mild residual changes

You're at day 28 with worsening symptoms (new urinary/bowel issues), which means this is NOT following a normal healing trajectory.

What to Demand from Your Urologist

Be direct: "I need penile MRI and Doppler ultrasound now. My symptoms are not improving at 28 days, and I've developed new urinary and bowel problems. I understand you don't think this was ischemic priapism, but something is wrong and we need imaging to figure out what."

If they resist, seek a second opinion at an academic medical center with a sexual medicine specialist or reconstructive urologist who manages priapism complications.

Prognosis

If imaging shows:

  • Minimal structural damage: Recovery may take 2-3 more months with possible residual ED requiring treatment
  • Significant fibrosis: You may need penile rehabilitation (vacuum erection device, low-dose daily PDE5i once cleared) or eventual prosthesis
  • Vascular injury: May require specific interventions depending on arterial vs. venous pathology
  • Neurological injury: Recovery is unpredictable; may be permanent

The urinary/bowel symptoms are most concerning and may indicate a separate neurological process that needs urgent evaluation beyond just penile assessment.

Bottom line: Stop accepting reassurance without investigation. At 28 days with progressive symptoms, you need imaging and possibly neurology consultation today, not more "wait and see."

References

2
Guideline

acute ischemic priapism: an aua/smsna guideline.

The Journal of urology, 2021

Related Questions

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