When Should a Patient with Erectile Dysfunction Seek Emergency Care
A patient with erectile dysfunction should seek emergency care immediately if they develop a persistent erection lasting more than 4 hours, as this represents acute ischemic priapism—a urological emergency that can cause permanent erectile dysfunction if not treated promptly. 1
The Critical 4-Hour Threshold
Any erection persisting beyond 4 hours, whether painful or not, requires emergency medical attention to prevent irreversible damage to erectile tissue and permanent loss of erectile function 1, 2
Ischemic priapism is characterized by rigid, tender corpora cavernosa with severe pain, representing a compartment syndrome of the penis that requires immediate intervention 1, 2
Smooth muscle edema and atrophy begin as early as 6 hours after onset, with progressive tissue damage occurring with each passing hour 1
Time-Dependent Risk of Permanent Damage
The likelihood of permanent erectile dysfunction directly correlates with duration of priapism 1, 2:
Less than 24 hours: Reasonable chance of preserving erectile function with prompt treatment 1
24-36 hours: Significantly increased risk of permanent erectile dysfunction; patients may be refractory to first-line treatments 1
Greater than 36 hours: Permanent erectile dysfunction is highly likely with minimal chance of recovery, even with aggressive surgical intervention 1, 2
Specific High-Risk Scenarios Requiring Emergency Care
After Using ED Medications
Patients using intracavernosal injection therapy (alprostadil, papaverine, phentolamine) who develop an erection lasting more than 4 hours must seek emergency care immediately 1, 2
Men taking PDE5 inhibitors (sildenafil, tadalafil) who develop prolonged erections greater than 4 hours should seek emergency medical attention, as priapism can result in irreversible erectile tissue damage 3, 4, 3
Even erections lasting less than 4 hours following intracavernosal injection may warrant emergency evaluation if fully rigid, as partial erections are less likely to progress to ischemic priapism 1
Patients with Predisposing Conditions
Men with sickle cell disease, multiple myeloma, or leukemia who develop any prolonged erection should seek immediate care, as they are at higher risk for ischemic priapism 4, 3, 5
Patients with anatomical penile deformities (Peyronie's disease, cavernosal fibrosis, penile angulation) who experience prolonged erections require emergency evaluation 4, 3
Critical Pitfall to Avoid
Do not wait to see if the erection resolves on its own after 4 hours—the natural history of untreated ischemic priapism includes permanent loss of erectile function and corporal fibrosis with penile shortening 1
Patients should not attempt home remedies or delay seeking care due to embarrassment, as every hour of delay increases the risk of permanent damage 1, 2
Non-Emergency Situations
Patients with partial, non-rigid erections that are painless may have non-ischemic priapism, which is not a medical emergency and can be evaluated during regular office hours 6, 7
Routine erectile dysfunction without prolonged erections does not require emergency care and should be managed through scheduled urology appointments 8, 9
Patient Education Points
All patients prescribed intracavernosal injection therapy or PDE5 inhibitors should be counseled at the time of prescription that any erection lasting greater than 4 hours requires emergency medical attention 3, 4, 3
Patients should be informed that prompt treatment within the first 24 hours offers the best chance of preserving future erectile function 1, 2