"Persistent erection" should prompt prompt medical attention; initial diagnosis of erectile dysfunction (ED) can impact self-confidence.

**If your erection persists, seek medical attention immediately.**

If the penis remains erect for more than 4 hours, you must seek medical attention immediately. Otherwise, if it remains erect for more than 48 hours, you may permanently lose your sexual function.

Recently, the Department of Andrology at Peking University Hospital has treated several such emergency patients. Priapism is defined as an erection lasting more than 4 hours without sexual stimulation, which cannot be relieved of its erection. Clinically, it is divided into ischemic and non-ischemic types.

Ischemic priapism can lead to ischemic necrosis, fibrosis, and erectile dysfunction of the corpora cavernosa, requiring emergency treatment. If the duration of ischemic priapism exceeds 24 hours, the incidence of ED is greater than 90%. Once it exceeds 48 hours, the incidence of ED is almost 100%, and due to extensive necrosis of the corpora cavernosa, sexual function is very likely to be permanently lost.

If treated promptly, priapism can sometimes be resolved with simple procedures such as injections or draining blood to quickly reduce pressure within the corpora cavernosa and restore venous return, allowing the penis to return to a flaccid state. The earlier the treatment, the less damage it will cause to future erections. Because not all patients seek medical attention-most are initially pleased with their erectile dysfunction until they experience pain due to prolonged erections-an accurate statistic on the incidence rate is currently unavailable, but it is showing a significant upward trend year by year.

High blood lipids, high blood pressure, and excessive medication are all contributing factors to ischemic priapism.

High cholesterol and high blood pressure are increasingly affecting younger men, which can lead to erectile dysfunction.

Many health supplements claiming to have "aphrodisiac" effects may contain excessive amounts of Viagra, sometimes even four or five times higher than the prescribed dosage. Some patients self-medicate with erectile dysfunction drugs, or men with normal erectile function use these drugs as aphrodisiacs to "enhance performance," both of which can lead to erectile dysfunction. Furthermore, sexual activity after drinking alcohol or excessive and prolonged sexual stimulation can also cause this condition.

Non-ischemic priapism is often related to trauma, such as kicking a ball, cycling, or impacts that cause injury to the pelvis, genitals, or perineum. This condition is also an emergency, but the time from injury to medical attention varies greatly, ranging from days to years. It occurs intermittently, sometimes mild and sometimes severe. Treatment also requires emergency medical attention. Most cases can be cured with conservative treatment, with a recovery rate of 62%, and the prognosis is better than that of ischemic priapism, with an incidence of ED of only 1/3.

While a firm and sustained erection is essential for successful sex, if an abnormal erection lasts for more than 4 hours, please seek medical attention immediately to avoid lifelong regret.

Author: Yuan Yiming, Department of Andrology, Peking University Hospital

**The initial consultation for ED can impact self-confidence**

Erectile dysfunction (ED) is both a barometer of physical and mental health and a direct or indirect result of various psychological and organic diseases. Many ED patients are initially embarrassed to seek treatment at reputable hospitals, believing that self-adjustment, rest, or purchasing "aphrodisiac" or "kidney-tonifying" health products from pharmacies, or obtaining "mystery drugs" from unofficial sources, will solve the problem. As a result, the condition not only fails to improve but also leads to further damage to self-confidence due to recurring symptoms. Therefore, men, especially those over 40, should promptly seek treatment at a reputable hospital if they experience this problem; improving the success rate of the initial diagnosis is crucial for ED treatment.

If the first stage of treatment yields positive results, the patient's confidence in overcoming the disease will greatly increase. Conversely, if the initial treatment is unsatisfactory, the consequences can be severe: the patient's "sexual confidence" will be damaged, they may no longer trust the medication, or even their doctor, and may become frustrated, believing that "their sex life is over."

To improve the success rate of initial diagnosis of erectile dysfunction (ED), patients and doctors must trust each other and cooperate fully to accurately identify the cause. During the initial consultation, patients and doctors need to discuss whether spontaneous erections occur in the morning and evening, past medical history, and analyze blood sugar, blood lipids, unhealthy lifestyle habits, or a history of psychological trauma. Only by analyzing the cause of ED can targeted treatment measures be developed, improving the success rate of the initial diagnosis and allowing patients to regain confidence in overcoming the disease and restoring their sexual function.

Furthermore, most current ED medications have a limited duration of effect, and sexual stimulation is required for them to work. Some patients, however, expect to achieve spontaneous erections after taking the medication. This incorrect approach is unlikely to yield good results. Therefore, ED patients should consult a doctor at a reputable hospital before using any medication.

Author: Li Zheng, Chief Physician of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine