What does a doctor do to fix an "erection lasting four hours", as advertised on the Cialis commercials?

The condition is called Priapism ( from Priapus - some greek diety with permanent erection )

When an erection lasts for more than 4 hours, usually from 4 to 6 hours, priarism is usually at work. There are two types of priapism though. One is venocclusive and one is arterial. This is important for the patient and doctor to know in order to seek the right treatment.

Venocclusive priapism is normally caused by a failure of blood to drain from the penis. It can also be caused by paralysis of the erectile smooth muscle caused by drugs or toxins or some blood disorders. Venoocclusive can be potentially dangerous and normally happens in those who have penile injection therapy for erectial dysfunction, drugs to treat depression, cocaine, and sickle cell disease as well as other blood disorders ( common amongs teens and children)

Arterial priapism is caused by unregulated blood flow to arteries of the penis ( Cialis works to make this happen), usually the drug would relax the arterial vessels, and smooth muscle of the corpus cavernosum ( one of the penis chambers, you can call it ). Usually, the sex enhacing drug would work without causing any problem, since without direct stimulation to the penis, the drug would not work ( hence Cialis is used to treat physical aspect of erectile dysfunction, much to the misconception that it can treat psychological issue too ). When it goes wrong, the first thing a doctor would likely to do is to administer pseudoephenerine . Depends on each doctor's judgement, some class of amphetamine can also be used to induce erectile dysfunction. Otherwise, the more effective treatment would be to aspirate blood from the corpus cavernosum ( UNDER local Anaethesia - but yeah it looks incredibly painful)

If that goes unsuccessful , or the painful erection comes back, injection of phenylaphrine directly into the corpus cavernosum's vein is likely be done.

If swelling occurs, surgical shunts maybe require. A trained urologist would shunt blood flow to the corpus cavernosa and divert it to the corpus spongiosum, by doing this, hopefully the old blood can be held and emptied, while allowing new blood to return to normal circulation.

There are more.......about the surgical shunts, which can be distal and proximal, the former can be done by bedside, and the latter more complicated and require proper surgical table and technique ( to stop blood flow to the penile chambers all together temporarily )

Edit : it isnt very common. The drugs would keep "it " up, usually enough and longer than what the man needs, and enable him to keep it functiong during sexual intercourse ( sexual stimulation causes nitric oxide to be released, and some chemical that inhibits the inhibition of nitric oxide - nitric oxide increases blood flow with nutrients, oxygen, etc to muscles , athletes and body builders usually use synthesized nitric oxide to enhance their performance, completely legal, the discovery of nitric oxide won a nobel prize in the 90s )

If the problem is mostly physical, then the drugs would help. If it is psychological, no amount will help. But priapism induced by these pills are not common. More common side effects of these pills would be headaches, blurred visions, to the more severe ones like blindness. Arterial priapism is usually caused by blunt trauma to the penis ( and perineum) causing rupture of an artery to the cavernosa, which can induce prolonged semi-hard state. However, this can heal itself without much intervention , this can also be called non-ischemic priapism where the blood flows out is less than the blood flow in ( the cause of simi-rigid penis, lol)

If the erection is very rigid then it can be very serious and immediate treatment is required since it can cause permanent damage, this happens when there is no blood flow out of the penile chambers, and the penile tissue is deprived of oxygen ( ischemic priapism ). Medical intervention is usually needed in these cases.

Ischemic - Ischemia medically means restriction of blood supply.

ED drugs, in extreme case, can cause the rigid state, but that is very rare. Other side effects usually are more common as said. BUT if rigid erection lasts more than 4 hours and pain is accompanied with it ( which ever comes first ), medical attention is reccommended. ( To the men out there : a working functioning penis is more important than your own little pride and humiliation )

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Lasting Erection

Unfortunately, many of the drugs on the market today that are designed to treat various conditions, have side effects that include the degradation of male sexual performance. The most common of these are blood pressure medications, but there are many others.

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If that’s the case, your doctor can prescribe you an alternative to help alleviate the problem.

If the condition of the erection is severe enough, they would have to insert a giant syringe into the patient's penis to remove some of the blood and relieve the pressure. If the pressure were not relieved, it could cause irreparable injury and impair a person's ability to perform sexually.

Mines not that bad due to certain meds....Its just a long erection that stay hard even when standing up to pee....So its not possible to pee into the toilet....Its a good problem to have......Because if the opposite were in effect...you could never have sex...And thats not cool

They stick a nice long shiny needle in the guys penis and use a iv machine or some other machine to suck some of the blood out of his penis.I would rather them cut it off instead of going through the machine!

well an erection is when loads of blood rush to your penis.. so im assuming they have to find a way to get it away from there... blood thinners, a saline iv or in desperate times i guess they might manually drain the blood....

usually they stick a syringe in your cock and suck some of the blood out