Author: Islam Ahmed / Editor: Sarah Edwards / Codes: SLO1, SLO6, UC4 / Published: 31/10/2024
A 39-year-old male arrives at the Emergency Department (ED) and reports taking Sildenafil (Viagra). He was desperate for a quick response in preparation for his date, so ended up resorting to injecting prostaglandin E1 directly into his penis. He bought this off the internet on advice of his friends. This led to an immediate and pronounced erection but since then has not had any sexual activity.
He could not bear the pain and called the out of hour’s medical advice line, who advised him to attend the ED within four hours. He attempted various methods to resolve the issue on his own, including warm baths but could not achieve detumescence. During the seventh hour, he couldn’t take the pain any longer and hence presented to ED.
He has no PMH and takes no regular medications. He has never had a similar problem in the past.
On examination, he is uncomfortable and visibly in pain. He consents to examination and his penis is found to be fully uncircumcised, erect, straight, extremely firm, and tender to the touch. His glans is soft and normal in colour. Scrotum examination is normal. Abdomen is soft and non-tender.
His observations are RR 22, Sats 98% on RA, HR 112, BP 128/85 and temp 36.7.
The patient states he’s desperate for relief. The nurse has given him paracetamol. It is Friday night and the Urology junior doctor is on-call but off site.
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