Clinicians in a recently published case study have concluded that cannabis was the likely culprit behind a 32-year-old man’s persistent, painful erections. It’s a rare and curious example of marijuana being associated with what’s known in medical jargon as priapism—an erection lasting more than four hours that’s not related to sexual activity.
Priapism can have serious consequences, the report notes, including “damage to the penile tissue, with notable destruction obvious at twelve hours” and “over 90% of those remaining erect for 24 h losing sexual function.” The effects can be permanent.
The patient in the case study, published this month in the Journal of Cannabis Research, had been previously treated at the hospital for an erection lasting 12 hours. In a second incident described in the report, he arrived at the emergency department with an erection that had persisted for six hours. He told doctors that he had been smoking marijuana several nights a week for the past six months and during that period experienced “four or more episodes of a persistent erection lasting close to four hours.” In each case, he had smoked within a two-hour period before the erection began.
The case study’s authors, a team at Coliseum Medical Centers in Georgia, call it “the first known case of cannabis-associated priapism in a patient where all other known causes of priapism have been excluded.”
“The abstinence and subsequent use of cannabis were the only appreciable factors in this patient’s battle with recurrent unwanted erections.”
Cannabis doesn’t appear often in published case studies involving unwanted erections. When it does, it’s often in cases where the erections have other, more likely causes. The team conducted a literature review and “was only able to identify four distinct cases of cannabis use coinciding with priapism,” the report says, “none of which were convincingly able to prove cannabis was the sole cause.”
Two of the past cases involved patients with sickle-cell disease, a leading cause of priapism. Another showed concurrent use of MDMA, or ecstasy, which the report says is another proven cause. The fourth involved a patient with diabetes—another known cause—who had also used a number of other substances, including cocaine—yet another cause—and anabolic steroids.
The new patient’s case is unique. “He had no medical history other than mild hypertension, he took no medications, and used only cannabis, supported by his urinary drug screen,” the report says. “Further, his history exhibited a convincing correlation between his cannabis use and his episodes of recurrent priapism.”
“On physical exam, the patient was mildly hypertensive with an erect, swollen, and tender penis.”
The man had smoked marijuana off and on over his life, he told doctors. The periods during which he consumed cannabis seem to align with past episodes of uncomfortable erections. “He admitted a history of cannabis use at age sixteen and seventeen, during which time he had recurrent priapism lasting less than four hours and never requiring medical treatment,” the report says. “He quit cannabis use in his twenties, and during this period did not have any episodes of priapism.”
The report’s authors were left to speculate about how cannabis could have actually caused the patient’s sustained erections. Among the possibilities they identified was that cannabinoids were affecting regulatory mechanisms that would otherwise signal an erection to end. Another explanation has to do with increased blood-platelet activation, which is associated with cannabis and increased chance of heart attack for 60 minutes after consumption.
Cannabis also has direct effects of its own on the vascular system, causing blood vessels to dilate. Researchers said that effect, too, “could potentiate the unrelenting erection notable in priapism.”
As with many areas of marijuana research, the drug’s classification as a federally controlled substance has historically stymied research. “There is a paucity of studies investigating human erections and marijuana,” researchers wrote in a separate 2008 study, “and as a result there is insufficient evidence to suggest that marijuana will cause priapism in humans.” Little progress has been made since then.
A case study published in 2018 examined a patient with priapism who had consumed not marijuana but lab-created synthetic cannabinoids. Authors of the new report call that case study “supporting evidence” for the theory that cannabis caused their patient’s lasting erection, although they note that synthetic cannabinoids are “100 times more potent activators” of the body’s cannabis receptors.
“If synthetic cannabinoids can cause priapism, plant cannabis, affecting the same [cannabinoid receptors], would also be capable to potentiate this reaction,” the report says.
Of what little research does exist on cannabis and sex, most has focused on more desirable results: making sex better. According to self-reported anonymous surveys—some more scientific than others—many people, especially women, report having more frequent and satisfying sex after consuming marijuana.
A study led by Becky Lynn, an associate professor of obstetrics and gynecology at Saint Louis University in Missouri, last year found that more than two-thirds of women (68.5 percent) who said they’ve consumed marijuana before sex “stated that the overall sexual experience was more pleasurable.” Respondents also said they had an increased sex drive (60.6 percent) and more satisfying orgasms (52.8 percent).
Another study last year, by an Eastern Carolina University graduate student, also found that “participants perceived that cannabis use increased their sexual functioning and satisfaction,” associating cannabis consumption with “increased desire, orgasm intensity, and masturbation pleasure.”
A literature review published this past September in the journal Sexual Medicines Review evaluated decades of evidence and concluded a link between cannabis and libido seems to exist, but effects depend heavily on dose.
“Several studies have evaluated the effects of marijuana on libido, and it seems that changes in desire may be dose dependent,” the review found. “Studies support that lower doses improve desire but higher doses either lower desire or do not affect desire at all.”
Even less research has been published on marijuana and erections. Anecdotal evidence suggests that some men find that consuming cannabis is helpful in achieving and maintaining erections, but consuming too much can impede arousal. It’s not clear the degree to which those effects are physiological and to what degree they are related to psychological factors like stress and anxiety.
As for the man with the 12-hour erection, it’s not clear how he’s fared. According to the case study, he was referred to urology and internal medicine specialists for further diagnosis, “however he was lost to follow-up in this period.”
Photo by Sharon McCutcheon on Unsplash