Bawa said a tell-tale sign that a man who has priapism — an erection lasting more than four hours without sexual stimulation — was his arrival at the ER wearing an unusually long, untucked shirt.
"Some of them try to hide it, but other times, you can see it standing to attention right off the bat," Bawa said.
She said it could be a drug reaction to erectile-dysfunction medications such as Viagra and Cialis. But, she said, it happens more often when the patient exceeds the recommended dose.
"A lot of men don't need the drugs," she said, adding: "They're often perfectly healthy and are just trying to show off to their partner."
She said that some made the priapism worse by injecting their penis with a medication such as Trimix. The shots are intended to increase blood flow and supposedly cause firmer erections.
"Most men think that a never-ending erection is what dreams are made of," the doctor said. "But after a while, they'll start to realize that something is wrong and they need urgent medical help."
She said many people "don't bother to read" the insert before taking the drug or ignore the small print on advertisements.
A man showed up at the ER, she said, with a severe case of priapism that needed immediate attention.
"He arrived at the four-hour mark — the point when you can start getting long-term tissue damage," Bawa said. There was no urologist on call.
Bawa said she injected the man's penis with phenylephrine, a drug that relieves congestion and pressure. But the erection remained. The doctor said she had no choice but to "take an 18-gauge needle and aspirate the blood" from the spongy tissue inside his penis.
"I had to make a slight incision in this case," Bawa added.
She said the worst case of priapism she'd ever seen involved a man who waited 24 hours before visiting the ER.
"He was so embarrassed he told the triage nurse that it was abdominal pain," she said. Unfortunately, it was too late for treatment. "The man suffered permanent impotence," Bawa said.
Bawa advises people to look for "safer" alternatives to medications that "promise erections" because they come with "so many side effects," she said.
"There is a time and place for Viagra and Cialis. But some men are popping them like candy," she said.
She advises them to visit their doctor to find out why they have erectile dysfunction in the first place.
"For instance, if you have high blood pressure, and they put you on a beta-blocker medication, it can cause ED," she said. "Maybe you are on an antidepressant causing you to have this. Sometimes the solution is as simple as switching medication."