New England Section of the American Urological Association

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Rates of Emergency Department Presentation for Priapism in the Era of Direct-to-Consumer Telemedicine
Phuong-Uyen Catherine Tran, BS, Xinyue C. Tan, MD, Winna Xia, MS, Rachel B. Engelberg, MD.
UMass Chan School of Medicine, Worcester, MA, USA.

BACKGROUND: Direct-to-consumer telemedicine (DTCT) platforms for men's health have substantially expanded over the past decade. Hims & Hers Inc. (HIMS), a leading DTCT company valued at over $10 billion, provides virtual evaluation and treatment for erectile dysfunction and other health conditions. With increasing use of DTCT, there may be an associated increased incidence of adverse events unique to this care modality. To date, the relationship between men's telehealth expansion and national priapism incidence remains poorly characterized.
METHODS: We conducted a retrospective cohort study assessing priapism incidence rates from 2010-2024. National claims data was extracted from TriNetX and stratified by year and documented use of tadalafil or sildenafil. Emergency department (ED) presentation for priapism was identified through ICD-10 and CPT codes. HIMS' subscriber statistics and market share were quantified via grey literature review. A Pearson correlation test was used to examine the association between annual priapism incidence and HIMS' subscriber totals.
RESULTS: Pearson correlation demonstrated a moderate, non-statistically significant, positive relationship between priapism incidence and HIMS subscriptions from 2019-2024 (r = 0.65; 95% CI: −0.34 to 0.96; p = 0.16). From 2017-2024, the proportion of annual priapism cases attributed to tadalafil or sildenafil users among all priapism cases remained stable at an average of 22.7% (SD = 0.023, MAD = 0.006), averaging a 4% (SD = 0.058) change year-over-year. CONCLUSIONS:The recent surge in men's telehealth utilization has not been accompanied by a parallel rise in priapism; there is no statistically significant correlation between national priapism incidence and men's telehealth platform expansion. The stable proportion of tadalafil- and sildenafil-associated cases over time suggests no new signal of increased priapism risk attributable to these medications.
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