Sex, Pregnancy & Reproductive Health

Can my fiancee's age and sickle cell trait cause a problem in pregnancy? We are hoping to get married next year.


Your fiancee's age is not an issue in pregnancy.  There is conflicting reports about pregnancy in women with sickle cell trait.  In the British literature it has been reported that there are no outstanding problems in pregnancies for women with sickle cell trait.  In the American literature there is reported to be issues such as: newborns who were smaller than what would be expected, infections during pregnancy, and prematurity.


Why would this be?  There are differences in these two populations of women.  In the UK there is the NHS that insures medical care for all people in the UK.  In the US the health care coverage is not as consistent throughout the country, some people having less access to health care.


My personal opinion is there is little or no difference in the risk of pregnancy between healthy women who have or do not have sickle cell trait.  I cannot support this with the medical literature.


You should know your sickle cell trait status.  I have seen people who thought they did not have sickle cell trait who actually had sickle cell trait.  You should be tested by a reputable laboratory, and a knowledgeable doctor to determine your trait status.  A couple in which both parents have sickle cell trait have a 25% chance of having a child with sickle cell disease with each pregnancy, a 50% chance of having a child with sickle cell trait with each pregnancy, and a 25% change of having a child with normal hemoglobin with each pregnancy.



Does priapism surgery cause infertility? Also, can the surgery cause a person to not have enough sperm to get a woman pregnant?


Surgery for priapism cannot cause infertility, it does not decrease the sperm count. The testis (were the sperm is made) are not involved in the usual priapism surgery. There are medications that can reduce the sperm count (such as hydroxyurea and chronic opioid therapy).  Although there have been no fetal problems reported in children of men taking hydroxyurea for sickle cell disease therapy, it is recommended that this therapy be discontinued if you are actively trying to become pregnant.



My fiance once had priapism and had to do a minor surgery. I want to know if the surgery can make him impotent. Is there any chance of him impregnating me, because his erection doesn't last long since his surgery?


There is a difference between “impotence” and “infertility”.


Impotence means that you cannot have or have trouble having an erection.  This is common in men who have had some kinds of surgery for priapism or who have repeated episodes of priapism.  In order to have an erection the penis (the corpus) fills with blood and the penis becomes erect.  Priapism causes scars in this tissue and having a erection may be not possible.  Sometimes there is scaring and the penis is always “semi-erect”.  There are a lot of reasons why an erection “doesn’t last long”. With a history of priapism it could be that is the reason, but sometimes it is psychological or some other reason. I would recommend that your future husband see a urologist and perhaps a psychologist. No man wants to do either, but I would encourage him to do both.


Fertility has to do with whether or not you make enough sperm to promote a pregnancy.  I know several men who have had priapism, some with radical surgery, and they are all fathers of beautiful children.  Most have more than one or two.  You can be impotent, but still fertile.  Of course if there is an issue with ejaculation, that is is not due to priapism.  If that is the problem your future husband should see a urologist to see why this is occurring.



I had priaprism in 2006 and a minor surgery was done by flushing and draining. Ever since then, my erection has not been normal. I only have erection when I want to have sex and it's not hard like before. What drug can I take to sustain a good erection to avoid erectile dysfunction?


Priapism is a medical emergency in sickle cell disease.  With each event, even very short term events that last less than an hour, there is tissue damage and scar formation.  Over time the tissue in the penis that fills with blood during an erection is scared and an erection is no longer possible.  This does not generally happen with one mild to moderate event, but can occur with one severe event.


There are medications for the type erectile dysfunction occurring in men who do not have sickle cell disease, but the mechanism for their erectile dysfunction is not the same as the mechanism in sickle cell disease.  Most of the drugs used for non-sickle cell erectile dysfunction have not been studied well for patients with sickle cell disease.  The most common drug, sildenafil (Viagra), has been used for pulmonary hypertension and in limited cases for priapism.  Unfortunately this medication increases pain episodes in people with sickle cell disease.  The pulmonary hypertension study (Walk PHAsST) was stopped due to increased pain (which means increased vaso-occlusion) in the patients who took sildenafil.


There are other medications that have been tired for recurrent priapism including hydroxyurea, leuprolide (Lupron), and some others.  None have been used extensively for priapism and the effectiveness has not been consistent patient to patient.


I would recommend you see a urologist who can do testing to see if there is a therapy that could be helpful for you.  This is very a very distressing complication, I would recommend you see a psychologist or counselor if you think that would be helpful.



Is it advisable for a sickle cell patient to actively engage in daily sex?


There is no issues with “active sex daily”.  Remember: safe sex, use protection.  If you are with a woman and not using birth control there is a possibility of having a child with sickle cell disease. Especially if you do not know the sickle cell status of your partner. If you are taking hydroxyurea there is a theoretical possibility of birth defects, none have been reported. You might be worried about priapism: a painful prolonged erection lasting hours.  This can be related to sexual activity, but I am not aware sexual activity is a “cause” of priapism.  If you do experience priapism it is a medical emergency and you should seek medical help if there is no resolution in an hour or less.  Viagra (sildenafil) has been associated with increased pain episodes when used to treat priapism, priapism has been associated with marijuana use in sickle cell trait.



Is there any research on women having irregular menstruation cycle because of their sickle cell?


There is no research for this problem.  Many women have irregular cycles.  You should see a gynaecologist to see why your cycles are not regular.  This may not be related to sickle cell disease.  People with sickle cell disease have all kinds of medical problems that are unrelated.  Too frequently some doctors (and people with sickle cell disease) think all problems are sickle cell problems.  Most may be, but not all.