What is Priapism?

Priapism is a condition where men experience a prolonged erection of penis. The full or partial erection can continue for hours and usually is not caused by sexual stimulation. These conditions happen when blood in the penis becomes trapped and is unable to drain. Priapism is a medical emergency. If not treated immediately, it will lead to scarring and permanent erectile dysfunction.

Priapism can occur in all age groups, even in newborns. However, the most common age groups that are affected are between ages of 20 to 50.

Types of Priapism

The two main types of priapism are ischemic priapism and non-ischemic priapism, otherwise known as low-flow priapism and high-flow priapism. 

  1. Ischemic priapism/low flow priapism:
  • Ischemic priapism is the result of blood not able to leave the penis or being trapped in the penis. The blood is trapped due to the problem with the contraction of smooth muscle within the erectile tissue of the penis. 
  • Ischemic priapism is the more common type of priapism
  • Immediate medical treatment is needed to prevent complications caused by not enough oxygen to penile tissue.
  1. Non-ischemic priapism/high flow priapism
  • Non-ischemic priapism occurs when blood flow through the arteries of the penis is not working properly. However, the penile tissue continues to receive some blood flow and oxygen.
  •  Usually, non-ischemic priapism occurs due to trauma

Signs and symptoms of priapism:

  1. Ischemic priapism: Erection lasting more than 4 hours and more or unrelated to sexual stimulation, erect but not fully rigid penile shaft and usually not painful
  2. Non-ischemic priapism: Erection lasting more than 4 hours and more or unrelated to sexual stimulation, rigid penile shaft but the tip of penis is soft and progressively worsening penile pain

Causes of priapism

The underlying cause of priapism usually cannot be determined but conditions/causes below can play a role to contribute to priapism:

  1. Blood disorders: Sickle cell disease, leukemia, thalassemia and multiple myeloma.
  2. Side effects of medications: medications that are injected directly into penis (Caverject), antidepressants, medications for prostate (alpha blocker), medications for anxiety, blood thinner
  3. Alcohol and drug use: marijuana, cocaine and others drug
  4. Injury/trauma: common cause for nonischemic/high flow priapism

How to diagnose priapism?

Usually, your doctor will get a complete history regarding the erection to try to find the causes of priapism. Secondly, your doctor will do a complete examination.

Diagnostic test might be needed to find out what type of priapism. 

  1. Penile blood gas measurement: this lab test can help to confirm the type of priapism
  2. Blood test:  blood will be taken to measure the number of red blood cells and platelets present. This result can help to show evidence of blood disorders like sickle cell disease.
  3. Ultrasound: Ultrasound can be used to estimate the blood flow through blood vessels. Ultrasound can measure the blood flow within penis to suggest it is ischemic or nonischemic priapism. Ultrasound can help to reveal an injury as well if it is present.
  4. Toxicology screen

Treatment for priapism

The goal of the treatment is to resolve the erection and preserve the ability to have erections in the future.

  1. Ice packs: applied ice on penis and perineum may help to reduce swelling 
  2. Intracavernous injection: Drugs known as alpha-agonists are injected into penis, it will cause the artery to become narrow and reduce blood flow to the penis.
  3. Aspiration: After numbing the penis, a needle will insert into penis to drain the blood from the penis to reduce pressure and swelling 
  4. Surgical procedure: sometimes surgery is needed if artery is ruptured or surgical shunt is required to divert the blood flow

Non-ischemic priapism usually will go away without treatment. Usually, it won’t cause any damage to the penis. 

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