Priapism is a condition that involves the persistent hardening of the penis, which is not caused by arousal or sexual stimulation. Any condition of unwanted erections of the penis that lasts for more than four hours should get medical attention immediately. When blood inside the penis is trapped and unable to drain, a prolonged erection develops. This can lead to severe erectile dysfunction if it is not treated immediately.
Treatment should be administered to prevent tissue damage that can result in the inability to get an erection. Priapism is common between the ages of 20 and 50 in men and ages 5 and 10 in boys.
Symptoms of priapism may vary according to the three types of priapism. The three types are ischemic, nonischemic, and stuttering priapism.
Ischemic priapism, sometimes called low-flow, is a persistent, nonsexual erection characterized by little or no blood flow and abnormal gases in the penis. Signs of this common type of priapism are unwanted erections that last more than four hours, on and off erections for several hours, and an usually painful penis.
A resolution for ischemic priapism is aimed to return to a flaccid and non-painful state of the penis. However, in some cases, persistent edema and partial erections may occur and can result in unresolved priapism. A resolution for this condition of priapism can be verified by the measurement of blood gases or blood flow through the use of color duplex ultrasonography.
Nonischemic priapism, sometimes called high-flow, is a nonsexual, persistent erection caused by too much blood flowing into the penis. Signs of this type of priapism are usually painless, include unwanted erections that last at least four hours, and the penis has an erect but not rigid shaft. The penis is neither fully painful or has a rigid feeling. A resolution for nonischemic priapism is aimed to return to a penis that is completely flaccid.
Stuttering (intermittent) priapism is another form of ischemic priapism which includes prolonged painful erections that happen repeatedly with random periods where there is swelling of the penis.
Causes of Priapism
People with sickle-cell anemia (a sickle-cell disease caused by the destruction of red blood cells and blocking of blood vessels) is one major cause of this disease. More than 40% of adults diagnosed with sickle cell anemia may also suffer from priapism.
Medications. The abuse or misuse of prescription drugs is a major cause of priapism. Some of these medications include the anti-depression drugs such as Desyrel and Thorazine which are used as medications for mental disorders. Oral or intravenous drugs prescribed for erectile dysfunction can also cause priapism.
Other causes include:
- Trauma inflicted on the genital area or the spinal cord
- Carbon monoxide poisoning
- Substance abuse (ex. marijuana and cocaine) and
- Black widow spider bites
Diagnosis of Priapism
Patients with priapism are advised to seek medical care immediately. Tell your doctor the length of your erection and how long it usually lasts. It is also important to tell your doctor about any legal or illegal drugs as well as medications you have used. Be honest in telling him the whole story, especially if you have used illegal drugs since both cocaine and marijuana have been known to ease the pain of priapism. Your medical history will be reviewed by the doctor and he or she will perform a physical exam to determine the cause of priapism.
The presence of medical attention is self-evident in patients where priapism has not been diagnosed and treated. The diagnosis and treatment of priapism should focus on the difference between ischemic and nonischemic priapism. Appropriate management of priapism can be initiated and determined once the type of priapism is identified.
The goal of the treatment of priapism is to eradicate an unwanted erection and enhance normal erectile function. Some recommended treatments include:
- Ice packs: Apply ice to the penis that may help reduce the swelling.
- Surgical litigation: With a ruptured artery, the doctor will perform a ligation of the artery that causes priapism so that the blood flow will be restored.
- Intracavernous injection: An alpha-agonist treatment drug is injected into the penis. This will narrow the veins and reduce blood flow and ease swelling of the penis.
- Surgical shunt: This is performed to allow blood circulation return to normal.
- Aspiration: A needle will be inserted into the penis and drain blood to release pressure and stop the swelling.
Patients with priapism should be diagnosed and evaluated attentively in order to get proper treatment. The goal of the treatment for patients with priapism is to achieve and preserve normal erectile function.
Some of the treatments aimed at curing priapism have complications when treating erectile dysfunction. Therefore, there are treatment procedures for priapism that involve a wide range of options. Some of these options should be applied with an effective treatment process so that there is a lower risk against the likelihood of prolonged erectile dysfunction and permanent damage to tissues in the penis if treatment is not properly administered.