Priapism is a medical condition that, while rare, is vital for every man to be informed about due to its potential consequences for sexual health. Characterized by prolonged and often painful erections that can last for several hours or even days, priapism can occur without sexual stimulation. Immediate medical attention is crucial for individuals experiencing this condition.
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In this article, we delve deeper into the underlying causes, symptoms, and treatments associated with priapism.
What is Priapism?
In basic terms, priapism is a persistent erection of the penis that continues hours beyond sexual stimulation or is not caused by sexual stimulation at all.
There are three main types:
- Ischemic Priapism: Also known as “low-flow” priapism, this is the most common form. It occurs when blood is not able to leave the penis, resulting in an erection that can be painful. Typically in this form the shaft of the penis is very hard but the head remains soft.
- Non-Ischemic Priapism: A less common form, known as “high-flow” priapism, it’s generally less painful. In this form the shaft is less hard, causing less pain. It often results from trauma, usually from a ruptured artery causing an influx of blood to the penis.
- Intermittent (or “stuttering”) Priapism: is a subtype of ischemic priapism characterized by recurring episodes of prolonged erections. These erections may temporarily subside only to return, potentially increasing in duration and discomfort with each recurrence.
Priapism vs a Normal Erection
First, it is important to understand how normal erections occur and the physiology of the penis.
Normal erections are caused by blood flowing into your penis when you are aroused. Sexual arousal, either mental or physical, causes the arteries in the penis to relax. This makes the arteries expand, allowing more blood to flow into the tissue of the penis shaft and head. The blood is trapped in the penis, causing an erection. After sex, or when the arousal disappears, the blood is allowed out of the penis back into the rest of the body.
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When there is a problem with the blood flow back into the body, this traps the blood in the penis, causing the painful erection we call priapism.
Causes of Priapism
While the precise cause of priapism can sometimes be unidentified, several conditions and factors can contribute to its onset:
Certain medications, especially those for erectile dysfunction, depression, anxiety, and hypertension, have been linked to priapism.
According to one study, drug-induced priapism “comprises about 30% of cases. The drugs most frequently implicated are psychotropic drugs (phenothiazines and trazodone), antihypertensives (mainly prazosin) and heparin.”
Conditions like sickle cell anemia, leukemia, and thalassemia can increase your risk of priapism.
Drug and Alcohol Use
Excessive alcohol, cocaine, marijuana, and other drugs might trigger priapism.
Trauma or Injury
Injuries to the penis, pelvis, perineum, or spinal cord can affect blood flow and cause priapism. Additionally, black widow spider bites can lead to the condition.
Signs and Symptoms
The primary symptom of priapism is a prolonged erection, typically lasting more than four hours. In ischemic priapism, the erection can be painful, while in non-ischemic priapism, pain might be minimal or even absent. It’s crucial to identify and treat priapism early to prevent complications.
Without prompt treatment, priapism can cause permanent damage to your penis.
If not addressed promptly, priapism can lead to complications such as:
Penile fibrosis is the formation of scar tissue in the penis. The development of fibrous tissue in the penis reduces elasticity, often leading to erectile dysfunction or a permanent inability to achieve an erection.
Penile Tissue Damage
Extended erections can damage penile tissues, leading to lasting erectile issues. The cells in your body use the oxygen in your blood to create energy. During an episode of untreated priapism, the trapped blood eventually runs out of oxygen, which can harm the tissues in your penis.
Treatment and Management
Immediate medical attention is crucial for priapism. If you have experienced a painful erection that lasts longer than four hours, see a medical provider immediately.
Treating Ischemic Priapism
Since ischemic priapism can get progressively worse and lead to an accumulation of blood trapped in the penis over time, treatment can involve invasive measures.
Typically the treatment for ischemic priapism involves the following:
- Drainage: In ischemic priapism, a doctor might use a syringe to withdraw blood to avoid permanent damage to the penis.
- Medication: Doctors may use an intracavernosal injection to restrict blood flow to the penis.
- Surgical Intervention: For recurrent or severe cases, surgery might be necessary to redirect blood flow. There are various surgical interventions that can shunt blood so it can drain from the penis.
Treating Non-Ischemic Priapism
In “high-flow” priapism, the blood is not being trapped in the penis, but the blood vessels are allowing too much blood into the penis. This means it needs a different treatment approach:
- Ice Packs and Compression: This non-invasive treatment is the first option to help relieve pressure and encourage the blood back out of the penis.
- Blocking Blood Vessels: Blocking the blood vessels that supply the blood to the penis can result in quick relief for suitable patients.
What Is Priapism: Conclusion
While priapism is uncommon, awareness about the condition is crucial for all men. Recognizing the signs and understanding the potential risks can ensure timely medical intervention and the prevention of long-term damage. Always consult a healthcare professional if you suspect you have priapism or any other medical condition.
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Priapism – Symptoms & causes – Mayo Clinic. (2021, August 31). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/priapism/symptoms-causes/syc-20352005
Prolonged erection (priapism). (n.d.). Healthy Male. https://www.healthymale.org.au/mens-health/prolonged-erection-priapism