Priapism

Description

Priapism is a prolonged erection of the penis. The total or partial erection continues hours beyond or is not caused by sexual stimulation. The main types of priapism are ischemic and non-ischemic. Priapism ischemic attack is a medical emergency.

Although priapism is an uncommon condition in general, it occurs commonly in certain groups, like people who have sickle cell disease. Prompt treatment for priapism is usually needed to prevent tissue damage that could result in the inability to get or maintain an erection (erectile dysfunction).

Priapism most commonly affects men in their 30 years of age and older, but it can also begin in childhood for children with sickle cell disease.

Symptoms

Priapism symptoms vary depending on the type of priapism. The two main types of priapism is priapism ischemic and non-ischemic priapism.

Priapism ischemic

Priapism ischemic attack, also called low-flow priapism is the result of blood not being able to leave the penis. The blood becomes trapped in the penis because it cannot flow out of the veins of the penis or there is a problem with the contraction of the smooth muscles in the erectile tissue of the penis. Priapism ischemic is the most common type of priapism and requires immediate medical attention to avoid complications caused by not getting enough oxygen to the tissues of the penis.

Signs and symptoms include:

  • The erection that lasts more than four hours or unrelated to sexual interest or stimulation
  • Rigid penile shaft, but the tip of the penis (glans penis) is smooth
  • Progressive worsening of pain in the penis

Stuttering priapism — also called recurrent or intermittent priapism — is a form of priapism ischemic. An uncommon condition, stuttering priapism describes repeated episodes of prolonged erections and often includes episodes of priapism ischemic. It occurs most often in men who have an inherited disorder that is characterized by the abnormal shape of the red blood cells (sickle cell anemia). Sickle cells can block the blood vessels in the penis. In some cases, the condition begins with unwanted and painful erections of short duration and can progress over time to more frequent and prolonged erections. Stuttering priapism may begin in childhood.

Non-ischemic priapism

Non-ischemic priapism, also known as high-flow priapism, which occurs when the flow of blood through the arteries of the penis is not working properly. However, the tissues of the penis continue to receive some flow of blood and oxygen. Non-ischemic priapism often occurs due to a trauma.

Signs and symptoms include:

  • The erection that lasts more than four hours or unrelated to sexual interest or stimulation
  • Erect but not fully rigid penile shaft
  • Usually is not painful

When to see a doctor

If you have an erection that lasts more than four hours, you need emergency care. The emergency room doctor will determine if you have priapism ischemic or non-ischemic priapism.

If you experience recurrent, persistent, painful erections resolve on your own, consult your doctor. You might need treatment to prevent new episodes.

Causes

An erection occurs normally in response to physical or psychological stimulation. This stimulation makes certain smooth muscles to relax, increasing blood flow to the spongy tissues of the penis. As a result, the blood fills the penis erect. After the end of stimulation, the blood flows and the penis returns to its non-rigid (flaccid) state.

Priapism occurs when any part of this system — the blood, blood vessels, smooth muscles, or nerves — changes in the normal flow of blood and an erection persists. The underlying cause of priapism often can't be determined, but with several conditions can play a role.

Blood disorders

Blood-related diseases could contribute to priapism (usually priapism, stroke, when the blood cannot flow out of the penis. These disorders include:

  • Sickle cell disease
  • Leukemia
  • Other diseases of the blood dyscrasias hematologic), such as thalassemia and multiple myeloma

The most common associated diagnosis in children with sickle cell disease.

Prescription drugs

Priapism, usually priapism ischemic, is a possible side effect of some drugs, including:

  • The drugs injected directly into the penis to treat erectile dysfunction, such as alprostadil (Caverject, Edex, others), papaverine, phentolamine (Oraverse) and other
  • Antidepressants, such as fluoxetine (Prozac), bupropion (Wellbutrin XL, Wellbutrin SR), citalopram, and sertraline (Zoloft)
  • Alpha-blockers including prazosin (Minipress), terazosin, doxazosin (Cardura), and tamsulosin (Flomax)
  • The medications used to treat anxiety or psychotic disorders, such as hydroxyzine (Vistaril), risperidone (Risperdal), olanzapine (Zyprexa), lithium (Lithobid), clozapine (Clozaril), chlorpromazine and thioridazine
  • Anticoagulants, such as warfarin (Jantoven), and heparin
  • Hormones such as testosterone or gonadotropin-releasing hormone
  • Medications used to treat attention-deficit/hyperactivity disorder (ADHD), such as methylphenidate (Concerta, Ritalin, others) and atomoxetine (Strattera)

Use of Alcohol and drugs

Alcohol, marijuana, cocaine, and other drugs can cause priapism, particularly priapism ischemic.

Injury

A common cause of non-ischemic priapism is an injury or trauma to the penis, the pelvis, or the region between the base of the penis and the anus (the perineum).

Other factors

Other causes of priapism include:

  • A spider bite, scorpion sting, or other toxic agents, infections
  • Metabolic disorders, including gout, or amyloidosis
  • Neurogenic disorders, such as a spinal cord injury or syphilis
  • Cancers involving the penis

Complications

Priapism ischaemic can cause serious complications. The blood trapped in the penis is deprived of oxygen. When an erection lasts too long — usually more than four hours — the lack of oxygen can begin to damage or destroy the tissues in the penis. Without treatment, priapism can cause erectile dysfunction.

Prevention

If you have stuttering priapism, to prevent future episodes of your doctor might recommend:

  • The treatment for an underlying condition, such as sickle cell disease, which could have caused priapism
  • The use of the mouth or injection, phenylephrine, and
  • Hormone-blocking medications — only for adult men
  • The use of oral medications is used to manage erectile dysfunction

Priapism

Diagnosis

If you have an erection that lasts more than four hours, you need emergency care.

The emergency room doctor will determine if you have priapism ischemic or non-ischemic priapism. This is necessary because the treatment for each is different, and the treatment for priapism ischemic should occur as soon as possible.

Clinical history and examination

To determine what type of priapism, your doctor will ask you questions and examine your genitals, abdomen, pelvis and perineum. Your doctor may be able to determine what type of priapism have been based on that if you are experiencing pain and stiffness of the penis. This test can also reveal the presence of a tumor, or signs of trauma.

Diagnostic tests

Diagnostic tests may be necessary to determine what type of priapism that you have. Additional tests can identify the cause of priapism. In an emergency room, your treatment is likely to start before all the test results are received.

The diagnostic tests may include:

  • Penile blood gas measurement. In this test, a small needle is inserted in the penis to extract a blood sample. If the blood is black — deprived of oxygen, the condition is more likely that the priapism ischemic. If it is bright red, the priapism is more likely than not ischemic. A laboratory test measuring the amounts of certain gases in the blood can confirm the type of priapism.
  • Blood tests. The blood of your arm can be tested to measure the number of red blood cells, and platelets present. The results may show evidence of diseases, such as sickle cell anemia, and other blood disorders or certain types of cancer.
  • Ultrasound. You could have the Doppler ultrasound — a noninvasive test that can be used to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. This test can be used to measure the flow of blood within your penis, which would suggest ischemic or non-ischemic priapism. The examination may also reveal an injury, or abnormality that could be an underlying cause.
  • Toxicology test. Your doctor may order a blood or urine test for the detection of drugs that could be the cause of priapism.

Treatment

Priapism ischemic

Priapism ischemic — the result of blood not being able to leave the penis — is an emergency situation that requires immediate treatment. After pain relief, this treatment usually begins with a combination of drainage of blood from the penis, and the use of medications.

  • The suction decompression. The excess blood drains from his penis with a tiny needle and syringe (aspiration). As part of this procedure, the penis can also be cleaned with a saline solution. This treatment often relieves pain, removes the oxygen-poor blood and you can stop the erection. This treatment can be repeated until the erection ends.
  • Drugs. A drug, such as phenylephrine, may be injected into the penis. This drug constricts the blood vessels that carry blood towards the penis. This action allows the blood vessels that carry blood out of the penis to open, increasing the flow of blood out of the penis. This treatment can be repeated several times if necessary. You will be supervised by the side effects, such as headache, dizziness and high blood pressure, especially if you have high blood pressure or heart disease.
  • Surgery or other procedures. If other treatments are not successful, a surgeon may perform other procedures to drain blood from the penis or surgery to divert the flow of blood so that the blood can re-move through your penis.

If you have sickle cell disease, you may receive additional treatments that are used for the treatment of diseases related to the episodes.

Non-Ischemic Priapism

Non-ischemic priapism often goes away without treatment. Because there is a risk of harm to the penis, your doctor may suggest a watch and wait approach. Place ice and the pressure on the perineum, the region between the base of the penis and the anus — could help end the erection.

Surgery may be necessary in some cases to insert material, such as an absorbable gel, which temporarily blocks the blood flow to your penis. With time, the body absorbs the material. You may also need surgery to repair the arteries or tissue damage caused by an injury.

Preparing for your appointment

If you have an erection that lasts more than four hours, you need emergency care. If you experience recurrent, persistent, partial erections that resolve on their own, see your doctor. The treatment may be necessary to prevent further episodes. The doctor may suggest that you make a follow-up appointment with a specialist in the urinary tract and the male reproductive system, such as a urologist or andrologist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

  • Make a list of the symptoms that you are experiencing, including any that may seem unrelated.
  • Make a list of all the medications, vitamins, herbs, and supplements you are taking. Tell your doctor if you use illegal drugs.
  • Prepare a list of questions to discuss with the doctor.

Questions for your doctor may include:

  • What is likely causing the problem?
  • What kind of tests may be needed?
  • What can you do to avoid this problem in the future?
  • If medication is necessary, is there a generic alternative?
  • There are activities, such as exercise or sex, that should be avoided? If so, for how long?
  • How priapism increase the risk of developing erectile dysfunction?
  • Do you have brochures, or can you suggest websites that explain more about priapism?

Do not hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

  • When did your symptoms first start?
  • How long does the erection or erection?
  • It was the painful erection?
  • He has had an injury to the genitals or in the groin?
  • Made an erection to occur after the use of a particular substance, such as alcohol, marijuana, cocaine or other drugs?

Your doctor may order certain lab tests to determine if a health condition that is causing priapism.

What you can do in the meantime

Do not stop taking prescription medications without first talking to your doctor.

Symptoms and treatment of Priapism