Priapism

Specialty of Andrology

What is priapism?

Priapism is a prolonged and painful erection of the penis that is not associated with sexual stimulation and can last between at least four hours to several days. It occurs when the penis begins to fill with blood, as it would during a normal erection, but the blood does not drain properly as the sex organs become blocked, or the systems that relax the organs fail. It is an uncommon condition and tends to appear in men in their 30s and those with sickle cell anaemia.
 



There are two types of priapism:

  1. Ischemic priapism (or low-flow priapism) is the most common type and occurs when the blood is unable to leave the penis. An erection tends to last more than four hours, the shaft is rigid but the tip of the penis is soft. It causes progressive penile pain. ​
  2. Non-ischemic priapism (or high-flow priapism) occurs when there is a rupture in an artery or a lesion in the penis and too much blood flows to it. It is usually painless and an erection lasts more than four hours. If you have an erection lasting over four hours it is necessary to see the doctor immediately for emergency care.

​It is possible for priapism to occur in women and is referred to as priapism of the clitoris. It is not a medical emergency in women as it is less likely that a blood clot will occur on the clit due to the abundant blood supply to the female external genitalia.
 

What are the symptoms of priapism?

Although the main feature of this pathology is the unwanted erection lasting several hours, the symptoms vary depending on the type of priapism. With ischemic priapism, the body of the penis becomes rigid, sensitive and in progressive pain. In contrast, non-ischemic priapism is the opposite as the body of the penis is unpainful and not fully rigid.
 

What is the cause of priapism?

Priapism may be a consequence of a disease such as leukaemia, traumatic injury of the spinal cord or the nerve centres, or due to inflammation in the urethra. Other causes may include alcohol and drug abuse (especially marijuana, cocaine and heroin), the use of antidepressant medications, tablets for blood pressure control or treatments used for erectile dysfunction.
 

Can priapism be prevented?

Some preventive measures for priapism are:

  • avoid the factors that can cause it, such as drug or alcohol use.
  • Use of muscle relaxants and injections of phenylephrine for long-lasting erections.
  • Review any medications that are consumed in case one is causing the condition.
     

What is the treatment of priapism?

Ischemic priapism is an emergency situation and should be treated immediately by a medical professional, who will drain the blood from the penis with the help of a needle and/or supply medicines to drain the blood. If drainage through injections and medications does not work, surgery can be performed where a surgeon might reroute the blood flow so it can move normally again.

Non-ischemic priapism will usually disappear without the need for treatment and as there is no danger of damaging the penis. It is recommended to apply an ice pack and pressure on the region between the base of the penis and the anus (the perineum).

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