What is Priapism?
Priapism is a condition where you have a prolonged erection lasting more than 4-6 hours without any sexual activity. This can be very painful and is a medical emergency that needs immediate attention.
Are There Different Types of Priapism
1. Ischemic (Low-Flow) Priapism
- What is it? This is the most common type and needs urgent treatment.
- Symptoms: A painful, very rigid erection that doesn’t go away. Blood tests will show low oxygen levels and high acid levels in the penis.
- Causes: Often happens without a known cause, but can be triggered by certain medications, blood disorders like sickle cell disease, or other health issues.
- Risks: If not treated within 48 hours, it can cause permanent erectile dysfunction.
2. Nonischemic (High-Flow) Priapism
- What is it? This type is rare and usually not an emergency.
- Symptoms: A persistent, painless, partially rigid erection. Blood tests will be normal.
- Causes: Usually caused by an injury to the penis or perineum. It doesn't typically lead to erectile dysfunction.
3. Stuttering (Intermittent) Priapism
- What is it? Repeated episodes of painful erections that come and go.
- Symptoms: These episodes are usually shorter but can turn into ischemic priapism if not managed.
- Risks: Common in people with sickle cell disease.
4. Partial Priapism
- What is it? A rare condition affecting just one part of the penis.
- Symptoms: Usually resolves on its own with pain medication.
- Causes: Can be linked to trauma, drug use, or blood disorders.
5. Malignant Priapism
- What is it? Rare, caused by cancer spreading to the penis.
- Symptoms: Can be similar to either ischemic or nonischemic priapism.
- Causes: Often related to cancers of the bladder or prostate.
Who is Most Affected?
- Men aged 40-50 years are most commonly affected by nonstuttering priapism.
- Children aged 5-10 years and men aged 20-50 years are often affected by stuttering priapism.
- Sickle cell disease: A major cause in children and young adults, with up to 64% of young males with this disease experiencing priapism.
What Causes Priapism?
Ischemic Priapism
- Medications: Erectile dysfunction drugs (like Viagra), certain psychiatric and blood-thinning medications.
- Recreational Drugs: Alcohol, cocaine, marijuana.
- Blood Disorders: Sickle cell disease, certain clotting disorders.
- Infections and Toxins: Malaria, rabies, scorpion stings, spider bites.
- Other Health Issues: Certain metabolic and neurological disorders, cancer.
Nonischemic Priapism
- Injuries: Trauma to the perineum or penis.
- Congenital Conditions: Arterial venous malformations.
Stuttering Priapism
- Common Causes: Similar to ischemic priapism, particularly sickle cell disease.
How is Priapism Diagnosed?
Symptoms to Look For
- Persistent Erection: Lasting more than 4 hours without sexual arousal.
- Painful and Rigid Penis: Especially in ischemic priapism.
- Painless, Partially Rigid Penis: Common in nonischemic priapism.
Diagnostic Tests
- Blood Tests: To check for underlying conditions.
- Imaging: Ultrasound to see blood flow in the penis.
- Blood Gas Analysis: To measure oxygen and acid levels in the blood from the penis.
How is Priapism Treated?
Ischemic Priapism
- Immediate Steps: Drain the trapped blood from the penis with a needle (aspiration).
- Medications: Inject drugs like phenylephrine to help constrict blood vessels.
- Surgery: Shunting procedures to create a new pathway for blood flow or implanting a penile prosthesis if other treatments fail.
Nonischemic Priapism
- Observation: Often recommended first, as it is not usually an emergency.
- Embolization: Blocking the abnormal blood flow using medical techniques if the condition persists.
- Surgical Ligation: Tying off the blood vessels if other treatments don’t work.
Stuttering Priapism
- Managing Episodes: Similar to ischemic priapism during acute episodes.
- Preventive Treatments: Medications like PDE5 inhibitors, hormonal therapies, and other systemic medications to reduce the frequency of episodes.
Supportive Care for Cancer-Related Priapism
- Cancer Treatment: Address the underlying cancer causing priapism.
- Palliative Care: To manage pain and symptoms.
Words of Wisdom from a Consultant Urologist
If you have an erection that lasts more than 4 hours, seek immediate medical help. Quick treatment is crucial to prevent permanent damage. If priapism lasts less than 24 hours, the likelihood of maintaining erectile function is high. However, if it persists for more than 72 hours, the risk of erectile dysfunction significantly increases. Long-term erectile dysfunction is a common complication in many patients, and recurrent episodes or prolonged durations of priapism are linked to a worse prognosis.
