Overview
Priapism is a prolonged, unnatural erection of the penis that lasts for several hours and is not caused by sexual stimulation. It is usually a symptom of an underlying medical condition. There are two main types of priapism: ischemic and nonischemic. Ischemic priapism is a medical emergency that occurs due to blood not being able to leave the penis, while nonischemic priapism is due to blood flow through the arteries not working properly. Prompt treatment for priapism is necessary to prevent complications and tissue damage.
Understanding the disease
Symptoms
The symptoms of priapism vary depending on the type of priapism. The two main types are ischemic priapism and nonischemic priapism. Ischemic priapism symptoms include:
- Progressively worsening penile pain
- No visible signs of an erection or a partially erect penis
- The inability to get or maintain an erection Nonischemic priapism symptoms include:
- A full or partial erection that lasts for hours and is not caused by sexual stimulation
- The penis may be swollen or firm to the touch
- The erection may be accompanied by pain in the penis or perineum (the area between the scrotum and anus) In both types of priapism, it's important to seek prompt medical attention to prevent potential complications.
Risk Factors
Risk factors for developing priapism include:
- Alcohol and drug use: Consuming alcohol, marijuana, cocaine, and other drugs can cause priapism, particularly ischemic priapism.
- Injury: Trauma or injury to the penis, pelvis, or the perineum can lead to nonischemic priapism.
- Other factors: Metabolic disorders such as gout or amyloidosis, neurogenic disorders (e.g., spinal cord injury or syphilis), cancers involving the penis, and certain medications (e.g., blood thinners, ADHD medications, and hormones) can also contribute to priapism.
- Smoking, obesity, and certain medicines can increase the risk of developing priapism.
Development
Priapism can develop due to different causes, including blood flow issues, trauma or injury, certain medications, metabolic disorders, neurogenic disorders, cancers, and infections such as syphilis. Ischemic priapism, the more common type, occurs when blood cannot leave the penis, while nonischemic priapism is typically caused by injury or other factors that disrupt blood flow. Syphilis can also cause priapism, although it is less common.
Assessment and Diagnosis
Triage
If priapism is suspected, it is important to seek medical attention promptly. Priapism is a medical emergency that requires immediate evaluation and treatment. You should contact your healthcare provider or visit an emergency department as soon as possible. Delayed treatment can lead to permanent damage to the penis and potential long-term complications.
Diagnosis
To diagnose priapism, a healthcare professional will first gather information about the patient's medical history and perform a physical examination. They may also order diagnostic tests such as penile blood gas measurement, blood tests, ultrasound, and toxicology tests to determine the type and cause of priapism. Prompt medical attention is necessary, as ischemic priapism, which is caused by blood not being able to exit the penis, is an emergency situation that requires immediate treatment.
Management and Treatment
Complications
Complications of priapism can arise due to the prolonged lack of oxygen in the trapped blood of the penis. The main complication is erectile dysfunction resulting from tissue damage. Untreated ischemic priapism can lead to scarring and fibrosis of the penile tissues, which may cause permanent erectile dysfunction. In severe cases, it can also lead to penile loss or gangrene, requiring amputation. Other potential complications include urinary tract infections, stress, and anxiety related to the condition.
Prevention
Priapism can be prevented in some cases, particularly ischemic priapism. To prevent future episodes of ischemic priapism, a doctor might recommend treatment for an underlying condition that may have caused the priapism, such as sickle cell disease. In addition, the use of oral or injectable phenylephrine, hormone-blocking medications for adult men, and oral medications used to manage erectile dysfunction may also be recommended. However, the best approach to prevention depends on the underlying cause of the priapism, so it is important to consult with a healthcare professional for personalized advice.
Treatment
Priapism is a medical emergency that requires prompt treatment. The treatment for priapism depends on the type and the underlying cause. Here are some common treatment options:
- Ischemic Priapism: Ischemic priapism is the more common type that requires immediate medical care. Treatment typically involves draining the blood from the penis using a needle. In some cases, a medication called phenylephrine may be injected into the penis to help restore blood flow. If there is no improvement, a surgical intervention called embolization may be performed to block the blood vessels of the penis.
- Nonischemic Priapism: For nonischemic priapism caused by injury or trauma, treatment may involve icing the affected area and administering pain medication. In some cases, surgery may be necessary to relieve the swelling and restore blood flow.
- Hormone-blocking Medications: In adult men, hormone-blocking medications may be prescribed to prevent future episodes of priapism. These medications work by lowering the levels of hormones that cause erections.
- Oral Medications: For cases of recurrent priapism, oral medications used to manage erectile dysfunction may be prescribed. It is important to note that treatment for priapism should be done under the supervision of a medical professional to ensure proper diagnosis and appropriate treatment. Remember, if you or someone you know is experiencing symptoms of priapism, seek immediate medical attention.