Priapism (penis disorder) involves prolonged erections that continue hours past sexual stimulation. The condition is extremely painful and usually requires medical intervention. The condition tends to occur in men in their 30s. Any erection lasting four hours or more is considered a medical emergency. This is because the lack of blood flow to the penis can deprive the area of much-needed oxygen so as not to cause damage to surrounding tissue.
Ischemic (low-flow) priapism develops when blood is blocked in the erection chamber. Sometimes, the condition is caused by a broken artery (non-ischemic priapism) that prevents adequate blood flow circulation into the penis that could be caused by an injury, often during sexual intercourse. If left untreated, ischemic or non-ischemic priapism can result in the destruction or damage of penile tissue and eventually cause permanent erectile dysfunction.
- Why Does Priapism Occur?
- Who Is at Risk for Priapism?
- Common Symptoms
- Diagnosing Priapism
- Priapism Treatments
Why Does Priapism Occur?
Erections develop in men as a response to a psychological or physical stimulation, usually involving sexual activity or thoughts. The response to the stimulation causes smooth muscles and blood vessels to relax and allows for an increased low blood into the penis's spongy tissue. As the penis begins filling with blood it becomes erect. At the end of the stimulation, blood is released back into the bloodstream allowing the penis to return to its flaccid (non-rigid) state.
However, when priapism is present at any portion of achieving or maintaining an erection, the nerves, smooth muscles, blood vessels or blood will change the normal flow of blood and cause the erection to persist.
Who Is at Risk for Priapism?
Even though the condition is uncommon, there are specific risk factors associated with priapism. This includes:
- Sickle-Cell Anemia – Males who have acquired sickle-cell anemia have an increased potential chance of suffering from priapism.
- Other Hematologic Conditions including leukemia, multiple myeloma, thalassemia, and others can increase the potential risk in men of developing priapism.
- Certain Prescription Drugs – Ischemic priapism is a likely side effect of taking a variety of drugs that include:
- Antidepressants – Wellbutrin (bupropion), Prozac (fluoxetine) and sertraline
- Hormones including the gonadotropin-releasing hormone or testosterone
- Blood Thinners including heparin and Coumadin (warfarin)
- Drugs like Strattera (atomoxetine) that treat ADHD (attention deficit/hyperactivity disorder)
- Anti-Anxiety/Antipsychotic Disorder Medications including Risperdal (risperidone), Zyprexa (olanzapine), lithium, thioridazine, and chlorpromazine.
- Alpha Blockers including tamsulosin, doxazosin, terazosin, and prazosin
- Drug and Alcohol Abuse – Abusing cocaine, marijuana, alcohol and other illegal drugs can cause priapism, especially ischemic priapism.
- Physical Injury – Non-ischemic priapism (a persistent erection where an excess amount of blood flow enters the penis) is caused by an injury or trauma to the penis, perineum, or pelvis.
- Toxins from scorpion stings and spider bites can cause priapism.
- Neurogenic Disorders including syphilis or spinal cord injuries can lead to priapism.
- Cancers associated with the penis can cause priapism.
- Metabolic Disorders including amyloidosis or gout can lead to priapism.
Ischemic priapism is often serious and can cause complications when the blood in the penis becomes trapped and deprived of oxygen. This often occurs when an erection lasts for an extended period destroying or damaging tissue in the penis. The complications often include permanent erectile dysfunction.
The symptoms associated with priapism depends on whether it is caused by ischemic (low-flow) conditions or non-ischemic (high-flow) conditions.
- Ischemic (Low-Flow) Priapism – This occurs when the blood is not able to exit the penis at the end of stimulation. This most common type of priapism produces symptoms that include:
- Erections the last four hours or more or not related to sexual stimulation/interest
- Progressive pain in the penis
- Rigid shaft where the glans (tip of the penis) remained soft
Stuttering or recurrent ischemic priapism is uncommon. Typically, men with an inherited disorder usually develop the condition because of sickle-cell anemia (abnormally shaped red blood cells). This disease blocks blood vessels that lead into the penis. Sometimes, the condition begins with painful, unwanted erections that only last for a minimal time but eventually progress in frequency causing more prolonged erections.
- Non-Ischemic (High Flow) Priapism – This form of the condition develops when blood flow to the penis lacks appropriate regulation. While typically painless, this type of priapism produces symptoms that involve:
- Erect penis shafts that are not fully rigid
- Erections lasting four hours or more that are not related to sexual stimulation or interest
Any time a man has an erection that lasts four hours or more should seek out medical attention. The doctor can determine what form of priapism the man is experiencing to ensure he receives the best treatment as quickly as possible. Persistent, recurring painful erections are sometimes resolved without medical attention. However, treatment can ensure future episodes are prevented.
Typically, a patient will seek out medical attention if they have an erection that lasts four hours or more. Typically, the emergency room medical team will determine if the male is suffering from ischemic or non-ischemic priapism to ensure they receive the best treatment to ensure a successful outcome.
The treating doctor will take a complete medical history, ask questions, and examine the man's genitals, groin area, perineum, and abdomen. Sometimes, the type of priapism can be determined by the level of pain or lack of pain the man is experiencing during his erection. The physical examination could reveal signs of trauma or the presence of a benign or malignant tumor.
The doctor will order numerous diagnostic tests that could include:
- Blood Tests – This test can reveal the number of platelets and red blood cells present in the bloodstream. This can rule out or verify sickle-cell anemia, certain cancers, or other blood disorders.
- Blood Gas Measurement – The technician will insert a tiny needle into the penis to remove a blood sample that can reveal the presence of oxygen or blood usually associated with ischemic priapism. If bright red blood is detected, the long-lasting erection is likely caused by nonischemic priapism. The levels of certain gases can confirm which type of priapism the man is experiencing.
- Toxicology Test – Urine tests can reveal any drugs that might be the cause of the man's priapism.
- Ultrasound Technology –The doctor might order of noninvasive Doppler ultrasonography test to estimate the flowing blood moving through blood vessels. The Doppler test can also reveal an abnormality or injury that could be the underlying because of the condition.
The kind of treatment the doctor will recommend would be based on the type of priapism found in the diagnosis. Typically, ischemic priapism is an emergency situation where immediate medical attention is required. Usually, the doctor will drain blood from the penis and provide medications.
Treatments for priapism include:
- Therapy – Extreme pain can be alleviated by draining excess blood from the penis through aspiration where a syringe and small needle extracts the blood or flushes it without using a saline solution. This allows oxygenated blood to enter into the penis and prevent the destruction of tissue.
- Drugs – Sympathomimetic drugs including phenylephrine is effective for treating ischemic priapism by being injected into the penis to constrict blood vessels carrying blood. The medication allows the penis to open up so the flow of blood can exit. Often, repeated treatments are required. The medication could cause side effects including high blood pressure, dizziness, and headaches, especially in individuals who already suffer from heart disease and high blood pressure.
Sometimes, surgery is necessary to ensure blood flow is temporarily blocked in the penis.