Priapism

Features

Priapism is a persistent, usually painful, penile erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. If the condition is not treated immediately, it can lead to permanent erectile dysfunction.

There are two categories of Priapism: low-flow and high-flow:

  • Low flow: This type of Priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.
  • High flow: High flow Priapism is more rare than low-flow and is usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.

Epidemiology

It can occur in all age groups, including newborn babies. However, it usually affects boys between the ages of 5 to 10 years and men between the ages of 20 to 50 years.

Causes

Sickle cell anemia: Some adult cases of Priapism are the result of sickle-cell disease and approximately 42% of all adults with sickle-cell anemia will eventually develop Priapism.

Medication

  • Some clients may use injectable medications to induce an erection. In these patients, excessive use may produce Priapism. Examples of agents used to induce an erection include papaverine, phentolamine, and prostaglandin E1.
  • Many psychotropic medications such as chlorpromazine, trazodone, quetiapine, and thioridazine have been associated with Priapism. The newer agents are not immune to this complication. Priapism has been described with citalopram, a selective serotonin reuptake inhibitor.
  • Rebound hypercoagulable states with anticoagulants such as heparin and warfarin have been associated.
  • Cocaine, marijuana, ethanol and ecstacy abuse has been cited in certain cases.

Other causes

  • Trauma to the spinal cord or to the genital area
  • Black widow spider bites
  • Carbon monoxide poisoning

Treatment

The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decrease blood flow to the penis, may be very helpful. Other treatment options include:

  • Ice applied to the penis and perineum to reduce swelling.
  • Performance of surgical ligation in cases where an artery has been ruptured. In this case the doctor will "tie off" the artery that is causing the Priapism in order to restore normal blood flow.
  • Intracavernous injection is used for low-flow Priapism. During this treatment drugs known as alpha-agonists are injected into the penis to reduce blood flow to the penis, causing the swelling to subside.
  • A surgical shunt can be used for low-flow Priapism. A shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
  • Aspiration can also be performed after numbing the penis. Here the doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you suspect that you are experiencing Priapism, you should not attempt to treat it yourself. Instead seek emergency help as soon as possible.

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