Priapism is a serious condition that can affect boys and men of all ages, in which the normal blood flow in the penis is disrupted. The result is an erection that will not go away. It can usually be successfully treated in the emergency room.
Definition & Facts
Priapism, named after Priapus, the Greek deity of the male genitals, is a condition where the erect penis does not return to its normal flaccid state for more than four hours without sexual stimulation. While often used as fodder for jokes, priapism is actually a dangerous and debilitating condition that should be treated immediately. Leaving priapism untreated can cause permanent damage to the structures and tissues of the penis, possibly harming the patient's ability to have a normal erection in the future.
Symptoms & Complaints
Priapism is divided into two types. In ischemic priapism, the more common type, blood is unable to leave the penis quickly enough to allow it to go flaccid. Ischemic priapism is usually marked by painful hardness in the shaft of the penis, although the head may still be soft. Stuttering priapism is most often of this type.
Nonischemic priapism is caused by too much blood flowing into the penis. In this case, the penis is usually erect but not hard, and there is much less pain than ischemic priapism. This is a less dangerous condition but should still be seen by a doctor.
Priapism is a blood flow disorder, so it can be caused by conditions that affect the blood. Sickle-cell anemia is the most common cause, and it can also be caused by leukemia as well. Blood clots in the penis can also lead to ischemic priapism.
Many prescription drugs also have priapism as a possible side effect, such as erectile dysfunction drugs, psychoactive drugs, antidepressants, and blood thinners. Abuse of these drugs, or use of alcohol or illegal drugs, can also cause this condition.
Nonischemic priapism is often the result of an injury to the penis, abdomen, or perineum (the area between the penis and the anus) that allows blood to rush freely into the penis. A severe injury to the spinal cord can also cause nonischemic priapism by disrupting the body's ability to regulate blood flow in the lower body.
Diagnosis & Tests
While priapism is easy to diagnose, it's important that the doctor determine whether it is ischemic or nonischemic before recommending a treatment. This determination begins with a medical history, including the duration of the erection, previous occurrences, and possible injuries to the penis and surrounding area. The doctor will also examine the patient's penis, testicles, perineum, and abdomen for signs of injury.
If the doctor is unsure whether the priapism is ischemic or nonischemic, he or she may call for a blood gas test. This involves a small sample of blood being taken from the penis and analyzed for the gases dissolved in it. In the case of ischemic priapism, the blood will usually be dark red and deoxygenated, while nonischemic priapism usually yields bright red oxygenated blood.
An ultrasound of the penis also helps to determine how blood is flowing in the penis and whether there is any damage to the blood vessels inside the penis that might be disrupting the blood flow. The doctor may also call for a blood test with special focus on the number of white blood cells in order to determine whether a blood disorder such as sickle-cell or leukemia may be the cause. If drugs or alcohol are suspected as a cause, the doctor will request an urine toxicology screen in order to determine which drugs are in the patient's system and in what quantity.
Treatment & Therapy
If the priapism is nonischemic, treatment is much less urgent because there is less risk of damage to the penis. The doctor may recommend application of ice and pressure to slow the incoming blood flow and monitor the situation to see if the penis goes down by itself.
In severe cases, nonischemic priapism may need to be treated by surgery or embolization (a minimally invasive surgery in which a catheter is used to insert blocks into blood vessels to lessen the flow). Ischemic priapism requires immediate treatment to avoid damage. The first step is aspiration: anesthesia is applied to the penis and a needle is used to draw out trapped blood. A saline solution may also be injected to help wash out the blood vessels.
If this is not enough to cause the erection to go away, the next step is to inject a sympathomimetic drug such as phenylephrine. These drugs cause the incoming blood vessels to the penis to constrict, allowing the outgoing blood vessels a chance to drain. Since they affect the blood flow, these drugs may be risky to use with patients who have heart disease and/or high blood pressure. If all else fails, the patient may need surgery to install a shunt to let the excess blood drain from the penis.
Prevention & Prophylaxis
For recurrent cases, the patient may be given instructions on how to self-administer phenylephrine or other sympathomimetic drugs in order to reduce blood flow. A painful erection that is slow to go away is a sign to see a doctor, even if it does not persist long enough to qualify as priapism. It may be an indication of blood flow problems that could develop into priapism if they are left untreated.