IASH India: Institute of Andrology & Sexual Health India
What is Priapism? Symptoms, Causes & Treatment

What is Priapism?

Priapism is a condition that causes persistent and painful erections sometimes. This occurs when an erection persists for at least four hours without any sexual stimulation. Although this may seem like a great opportunity for some men, it may be a very uncomfortable and unpleasant condition, and in extreme circumstances, it might cause irreversible penile injury.

Multiple reasons distinguish priapism from a typical erection:

  1. It is not often accompanied by sexual desire or excitement.
  2. It is often far more painful and long-lasting than a typical erection. The erections usually last for four or more hours.
  3. It may develop in men of any age 30 or over. However, any male gets it from childhood if they have sickle cell disease. 

Priapism Types

1. Ischemic priapism

Ischemic priapism, also known as low-flow priapism, occurs when blood cannot escape the penis. Blood cannot exit the penile’s veins, or there is difficulty with relaxing smooth muscles inside the penis’ erectile tissue. Further, it is the most prevalent kind, and it needs prompt medical attention to avoid problems caused by insufficient oxygen towards the penile tissue.

2. Nonischemic priapism

Nonischemic priapism, sometimes called high-flow priapism, happens when blood flowing through the penis’s arteries is impaired. However, blood flow and oxygen keep reaching the penile tissues, and trauma often causes this condition.

Priapism Symptoms

The symptoms of priapism vary depending upon whether you have high flow or low flow priapism. Have a look at the symptoms of both High flow and Low flow:

The symptoms of Ischemic priapism include:

  • Erection that lasts longer than four hours or is unconnected to sexual attraction or stimulation.
  • The penile shaft is rigorous. However, the penis tip (glans) is tender.
  • Increasingly severe penile pain

Stuttering priapism, also known as recurrent or intermittent priapism, is ischemic priapism. A rare condition, stuttering is characterised by repeated occurrences of long-lasting erections and frequently involves ischemic priapism. 

An inherited condition characterised by abnormal red blood cells is more prevalent in males (sickle cell disease). Sickle cells can obstruct penis blood vessels. In some instances, erectile dysfunction begins with painful, short-lasting erections and may grow into more frequent and more prolonged erections. The possible onset of stuttering priapism is in childhood.

The symptoms of Nonischemic priapism include:

  • Erection that lasts longer than four hours or is unconnected to sexual attraction or stimulation.
  • Not a completely rigid penile shaft
  • Normally not painful

What Causes Priapism?

Normal penile erections trigger by a physical or physiological stimulus. Increased blood flow towards the penile region induces an erection. Once the stimulus ceases, blood flow decreases, and the erection subsides.

However, if a man encounters prolonged erections, there seems to be an issue with the blood flow to the penis. Several conditions might affect the blood flow to and out of the penis, and some of these may include:

  • Certain drugs may impact nerves throughout the body, including those in the penis. Typically, these neurons dilate the arteries supplying the penis, causing it to swell and then become upright.
  • Injuries to the penile artery or perineum will prevent blood from flowing or draining. Further, this is a frequent reason for nonischemic priapism.
  • Abnormally appearing red blood cells may induce by blocking the penile artery called a sickle cell. Around 42 per cent of people with sickle-cell anaemia will ultimately develop this condition. 
  • Rarely, priapism may be due to malignant growths, particularly if they obstruct the penile arteries or nerve supplies and cause blockages.
  • Occasionally, some blood problems might induce priapism. Notably, chronic leukaemia, thalassemia,  and multiple myeloma have been linked.
  • Common causes of nonischemic priapism include trauma or damage penis, pelvis, or area between the genitals and the anus (perineum).

Other factors that may contribute to priapism causes include:

  • Infections caused by spider bites, scorpion stings and other toxins
  • Metabolic illnesses are gout and amyloidosis.
  • Neurogenic diseases, including spinal cord injuries and syphilis
  • Penis-afflicted malignancies

How is Priapism Diagnosed?

If your erection lasts longer than four hours, you require immediate medical attention.

The doctor will decide whether you have ischemic or nonischemic priapism. So this is crucial since each condition’s management and treatment approach is distinct, and ischemic priapism requires immediate medical attention. 

Medical History & Examination

Your physician will question you about your medical history and check your genitalia, belly, groin, and perineum to diagnose the kind you have. Further, your doctor may be able to diagnose the sort of you have, depending on whether or not you experience discomfort and penis stiffness. Additionally, this examination might potentially detect a malignancy or symptoms of damage.

Diagnostic Testing

Diagnostic testing may be required to ascertain the sort of priapism you have. It may be possible to establish the cause by further testing. Treatment will generally begin before receiving all findings in an emergency department situation.

  • Penile blood gas analysis: A small needle is injected into the penis to get a blood sample. If the blood is dark – devoid of oxygen — ischemic priapism is the most probable diagnosis. If it is brilliant red, it is probably nonischemic.
  • Blood test: The doctor will draw a blood specimen to determine the red blood cell and platelet count. So the results might indicate the presence of illnesses like sickle cell anemia, other blood abnormalities, or certain malignancies.
  • Ultrasound: You may undergo a Doppler ultrasonography. So this is a non-invasive technique that assesses blood flow via blood arteries. So this test measures blood flow inside the penis, which might indicate ischemic or nonischemic priapism. In addition, the examination may identify an injury or anomaly that may be the underlying cause.
  • Toxicology analysis: Your physician may arrange a urine and blood test to check for medicines that might be causing it.

Priapism Treatment Options

Treating Ischemic Priapism

The treatment often starts with a mix of penile drainage and drug administration.

1. Aspiration decompression

So in this process, your doctor would drain excess blood utilizing a tiny needle and syringe. Further, the doctor may flush your penis with saline solution. This therapy often alleviates discomfort, eliminates oxygen-depleted blood, and may forestall an erection. Moreover, this procedure may repeat until the erection is no longer present.

2. Medication

The doctor may inject medication phenylephrine into the penis. So this medication constricts the blood arteries that supply the penis with blood. Further, this movement causes the blood arteries that transport blood away from the penis to dilate, boosting blood flow away from the penis. If necessary, the doctor may repeat this process. 

However, the doctor will constantly monitor you when conducting this process. They will check some side effects, including headache, vertigo, and blood pressure, especially if you have hypertension or heart problems.

3. Surgical or alternative techniques

A surgeon may undertake further operations to drain blood from the penis or redirect blood circulation if earlier therapies fail. 

If you have sickle cell disease, there would be further treatment for the illness-related problems.

Treating Nonischemic Priapism 

Most cases of nonischemic priapism resolve without treatment. The application of cold packs and strain to the perineum — the area between the penis’s bottom and the anus — may assist in weakening an erection.

In some instances, surgery may be essential to put material, including an absorbable gel, that intermittently obstructs blood flow to the penis. Further, your body will eventually soak up the substance. Injuries may also necessitate surgery to fix arteries or damaged tissues.

Priapism Treatment At Home

  • Apply a cold compress or ice pack to the affected region for approximately 10 to 20 minutes. Place a small towel over your skin and the ice.
  • Urinate frequently. Do not wait till the necessity arises.
  • Avoid taking medication that may have contributed to the uncomfortable erection.

Final Say

With prompt treatment, the outlook for priapism is favourable. Nevertheless, if you delay the treatment hoping that the condition will resolve, irreparable harm to the penis might occur. 

In case you experience such conditions or any other men’s sexual health-related condition, the specialists at IASH will help you overcome your concerns. Dr Chirag Bhandari, the best andrologist and sexologist in Jaipur has over eight years of experience in addressing concerns like premature ejaculation, erectile dysfunctionpenile disorderinfertility, Retrograde Ejaculation, varicocele, nightfall problem and other male sexual condition. 

You can book an appointment to consult with him regarding any health condition. 

Frequently Asked Questions

Q1. What causes priapism?

If a man encounters prolonged erections or priapism, there seems to be an issue with the blood flow to the penis. Several conditions might affect the blood flow to and out of the penis. These may include medications, penile injuries, sickle cell anaemia, and other blood-related disorders.

Q2. How do you get rid of priapism?

In the case of Ischemic Priapism, the doctor either may drain excess blood or inject any other medication to the penis. Or else ice packs could also work in case of nonischemic.

Q3. Can priapism be Caused by Viagra?

Viagra has never caused prolonged erection by itself; it can only happen if you take penile injection therapy. Penile injection therapy makes your erection hard, and combining viagra with it makes the erection more hard and long-lasting. So, it is advised don’t pair them for the safe side.

Q4. Can priapism go away on its own?

If you have high-flow priapism, treatment may not be essential right away, and this form of priapism usually disappears on its own. Before prescribing a therapy, your doctor may examine your situation. A spontaneous erection may be treated with cold treatment and ice packs.

Q5. Is priapism always painful?

Non-ischemic is characterized by nonsexual erections that are painless, prolonged, and partly stiff. Excessive blood flow from capillaries into the corpora cavernosa causes it.

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