Priapism, or persistent erection, is a condition in which blood is unable to flow out of the penis, causing pain and an erection lasting more than four hours. It can occur even without sexual arousal.
Priapism is a condition that can occur in men of all ages, especially those between the ages of 5–10 and 20–50. The symptoms that occur require urgent treatment because if left untreated, it can lead to other serious complications, such as erectile dysfunction.
Symptoms of Priapism
Priapism is divided into two types:
- Ischemic priapism
is the most common form. Blood cannot flow out of the penis, making it irreversible. The erection may last longer than 4 hours or be unrelated to sexual response. The penis is hard and the tip is tender. The pain may increase over time. Ischemic priapism also has a subtype called stuttering priapism. Symptoms may start with a short, painful involuntary erection. Symptoms may gradually increase. It is more common in people with sickle cell disease ( SCD), in which red blood cells block blood vessels in the penis and cause blood clots. - Nonischemic priapism
is a rare form in which there is a large amount of blood flow into the penis, but patients usually do not experience pain because the condition does not usually cause ischemia, and therefore there is no subsequent tissue death.
If you find that you have an erection that lasts for more than 4 hours, you should see a doctor immediately because it is a condition that should be treated urgently. In cases where the painful erection occurs repeatedly or frequently and disappears on its own, you should see a doctor for treatment and to prevent abnormalities that may occur in the future.
Causes of Priapism
Priapism occurs when some of the internal systems of the penis malfunction, such as the circulatory system, muscles, or nerves. This results in a change in the amount of blood flowing into the penis, but the penis can still be erect. Abnormalities in the penis can occur from the following causes:
Blood disease or blood cell disorder
Priapism can be associated with blood disorders or blood cell disorders, such as sickle cell disease, leukemia, thalassemia, or multiple myeloma. However, most patients who experience penile priapism have sickle cell disease, as the blood cells affect the blood flow out of the penis.
Drug use
Priapism can be a side effect of certain medications or incorrect use of medications, such as:
- The use of drugs that are injected directly into the penis to treat erectile dysfunction, such as sildenafil, alprostadil, papaverine, or phentolamine.
- Medications for treating ADHD, depression, anxiety, or psychiatric disorders
- Alpha Blocker Drug Group
- Medicines that help with blood circulation
- Taking hormones
In addition, priapism can result from other causes such as alcohol consumption, drug abuse, injury or cancer in the pelvic, penis, groin and buttocks area, neurological disorders due to spinal injuries, syphilis or metabolic disorders, animal bites, etc.
Diagnosis of Priapism
Because priapism requires emergency medical treatment, patients should inform their doctor about their medical history and any unusual symptoms, such as abnormal erection duration, normal erection duration, use of drugs or narcotics, especially marijuana and cocaine, or symptoms that occur after an injury to the area. The doctor will use this information to diagnose along with the medical history and physical examination.
In addition, the doctor may also perform other tests, such as:
- Blood Gas Measurement is a laboratory test that helps determine the pattern of priapism, the duration of symptoms, or the severity of symptoms. Blood is taken from the penis and tested in a laboratory for blood gas levels.
- Blood teststo count red blood cells and platelets, which helps doctors diagnose or detect symptoms of blood diseases.
- Ultrasound (Doppler Ultrasonography) uses high-frequency sound waves to examine the blood flow characteristics in the penis, which helps identify the type of priapism, abnormalities or injuries that may be causing priapism.
- Toxicology Test: A urine test to detect drugs that may cause abnormal erectile dysfunction.
Treatment of Priapism
If a patient has Nonischemic Priapism, the symptoms that occur often go away on their own without treatment because it is a symptom that does not cause damage to the penis. However, the doctor will have the patient observe the symptoms and relieve symptoms by applying ice or other methods to reduce swelling. In addition, some cases may be treated with surgery. The doctor may perform surgery to insert an absorbable device to block blood flow to the penis. In some cases, surgery may be used to repair blood vessels or tissues that have been damaged due to injury.
In the case of Ischemic Priapism, it is a condition that requires immediate treatment. Doctors treat patients in the following ways:
Blood Drainage
The doctor will use a local anesthetic before using a small needle to drain excess blood until the clotting goes away. This treatment can reduce pain, drain low-oxygen blood, and help relieve the clotting.
Drug use
Doctors will use medication in conjunction with blood drainage. This is a sympathetic nervous system stimulant, such as phenylephrine, which is injected into the penis to help increase blood flow from the penis. Doctors will also monitor for possible side effects from the medication, such as headaches, dizziness, and high blood pressure, especially in patients with high blood pressure and heart disease.
Complications of Priapism
Priapism can cause serious complications if deoxygenated blood remains in the penis for an extended period of time, which can damage the penile tissue and lead to erectile dysfunction.
Prevention of Priapism
Some types of priapism can be prevented by treating the underlying medical conditions that may be causing the disorder. If you are taking a medication that has side effects that can cause priapism, talk to your doctor or pharmacist about changing your medication. You should never change or stop taking your medication on your own.
