Priapism: Symptoms, Causes, Treatment

What are the symptoms of priapism?

Priapism is a condition characterized by a prolonged and often painful erection that persists beyond or is unrelated to sexual stimulation. The symptoms include:

• Prolonged Erection: An erection lasting longer than four hours without sexual arousal or stimulation.
• Pain: Discomfort or pain in the penile area, which may vary in intensity.
• Penile Rigidity: The penis may be hard and erect throughout its length, but the glans (head) may be softer.
• Swelling: There may be noticeable swelling of the penis, though this is less common.
• Discoloration: In some cases, the penis may appear darker in color due to changes in blood flow.

Priapism is a medical emergency that requires prompt treatment to prevent complications and potential long-term damage.

What are the causes of priapism?

Priapism can arise from various causes, which are typically categorized into two main types: ischemic (low-flow) and non-ischemic (high-flow) priapism.

Ischemic Priapism: This type is more common and occurs due to impaired blood flow out of the penis. Causes include:

• Blood Disorders: Conditions such as sickle cell disease, leukemia, or thalassemia can lead to priapism due to abnormal blood flow.
• Medications: Certain drugs, including some antidepressants, antipsychotics, and medications used for erectile dysfunction (e.g., alprostadil), can cause priapism as a side effect.
• Substance Abuse: Alcohol or recreational drug use, particularly cocaine, can be a factor.
• Trauma: Injury to the genital area or pelvic region can disrupt normal blood flow.
• Neurological Conditions: Disorders affecting nerve function, like spinal cord injury or multiple sclerosis, can lead to priapism.

Non-Ischemic Priapism: This type involves excessive blood flow into the penis and is less common. Causes include:

• Arterial Injury: Trauma leading to the rupture of an artery supplying the penis can cause increased blood flow.
• Penile Injury: Injury to the penile tissues, often during sexual activity or trauma, can result in non-ischemic priapism.

In some cases, no specific cause is identified, and the condition is termed “idiopathic.” Regardless of the cause, priapism is a medical emergency that requires prompt evaluation and treatment to prevent complications.

What is the treatment for priapism?

The treatment for priapism depends on the type and underlying cause of the condition:

Ischemic Priapism:

• Medications: Initial treatment often involves medications such as alpha-adrenergic agonists (e.g., phenylephrine) to constrict blood vessels and help reduce the prolonged erection.
• Ice Packs: Applying ice packs to the area can help reduce swelling and discomfort.
• Aspiration: In some cases, a healthcare provider may use a needle and syringe to withdraw blood from the penis to relieve pressure and restore normal blood flow.
• Surgical Intervention: If other treatments fail, surgical options such as creating a shunt to facilitate blood drainage from the penis may be considered.

Non-Ischemic Priapism:

• Observation: In cases where the priapism is not causing significant pain or damage, doctors may opt to monitor the condition over time as non-ischemic priapism often resolves on its own.
• Arterial Embolization: If necessary, a procedure to block the abnormal arterial blood flow to the penis (arterial embolization) can be performed by an interventional radiologist.

General Management:

• Addressing Underlying Conditions: Treating any underlying causes or contributing factors, such as adjusting medications or managing blood disorders, is crucial.
• Pain Management: Analgesics or other pain relief measures may be used to manage discomfort.

Priapism is a medical emergency, and prompt evaluation and treatment are essential to prevent complications such as erectile dysfunction or tissue damage.