Priapism | Erectile Dysfunction

Priapism is a highly discomforting and painful form of erectile dysfunction (ED Help Learn More) that is associated with moderately agonizing episodes of erection without the involvement of sexual stimulations(Female Stimulants Learn More).

The episodes can last over a couple of hours and can result in serious damage, including permanent erectile dysfunction if left untreated.

The global prevalence of priapism is 1.1 cases per 100,000 of population (1)

Notable Causes of Priapism

Priapism can occur due to several reasons such as

– Accidental trauma (Trauma & ED Learn More) to pelvic region

– Drug abuse (Drugs & ED Learn More) e.g. cocaine and heroin

– Toxic poisoning

– Excessive use or abuse of certain anti-depressants

– Diseases that are associated with hypoxia-ischemia conditions like sickle cell anemia

– Black widow spider bite

– Exposure to excessive carbon monoxide

Pathophysiology of Priapism

Generally priapism can be classified in two broad categories on the basis of pathogenesis

– Prolong painful erection (Priapism Treatment Learn More) resulting from inadequate blood flow

Priapism resulting from low blood flow is characteristic of certain cardiovascular issues (Cardiovascular & ED Learn More) such as hypotension, anemia and over use of drugs acting on the central nervous system. Also aging and atrial vessel blocking may cause or aggravate priapism

– Discomforting pain and elongation of penile tissue due to excessive blood flow.

In certain vascular disparities when the flow of blood is unnecessarily high, penile erection may result with/ without sexual stimulation. Most common causes include, high blood pressure, the risk of vessel being damaged or ruptured blood vessel.

Differentiate Priapism From Normal Penile Erection

Priapism should be suspected if

– You are experiencing erections that are not related to the sexual stimulation

– The erections are painful and discomforting

– The erections last over a few hours

– If you have a history of drug abuse

– If you have a recent history of accidents or trauma along your pelvic/ inguinal region

– Previous history of any medical or vascular illness that is associated with hypoxic states.

How to Manage Priapism

The treatment focuses on preservation of male genital and countering swelling along with restoration of normal blood flow to the penile region (2).

– IV Alpha agonists: Alpha agonists are given intravenously as a vessel constricting agent to reduce pressure from any swelling which is likely to occur. This treatment is used mostly when blood flow towards the penis is low.

– Icing: Using ice packs is an efficient remedy to control swelling; this can also be done at home and is effective because it does not need any supervision. Also at the same time it provides quick remedy for pain and swelling.

– Blood aspiration: This technique is used mainly in case of emergencies and it is also invasive in nature (that’s why should not be attempted at home). The physician will insert a needle to draw blood from the penis, which results in reduction of pressure and ease of blood flow at the same time (in case of any blockage).

– Shunt insertion: A shunt is placed in the penis to facilitate the blood flow through an alternative path. This also helps the otherwise altered circulation to resume the flushing of muscles with oxygenated blood to prevent ischemic injury.

– Ligation surgeries: This surgical method of intervention involves knotting of vessels that are ruptured to ensure smooth blood flow through the vessel sinuses. This method is used when atrial damage is comparatively less and can be used for emergency treatments.

Priapism & Erectile Dysfunction

It has been observed that prolonged priapism can lead to permanent damage to penile machinery leading to permanent ED as a result of fibrosis. Priapism lasting for more than 48 hours (3) is a recognized risk factor for impotency.

If you are experiencing priapism, do not delay in seeking emergent and immediate medical care to prevent irreversible damage to male copulating organ.

References

O’Brien, K., Gross, M., & Munarriz, R. (2013). Priapism. In Urological Emergencies (pp. 195-206). Humana Press.
Nixon, R. G., O’CONNOR, J. L., & Milam, D. F. (2003). Efficacy of Shunt Surgert for Refractory Low Flow Priapism: A Report on the Incidence of Failed Detumescence and Erectile Dysfunction. The Journal of urology, 170(3), 883-886.
El‐Bahnasawy, M. S., Dawood, A., & Farouk, A. (2002). Low‐flow priapism: risk factors for erectile dysfunction. BJU international, 89(3), 285-290.