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What is Priapism?

If you’ve ever read the side effects of erectile dysfunction drugs or seen an advertisement for one, you’ve likely encountered the warning to seek medical attention for any erection lasting more than four hours. This condition is called priapism, and it’s a rare but serious side effect that can occur when taking erectile dysfunction medication.

Priapism gets its name from the Greek fertility god Priapus, who is portrayed in art and sculpture as having a large, permanently erect penis. In actuality, a permanent erection would be anything but enjoyable. Priapism can cause extreme pain and, in some cases, permanent damage.

Priapism is defined as a persistent or recurring erection that is not caused by sexual stimulation. It can happen in one of two ways: ischemic and nonischemic priapism. An ischemic priapism, also called low-flow, occurs when blood in the penis does not drain properly back into the body. This is usually caused by a blocked or damaged vein. Nonischemic or high-flow priapism happens when too much blood flows into the penis. Of the two, ischemic priapisms are more common and also more serious.

Despite its link to erectile dysfunction medicine, priapism can and does sometimes on its own. It is caused by a vascular problem, so any condition that may affect blood flow to the penis could be responsible for priapism. Children and adults can both experience priapism as a result of blood disorders like sickle cell anemia, leukemia, tumors, high blood pressure, trauma among other conditions.

Symptoms and Indications of Priapism

Priapism presents somewhat differently between patients, and the symptoms can vary depending on the root cause of the priapism. The priapism signs to look out for include:

• An unwanted erection that recurs frequently for several hours without sexual stimulation
• An erection that will not go away after sexual activity has ended
• A persistent erection that lasts for several hours
• A penis with a rigid shaft but soft glans
• A penis that is erect but not firm and rigid
• Pain or tenderness in the penis
• Discoloration, usually red or purple, of the penis

Any or all of these symptoms may be present during priapism. Regardless of the presence of other symptoms, any persistent erection is considered a priapism and should be treated as a medical emergency. This means that you should still see a doctor even if you are not currently experiencing pain as the priapism itself may cause damage to the penile and vascular tissue if not treated.

Why Is Priapism a Medical Emergency?

In general, the persistent erection experienced with priapism is caused by poor circulation: Either too much blood pumps into the penis, or blood does not flow away from the penis and back to the rest of your body. In either case, blood can become trapped within your erectile tissue.

Blood is pumped away from your heart through arteries and returns to the heart through your veins. One of the purposes of blood is to transport oxygen throughout the body to nourish your cells and tissue. If blood becomes trapped in a vein, it will not return to circulate through your body, and it will not be properly oxygenated. This means that your tissue will be deprived of oxygen, essentially suffocating your cells.

This in turn may result in tissue damage. This could cause future difficulties with achieving or sustaining an erection. In severe cases, it could also result in disfigurement or even gangrene of the penis. Most cases of priapism are treated before they get to this point, but early treatment is important to prevent future complications. Even a non-painful priapism can make you more likely to have a more severe or painful priapism in the future if there is no medical intervention taken to prevent this from occurring.

What Causes Priapism?

Normally, an erection is caused by physical or psychological stimulation of the penis. When stimulated, your body is prompted to modify the flow of blood, contracting some blood vessels while opening others. This increased blood supply flows into the penis, which is made of spongy tissue. As this tissue fills with blood, it expands and becomes rigid, creating an erection.

After sexual activity, or if stimulation stops, the blood vessels will return to their normal state. Blood will flow back out of the penis tissue, causing it to become flaccid.

In priapism, this process is disrupted. A vascular issue may cause blood vessels to expand without stimulation, leading to an unwanted erection. These vessels may then stay expanded, keeping blood in the penis rather than allowing it to drain. Alternatively, the blood vessels may expand and contract at intervals without stimulation, resulting in intermittent erections. This condition is called stuttering priapism.

There are several priapsim causes:

• Blood disorders, like sickle cell anemia and leukemia. In these conditions, blood cells can be present in strange sizes, shapes or number. This can lead to blood vessels becoming blocked, inhibiting the flow of blood to and from the penis.
• Erectile dysfunction drugs like Levitra, Cialis and Viagra. These drugs work by stimulating blood flow to the penis, but they can sometimes work too well, creating a persistent erection.
• Other prescription drugs, including some antidepressants and blood thinners, which can also affect your circulation and create various circulatory problems including priapism.
• Drug use, particularly cocaine.
• Excessive alcohol intake.
• Injury or trauma to the penis. This can rupture blood vessels and damage your circulation.
• Other injuries, including spinal injury and blood clots throughout the body.

Priapism is first and foremost a vascular condition, so anything that might cause a disruption in proper circulation could result in priapism. Priapism can also occur spontaneously, and all of the causes of priapism are currently unknown. Therefore, the above should be considered as a set of risk factors rather than a definitive list of all priapism causes.

How Does Priapism Treatment Work?

If you have experienced stutter priapism, where erections recur frequently without stimulation over the course of several hours, or a non-painful erection lasting fewer than four hours, you should make an appointment with your primary care doctor to discuss the issue. If you experience an erection lasting more than four hours, you should seek emergency medical care as this type of prolonged erection can cause immediate damage to your vascular tissue.

The type of priapism treatment you receive will depend on several factors, including the type of priapism you’re experiencing and the severity of the symptoms. When you go to the doctor, you will be asked some questions about your medical history, medications that you take and any risk factors that may be contributing to the priapism. If you have ever experienced priapism before, whether or not you sought treatment for it at the time, be sure to mention this. A history of priapism is a risk factor for future recurrences of the problem.

When assessing your priapism symptoms, your doctor will also attempt to identify whether the priapism is ischemic or nonischemic. Nonischemic priapism does not always require medical intervention, and a “wait and see” approach may be prescribed in these cases. This is especially true if this is only the first time you’ve experienced a nonischemic priapism. If you have a more chronic or frequently occurring problem with nonischemic priapism, a more aggressive treatment is necessary.

The doctor may be able to diagnose the priapism through a medical examination alone, or blood work may be required to pinpoint the exact cause of the priapism. Some of the tests that can be completed to identify priapism causes include a blood gas measurement, where a tiny needle is inserted into the penis to test a blood sample for oxygen concentration, or an ultrasound of the penis to check for vascular injuries.

Once the cause of the priapism is discovered, treatment can begin. In ischemic priapism, where blood is trapped in the penis, the first treatment is aspiration. This allows the doctor to drain blood from the penis and flush the blood vessels, removing the poorly-oxygenated blood and allowing healthy circulation to resume.

Medication may be prescribed to help prevent the priapism from recurring. These drugs, called alpha-adrenergic sympathomimetics, are injected directly into the penis and work by constricting the blood vessels in that area. Be aware that these drugs can cause high blood pressure, so be sure to mention to your doctor if you are taking medication for that disorder or have a history of hypertension.

In some cases, surgical intervention is necessary to treat priapism or prevent future problems from occurring. Surgery is usually necessary only when a person has a recurring history of priapism or when the vascular structure of the penis is damaged and unable to work correctly. In these situations, a shunt can be surgically inserted into the penis to improve circulation. This may be the best priapism treatment for people with recurring nonischemic priapism.

Preventing Priapism

Priapism prevention is dependent on the root cause of the issue. For people with blood or clotting disorders, treatment of these underlying issues will usually also resolve priapism. Other forms of prevention may include changing medications, avoiding excessive alcohol or drug use, taking certain hormone-blocking medications or in some cases self-administering injections of phenylephrine.

You should discuss priapism prevention methods with your doctor. Since priapism can have so many causes, understanding the root cause of your specific issue is vital to protecting your longterm health and preventing future priapism from occurring. If you experience priapism after taking an erectile dysfunction drug, speak with your doctor: You may be able to obtain a prescription for a different drug that can still work for you to relieve performance issues without causing priapism.


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