Priapism (Ischemic & Nonischemic): Causes, Symptoms, Diagnosis, Treatment, Prevention

What Is Priapism?

Priapism is a medical condition in which there is unwanted and prolonged erection of penis, which is not due to sexual arousal. Priapism is a significantly painful condition. It is quite a rare condition, but requires immediate medical attention because if this condition is not promptly treated then it may lead to tissue damage causing ultimately erectile dysfunction. This condition is quite common in boys from ages 5 to 10 and 20 to 45 in adults.

What Is Priapism?

What Are The Causes Of Priapism?

To understand Priapism, it is important to understand how an erection takes place in normal circumstances. Normally, because of physical or psychological stimulation some blood vessels contract and expand which results in increased blood flow to the penis making it tight and erect. Once the stimulation is no longer present the blood flows out of the penis and it returns to its normal docile state. In Priapism, because of some abnormality in the blood vessels or nerves, the routine blood flow to the penis changes resulting in abnormally prolonged erections without any stimulation. Some of the causes of Priapism are:

Priapism Caused Due To Blood Related Disorders: Certain disorders of the blood may lead to Priapism, normally ischemic form of Priapism in which the blood is unable to flow out of the penis. One main blood disorder causing Priapism is Sickle Cell Anemia, which is the most common cause of Priapism in boys and young adults. This condition is congenital in which the RBCs are abnormally shaped which block the normal flow of blood resulting in anemia.

Prescription Medications That Can Cause Priapism: Another cause of Priapism can be certain classes of medications like Viagra, Cialis, and Levitra which are usually given for erectile dysfunction. Drugs that are injected directly to the penis to treat erectile dysfunction can also cause Priapism. Certain antidepressants like Prozac and Wellbutrin also tend to cause Priapism. Certain antipsychotics like Zyprexa and Risperdal also has the potential to cause Priapism.

Priapism Caused Due To Alcohol and Drug Abuse: Alcoholics and drug abusers are at an increased risk for developing Priapism.

Injury: Any type of injury or trauma to the genital area or the testicular area can also cause Priapism.

Some of the other known causes of Priapism are:

Types And Symptoms Of Priapism

The symptoms of Priapism depend on the type of Priapism the patient is experiencing. There are basically two main types of Priapism, one is ischemic Priapism and the other is nonischemic Priapism.

Ischemic Priapism: This is a type of Priapism in which the blood is not able to move out of the penis. This is the most common type of Priapism. The symptoms of ischemic Priapism are:

  • Unstimulated erection for more than four hours
  • Waxing and waning erections without any stimulation
  • Rigid penile shaft with soft glans
  • Pain and tenderness in the penis.

Nonischemic Priapism: This is a type of Priapism in which there is excessive blood flow to the penis causing prolonged erection. The symptoms of nonischemic Priapism are:

  • Unstimulated erection for more than four hours
  • Erect but flaccid penile shaft.

How Is Priapism Diagnosed?

If an individual experiences an unstimulated erection which lasts for greater than four hours then the individual needs to seek immediate medical attention. The treating physician will first determine whether the individual has an ischemic or a nonischemic form of Priapism. It is required as the treatment for both forms of Priapism is different and this condition requires immediate treatment.

In order to find out what type of Priapism an individual has, the physician will first take a detailed history and conduct a physical examination of the genital area. The physician will also conduct an abdominal examination and an examination of the groin areas. The type of Priapism may be determined depending on the rigidity and the stiffness observed in the penile shaft. Examination may also reveal any type of injury that may be causing Priapism.

Diagnostic Tests: The next step is to conduct diagnostic studies in order to determine the type of Priapism an individual has. The treatment will begin once all the test results have been achieved and the type of Priapism determined.

The diagnostic studies which are done include the following:

Measuring Blood Gasses: In this test, a small amount of blood is removed from the penis. If the blood removed is dark in color this will signify lack of oxygen in the blood obtained confirming ischemic Priapism. If the blood obtained is bright red in color, then more likely than not it is a case of nonischemic Priapism.

Blood Tests: Blood tests will be conducted to measure the RBC and platelet count, which may help identifying diseases like sickle cell anemia or other blood disorders which cause Priapism.

Ultrasound: An ultrasound may also be performed to look at the blood flow to the penis to determine the type of Priapism an individual has. An ultrasound may also reveal any type of injury to the penile area causing Priapism.

Toxicology Screening: This may done to find out of the individual has been consuming any illegal drugs or has been abusing alcohol which can cause Priapism.

What Are The Treatments For Priapism?

The treatment for Priapism depends on the type of Priapism the individual is suffering from.

Treatment For Ischemic Priapism: Ischemic Priapism is a medical emergency and immediate treatment is required to treat this condition. Since this condition is caused due to blood not being to move out of the penis, the frontline treatment is to drain the blood out of the penis and then giving medications. The best way to drain blood put of the penis is by aspiration. In this method, the penis is made numb with local anesthesia and then a needle is inserted into the penis and excess blood is drained out from the penis. The veins are then flushed with saline solution. This instantly relieves the pain and discomfort and the erection is resolved. Post drainage a medication called as phenylephrine is given which results in constriction of the blood vessels carrying blood to the penis, thus allowing the blood vessels that carry blood out of the penis to open up thus facilitating smooth flow of blood out of the penis. There may be some side effects of hypertension, dizziness, or headache, especially if the individual has already some cardiac condition.

Surgical options are considered if noninvasive treatments do not prove successful. The procedure involves implanting a device which facilitates smooth movement of the blood out of the penis.

In case if an individual has sickle cell anemia as a cause of Priapism, then the individual may be treated for that condition.

Treatment For Nonischemic Priapism: This type of Priapism usually does not require any treatment and physicians usually follow the condition with close observation as there is no risk of damage to the penis due to this type of Priapism. The physician may suggest application of ice to the affected region to reduce pain and end the erection.

In some cases, a surgical method to block the flow of blood to the penis may be required as a form of treatment for Priapism.

What Are The Ways To Prevent Priapism?

Depending on the cause, certain steps can be taken to prevent Priapism from occurring. These steps are:

  • Prompt treatment of the disease that may cause this condition
  • If medication is found to be the cause of Priapism then changing the medication
  • Abstaining from alcohol and drugs 
  • Injection of phenylephrine in order to stop sustained erections.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:January 24, 2019

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