Summary about Disease
Priapism is a prolonged, painful erection that is not associated with sexual stimulation or arousal. It can last for several hours or longer and is a medical emergency because it can cause permanent damage to the penis if not treated promptly. There are two main types: ischemic (low-flow) priapism, which is the more common and more serious type, and nonischemic (high-flow) priapism.
Symptoms
Prolonged erection lasting more than 4 hours
Pain in the penis
A rigid penile shaft, but the tip of the penis (glans) may be soft
Ischemic priapism symptoms can also include progressively intense pain.
Nonischemic priapism may present with a less rigid, non-fully erect penis, and little to no pain.
Causes
Priapism can be caused by:
Blood disorders: Sickle cell anemia, leukemia, thalassemia, multiple myeloma
Medications: Some antidepressants, blood thinners, medications for erectile dysfunction, certain antipsychotics, and recreational drugs like cocaine
Trauma: Injury to the penis or perineum
Spinal cord injury
Alcohol and drug abuse
Other medical conditions: Cancer, infections, metabolic disorders
Idiopathic: In some cases, the cause is unknown (idiopathic)
Medicine Used
Treatment for priapism depends on the type:
Ischemic Priapism:
Aspiration and irrigation: Removing blood from the penis with a needle and syringe, followed by irrigation with saline solution.
Alpha-adrenergic agonists: Medications like phenylephrine, injected directly into the penis to constrict blood vessels and reduce blood flow to the penis.
Surgery: If other treatments fail, surgery may be necessary to shunt blood flow.
Nonischemic Priapism:
May resolve on its own.
Observation and ice packs may be recommended.
Selective arterial embolization (blocking the artery causing the high flow) may be needed in some cases.
Is Communicable
No, priapism is not a communicable disease. It cannot be spread from person to person.
Precautions
Priapism is not something that can typically be prevented with general precautions, but the following can be considered:
If you have sickle cell anemia or another blood disorder, follow your doctor's recommendations for managing your condition.
Be aware of the potential side effects of medications you are taking, especially those known to cause priapism.
Avoid excessive alcohol and drug use.
Seek immediate medical attention if you experience a prolonged erection.
How long does an outbreak last?
Priapism is not an "outbreak" situation. It is a single event of prolonged erection. If untreated, it can persist indefinitely. However, prompt treatment is crucial to prevent permanent damage.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical exam: The doctor will ask about your symptoms, medications, and medical history.
Blood tests: To check for underlying blood disorders like sickle cell anemia.
Blood gas analysis: A sample of blood is taken from the penis to determine if it is low-flow (ischemic) or high-flow (nonischemic).
Doppler ultrasound: To assess blood flow in the penis.
Toxicology screen: To rule out drug use.
Timeline of Symptoms
The timeline is generally as follows:
Initial symptom: A persistent erection lasting longer than 4 hours and unrelated to sexual stimulation.
Progressive Pain (Ischemic): If ischemic, pain will progressively intensify as time passes.
Potential Complications: If not treated within 24-48 hours, permanent erectile dysfunction is highly likely.
Non-ischemic can present with minimal to no pain.
Important Considerations
Emergency: Priapism is a medical emergency. Seek immediate medical attention. The sooner treatment is started, the better the chance of preventing permanent damage.
Underlying Causes: It is important to identify and address the underlying cause of priapism to prevent future episodes.
Psychological Impact: Priapism can be a distressing experience. Mental health support may be beneficial.
Fertility: Prolonged ischemic priapism can lead to infertility.
Self-Treatment: Do not attempt to treat priapism yourself. It requires medical intervention.