Priapism


Priapism

Description, Causes and Risk Factors:

Persistent erection of the penis, accompanied by pain and tenderness, resulting from a pathologic condition rather than sexual desire; a term loosely used as a synonym for satyriasis.

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

An erection normally occurs in response to physical or psychological stimulation. This stimulation causes certain blood vessels to relax and expand, increasing blood flow to spongy tissues in the penis. Consequently, the blood-filled penis becomes erect.

After stimulation ends, the blood flows out, and the penis returns to its nonrigid (flaccid) state.

Priapism occurs when some part of this system — the blood, blood vessels or nerves — changes normal blood flow. Subsequently, an unwanted erection persists. Factors that can contribute to priapism include the following: It can occur in all age groups, including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years.

There are two categories of priapism: low-flow and high-flow.

    Low-flow: This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.

  • High-flow: High-flow priapism is more rare than low-flow and usually not painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.

Risk Factors:

    Trauma to the spinal cord or to the genital area.

  • Black widow spider bites.

  • Carbon monoxide poisoning.

  • Illicit drug use, such as marijuana and cocaine.

Symptoms:

Signs and symptoms include:

    Unwanted erection lasting more than four hours.

  • Rigid penile shaft, but usually soft tip of penis (glans).

  • Erection not related to sexual stimulation or persistent after stimulation.

  • Usually painful or tender penis.

Diagnosis:

If you experience priapism, it is important that you seek medical care immediately. Tell your doctor:

    The length of time you have had the erection.

  • How long your erection usually lasts.

  • Any medication or drugs, legal or illegal, which you have used. Be honest with your doctor - illegal drug use is particularly relevant since both marijuana and cocaine have been linked to priapism.

  • Whether or not priapism followed trauma to that area of the body.

Your doctor will review your medical history and perform a physical examination to help determine the cause of priapism.

After the physical exam is complete, the doctor will take a blood-gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, some of the blood is drawn and then it is sent to a lab for analysis. This provides a clue to the type of priapism, how long the condition has been present, and how much damage has occurred.

Other Tests:

    Blood gas measurement. In this test, a tiny needle is inserted into your penis to remove a sample of blood. If the blood is dark — deprived of oxygen — the condition is most likely ischemic priapism. If it's bright red, the priapism is most likely nonischemic. A laboratory test measuring the amounts of certain gases in the blood can confirm the type of priapism.

  • Blood tests. Your blood can be tested to measure the amount of red blood cells and platelets present. Results may provide evidence of diseases, such as sickle cell anemia, other blood disorders or certain cancers.

  • Ultrasound. You may have a color duplex ultrasonography, which uses sound waves to create an image of internal organs. This test can be used to measure blood flow within your penis that would suggest ischemic or nonischemic priapism. The exam may also reveal an injury, tumor or abnormality that may be an underlying cause.

  • Toxicology test. Your doctor may order a toxicology test to screen for illegal or prescription drugs that may be the cause of priapism. This may be done with blood or urine samples.

Treatment:

The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decrease blood flow to the penis, may be very helpful. Other treatment options include:

    Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

  • Ice packs: Ice applied to the penis and perineum may reduce swelling.

  • Surgical ligation: Used in some cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.

  • Intracavernous injection: Used for low-flow priapism. During this treatment, drugs known as alpha-agonists are injected into the penis that cause the veins to narrow, reducing blood flow to the penis and causing the swelling to subside.

  • Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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