Priapism

Description of the disease

Priapism is described as a prolonged painful erection that is not related to sexual arousal or stimulation. This condition requires urgent medical attention, as it can lead to certain tissue damage, which can later result in erectile dysfunction (inability to achieve or maintain an erection).

This condition most commonly occurs in young boys (aged 5 to 10 years) and middle-aged men.

Cause of the disease

Normally, an erection occurs during sexual arousal. At that time, the penile blood vessels dilate and fill with blood, causing it to become erect. After the arousal subsides, the blood flows out, and the penis returns to its original state. During priapism, due to various reasons, the normal regulation of filling is disrupted, leading to an erection occurring at an unwanted time (i.e., without sexual arousal). Conditions that can contribute to the development of priapism include:

Blood flow-related causes: sickle cell anemia, leukemia (blood cancer). During these diseases, due to altered red blood cell shape, blood may no longer flow out of the penis normally.
Medication-related causes: use of medications that enhance sexual function, antidepressants, blood thinners.
Pelvic trauma, where blood flows into the genital organs.

Symptoms

The clinical signs characteristic of priapism are:

Erection lasting longer than 4 hours,
Erection not caused by sexual arousal,
Penile pain.

Diagnosis

The patient’s complaints are investigated, a physical examination of the genital organs is performed. A blood sample is taken from the penis with a thin needle to determine the concentration of blood gases, blood pH, in order to determine the type of priapism that has developed (this can help identify the cause).

Treatment

During priapism, it is necessary to provide assistance as quickly as possible, as prolonged condition can lead to complete infertility. An attempt is made to aspirate blood with a needle, and if unsuccessful, an infusion of α-agonists (phenylephrine) is administered. If these procedures are not effective, surgical treatment is applied: shunt surgery.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology