Priapism is the term used to describe a pathological permanent erection of the male member that lasts for more than two hours and is usually painful. Priapism occurs regardless of sexual arousal; orgasm and/or ejaculation do not occur in this condition.
What is priapism?
Sometimes an initially normal erection of the penis does not subside after sexual activity, such as after ingestion or overdose of erection-promoting drugs or injury to the penile erectile tissue during sexual intercourse or masturbation. Priapism is always a urological emergency that should be treated by a physician as soon as possible. If this does not happen, there is a risk of permanent damage to the corpus cavernosum of the penis and thus erectile dysfunction (ED, impotence). The condition is named after the Greek fertility god Priapos, who is regularly depicted in art with an oversized, erect penis.
Causes
In most cases (90%), priapism is the direct result of a severely reduced or completely interrupted outflow of venous blood from the penile erectile tissue (low-flow priapism). Due to the associated inadequate oxygen supply to the penile smooth muscle, there is an acute risk of permanent damage to the erectile tissue, resulting in erectile dysfunction. In addition, in about 10% of cases, a significantly increased blood inflow into the penis is responsible for permanent erection (high-flow priapism). However, the risk of hypoxia is lower in this case. Occasionally, this form of priapism is even painless, but requires no less prompt medical treatment. The exact causes of priapism are unknown or cannot be determined with certainty in about 50 to 60% of cases. However, priapism is often associated with the following behaviors or medical conditions:
- Accidental or intentional overdose of erection-promoting drugs, especially so-called PDE-5 inhibitors (Viagra, Levitra, Cialis),
- Injuries to the corpus cavernosum of the penis, penile trauma (eg after surgery, accident, but also by too tight, inflexible penile rings, which can no longer be removed when the member is fully erect and block blood flow and thus the oxygen supply to the penis,
- Injuries to the spine, spinal cord, and/or nerve pathways that transmit stimuli from the brain to the reproductive organs,
- Substance abuse (e.g., cocaine, marijuana, ecstasy),
- Multiple sclerosis (MS),
- Diabetes mellitus,
- Consumption of certain aphrodisiacs,
- Side effects of certain antidepressants,
- Allergic reactions to the use of erection-enhancing preparations injected into the corpus cavernosum of the penis (corpus cavernosum auto-injection therapy, or SKAT for short),
- Malaria,
- The bite of the “black widow” and related spiders, which release the neurotoxin alpha-latrotoxin and prefer to lay their webs under toilet seats. The same applies to the even more poisonous Brazilian wandering spider.
Symptoms, complaints and signs
The symptoms that occur in priapism depend on what is causing the priapism. Thus, a distinction is made here between the symptomatology of low-flow priapism and the symptomatology of high-flow priapism. Low-flow priapism is primarily manifested by a prolonged erection. This lasts longer than two hours and sometimes leads to very severe pain. The area of the glans increasingly turns blue and then loses color. There is an undersupply of oxygen to the tissue and thus tissue damage with increasing duration of the erection. The pain often intensifies with increasing duration of the erection. In this case, the erectile tissue is maximally erect because the backflow of blood is impeded. This form of priapism accounts for approximately nine out of ten cases. The remaining ten percent of cases show the symptoms of high-flow priapism. Here, too, there is a persistent erection, but it is rarely painful. Instead, the erection is often pulsating and the member still remains elastic to a certain degree. In keeping with the causes of high-flow priapism, pain and swelling also occur at the possible site of injury. In women, permanent erection of the clitoris is called clitorism. It is also accompanied by pain.However, no distinction is made here between the forms as in male priapism.
Diagnosis and course
Priapism is mostly recognizable by the fact that although the penile erectile tissues are maximally erect, the glans remains soft and relatively small compared to a healthy erection. Typical is an upward curvature of the member. If the condition persists for a longer period of time, the foreskin, then the glans and finally the entire penis turn blue, which is an alarming indication of a lack of oxygen that threatens the existence of the affected tissue. The medical diagnosis is usually made during the patient’s consultation and is confirmed by laboratory analysis of a blood sample taken from the penile corpus cavernosum. In particular, examination of the penis by ultrasound (duplex ultrasonography) makes it possible to detect and precisely localize injuries to the corpus cavernosum, blood vessels or other causes of priapism.
Complications
Priapism should be considered a medical emergency at any stage and treated immediately. Treatment of low-flow priapism should be started no later than four to six hours after the onset of continuous erection to avoid late complications. Failure to treat priapism may result in permanent loss of potency. Complications despite timely treatment are to be expected especially if surgery becomes necessary because puncturing of the penis as well as irrigation of the corpora cavernosa with saline solution was not successful. In case of surgery, injury to the penis and surrounding areas may occur. Heavy bleeding, secondary bleeding and bruising are possible, as well as nerve damage to the glans, which can affect sexual sensation. Other possible complications include infection and wound healing problems. Abnormal scarring is also possible. Regardless of the treatment method, the shape of the penis may change permanently after priapism, with curvature in particular to be expected. In this case, psychological complications often present themselves. Affected men feel disfigured and develop complexes, often towards their partner, which is accompanied by a considerable reduction in quality of life and may require psychotherapy.
When should you see a doctor?
If an erection lasts longer than two to three hours and is accompanied by severe pain, a doctor should be consulted quickly. Priapism is usually a medical emergency and can lead to erectile dysfunction if left untreated. Affected individuals are best to seek treatment immediately to avoid permanent damage. If the swelling persists overnight or is associated with physical discomfort such as chills and fever, a visit to the doctor is recommended. People suffering from blood disorders, tumors, thromboses, metabolic diseases or damage to the nervous system are particularly at risk of priapism. Those who belong to the risk groups should consult their family doctor with the symptoms described. Other points of contact are the urologist or an internist. Treatment usually takes place in a specialized clinic, although drug treatment may also be possible under certain circumstances, which can be carried out in the doctor’s office. If treatment is given early, permanent damage to the organ can be avoided in up to 90 percent of cases.
Treatment and therapy
Treatment of priapism initially focuses on pain management. Only the rare high-flow priapism is sometimes painless. Next, an attempt is made to reduce the swelling of the limb by administering special medications. If this does not succeed, the amount of blood in the penis is reduced by withdrawing blood from the erectile tissue by syringe/cannula. Vasodilator injections are used to restore or improve blood return from the member to the body. Finally, as a last resort, surgical intervention may be indicated. This involves either inhibiting the blood supply to the penis or improving blood outflow from the member by creating an artificial connection between the venous and arterial systems, “unloading” the penis, and thus ending priapism (shunt surgery).
Prevention
Effective prevention of priapism consists essentially in consciously avoiding those causes over which the man himself has control, such as by using erection-enhancing drugs and aphrodisiacs responsibly, avoiding drug abuse, and exercising caution when using various sex toys.
Aftercare
The aftercare of priapism depends on the effects that such a permanent erection has caused in the patient. In acute treatment, it is important that the cause of priapism could be found and eliminated as soon as possible, respectively that the patient has sought expert treatment quickly enough. Consequences of priapism such as erectile dysfunction cannot be ruled out and must be treated by a urologist during follow-up care. After-effects or late effects usually occur if treatment was not started until many hours after the priapism occurred. In very bad cases, there may also be late sequelae such as penile deviation, in which the penis is curved. Very rarely, there are also forms of tissue necrosis, in which tissue of the penis dies. Immediately after acute treatment, which sometimes requires surgical intervention, follow-up care must be followed. Here it must be ensured that none of the late effects occur in the patient and that the organ could be preserved perfectly in its function. If the first signs of late effects appear, the patient must be immediately presented to the urologist, who can plan further measures as needed. If the priapism could be treated quickly and completely, it can be assumed that the patient could be cured completely and no extensive follow-up is required.
What you can do yourself
In most cases, priapism can be stopped by exercising. If these measures show no effect, surgery must be performed. Affected persons who repeatedly suffer from continuous erections that only subside after two or more hours and are accompanied by severe pain should consult their family doctor. It is often sufficient to perform regular relaxation exercises, moderate exercise and, if necessary, to take blood-thinning medication. An adapted diet can also regulate blood flow. If the symptoms persist, it is necessary to see a urologist. If the symptoms are severe, a visit to the hospital or a consultation with the emergency medical service is recommended. Since permanent erection often occurs in awkward situations, underwear with a tight waistband should be worn. However, the penis should not be moved forcibly, as this may cause tissue damage. If the symptoms occur in connection with alcohol, drugs and medication, the triggering agent can be discontinued first. In case of chronic complaints, surgical intervention is necessary in any case. After an operation, rest, bed rest and various hygiene measures apply. Affected persons are best advised to contact a urologist or the medical emergency service.
