Priapism – What Is It, What Is It Caused By and How Is It Treated?

Priapism in men is a male condition that occurs much less frequently than erectile dysfunction, and in fact it is the “opposite” of ED. On the one hand, patients with such a diagnosis should be happy, because their penises can be in the erect condition for a long time.

However, this condition brings uncomfortable and painful sensations, moreover, it can be very dangerous to health.

What Is Priapism?

Priapism is a pathological condition in which the penis of a man is in a state of erection, not provoked by sexual arousal, lasting more than 4 hours (according to some sources – more than 6 hours). After a while, this condition begins to be accompanied by pain. Priapism is relatively rare, affecting mostly young individuals and adults, not elderly persons.

Priapism received its name from the name of the god of fertility among the ancient Greeks – Priapus, who is depicted in ancient Greek frescoes with a hypertrophied erect penis.

Types of Priapism

There are 2 main types of priapism:

• Ischemic. It occurs if the blood can not leave the cavernous bodies of the penis for certain reasons. This is a more common form of the disease.

• Non-ischemic. This condition occurs if the blood flow in the male body is not regulated correctly. The main difference of this type of disease from ischemic one is painlessness.

One of the varieties of priapism is stuttering priapism. It is a non-typical relapsing form of ischemic priapism characterized by incursions of unwanted painful erections usually lasting for less than three hours. These episodes occur repeatedly with periods of detumescence. If they are neglected, a classic ischemic priapism can develop which can eventually evolve into irreversible corporal fibrosis and inconvertible erectile dysfunction.

Signs and Symptoms

Symptoms and signs of the disease are simple and usually don’t require a doctor to perform differential diagnosis. Ischemic priapism has the following differences from the usual healthy penile erection:

• Erection is not associated with sexual stimulation.

• The condition does not go away after orgasm (ejaculation).

• Glans of the penis, as a rule, remains soft.

• The pain develops after some time from the onset of the disease and gradually intensifies.

Patients with non-ischemic disease usually do not experience pain. This is due to the fact that the penile shaft (which consists of 3 bodies) is erect but it is not fully rigid.

What Are Causes of the Condition?

Quite often priapism is a sign of neurological diseases namely acutely developing transverse lesions of the spinal cord. Injuries, herniated intervertebral discs, tumor-induced compressions can lead to such neurological disorders. In addition, patients suffering from certain diseases, such as sickle cell anemia, leukemia, and thalassemia, are predisposed to the development of priapism.

For example, sickle cell anemia is characterized by sickle red blood cells, which may block penile blood vessels resulting in priapism.

Other possible causative factors of priapism are:

1. The use of certain medications. Priapism may occur due to prolonged and uncontrolled use of hormonal drugs and injectable medications used to treat erectile dysfunction. Some anticoagulants, antidepressants, and anti-hypertensive agents also belong to the medications which are likely to cause priapism.

2. Harmful habits. They include prolonged and frequent smoking, the use of large quantities of alcoholic beverages and any kinds of drugs and recreational medicines. Even marijuana is a risk factor in the development of priapism.

3. Intoxication of the body. Usually it's about poisoning the body with the poison of a snake or a scorpion. But this cause is very rare.

Other causes include malignant diseases involving the penile organ, metabolic disorders, and penis traumas.

Priapism Treatment

Priapism is dangerous due to the development of blood stasis, which inevitably leads to an inflammatory process up to the gangrene of the penis and even its amputation.

How to Stop Erection

Therefore, if a man experiences an impending erection for more than 4 hours, he needs to see a doctor for emergency help. The doctor will determine the nature of priapism, whether it is ischemic or non-ischemic.

It is important! There is a widespread opinion that erection with priapism will disappear after sexual intercourse or masturbation, as happens in the case of physiological erection. However, this opinion is not only incorrect but also dangerous for health. Any sexual arousal only strengthens blood inflow and slows down its outflow, aggravating the condition.

The ischemic form of the disease is an emergency situation that requires urgent treatment. For the purpose of treatment, doctors use the drainage of the penis with a syringe and a needle. This allows them to remove excess blood. Instead of blood, a saline solution can be injected into the penile organ, so that the unwanted erection disappears.

Other treatments for ischemic priapism include:

1. The use of injectable sympathomimetic meds (like phenylephrine). They narrow the blood vessels that transport blood to the penile organ. In turn, the vessels that transport blood from the penis expand.

2. If other therapies are futile, the patient may be advised to undergo a surgical procedure that involves redirecting the blood flow.

As for the non-ischemic form of the disease, it does not require urgent treatment. If the patient is healthy in general, a cold shower is useful to him. If cold water is unacceptable, he can apply ice in the cellophane bag to the base of the penis (to the perineum).

The Use of PDE5 Inhibitors (Viagra, Cialis, etc.) and Priapism

One of the rare but dangerous side effects of the use of PDE5 inhibitors such as Viagra, Cialis and Levitra is priapism. The first case of sildenafil in clinical practice was the case of a 53-year-old man from Japan who was described in a study by Japanese scientists T. Aoyagi, K. Hayakawa and others in 1999. The man was taken to hospital with the persistent priapism diagnosis. The condition had been triggered by taking a large dose (200 mg) of Viagra (sildenafil citrate), its recommended dose being 25 – 50 mg. The man had an erectile dysfunction history and had been prescribed penile injections however he had not been given an injection on the eve of that incident. He decided to take sildenafil on his own without consulting a doctor. He did not mention taking any drugs that could affect sildenafil metabolism or having any medical conditions that could trigger priapism. The hospital staff applied such first line therapy methods as needle aspiration and irrigation which appeared ineffective, then they resorted to surgical treatment. From this it can be concluded that an overdose increases the risk of priapism.

However, we repeat, priapism as a side effect of Viagra develops extremely rarely and usually in case of predisposition to this condition. Moreover, according to a study by Helen R. Levey et al. (2014), the use of PDE5 inhibitors may have a preventive effect in patients suffering from stuttering priapism. Some scientists suggest that recurrent forms of priapism may be caused by a decrease in the availability of nitric oxide (NO). Viagra and other medicines have a positive effect on the level of NO, which contributes to the reduction of risk of recurrent priapism episodes.

In conclusion, if you are predisposed to priapism, always consult a doctor before starting treatment with Generic Viagra.