What is priapism?

Priapism is a medical condition in which the penis becomes continuously erect and usually painful over a period of several hours or more. It is a medical emergency that if left untreated can cause permanent damage to the penis. A single incident can affect the future ability to achieve erections.

During an episode of priapism, the shaft of the penis will be hard and sometimes painful. The tip of the penis may remain soft.

Why does this happen?

During times of sexual stimulation, arteries open up to supply blood to the penis. This increases the amount and pressure of the blood in the penis and leads to stiffness. If the blood settles in the clogged hard penis and does not drain normally at the end of stimulation, the penis remains hard and can be damaged over a few hours.

What causes priapism?

Any condition that causes an accumulation of blood and pressure or prevents its release leads to priapism.

Physical causes

It is more likely to occur in men who have an increased tendency to thicken and stickiness of the blood. This can occur in hereditary diseases such as sickle cell anaemia, but also in acquired diseases such as lymphoma and myeloma.

A congenital or acquired injury to the spine can affect the nervous system of the penis and alter normal blood flow.

Injuries at the base of the penis and around the anus or tumors such as bladder and prostate cancer can affect blood flow.

Prescription drugs

Some prescription drugs are associated with an increased risk of priapism, although the risk remains low. Sildenafil (Viagra), tadalafil (Cialis), avanafil (Spedra) and vardenafil (Levitra) have been identified as possible causes, as well as topical treatments for erectile dysfunction with alprostadil, such as Vitaros cream. It is worth repeating this; the risk is low.

Other treatments that have the potential to cause priapism include antidepressants such as Prozac and anticoagulants such as warfarin and heparin, and blood pressure medications medically known as calcium channel blockers.

Medicines for leisure

Priapism has been associated with the use of the following recreational drugs, especially when abused with drugs to treat erectile dysfunction

Cocaine
Ecstasy
Methamphetamine (crystal meth)
Cannabis

The combination and the associated failure to seek treatment has occasionally resulted in permanent damage in a few young men. Men who have taken recreational drugs and alcohol may not seek treatment and ignore the pain.

Treatment

There is an urgent need to drain the accumulated blood and reduce the pressure within a few hours. This is best done in a hospital A+E or emergency room. The blood can be drained directly through large caliber needles inserted into the erectile tissue on both sides of the penile shaft. Alternatively, diluted phenylephidrine (adrenaline) can be injected into the penis to reduce the blood flow inwards and increase it outwards. Side effects such as rapid heart rate and increased blood pressure must be monitored during administration.

If other treatments fail, surgical procedures to relieve pressure can be performed. This is usually a last resort treatment.

Important points

Priapism is rare in otherwise healthy men. It is a medical emergency requiring rapid medical treatment within hours to avoid permanent damage. Some men with pre-existing conditions are at increased risk.

Some drugs, especially those used to treat erectile dysfunction, are predisposed to this condition, especially when taken together with recreational drugs.

Treatment is possible, although not without the difficulties and complications associated with it.