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Priapism is a prolonged erection of the penis. The unwanted, persistent erection isn't caused by sexual stimulation or arousal, and it's usually painful. Priapism is an uncommon condition that needs immediate medical attention. Prompt treatment for priapism is usually needed to prevent tissue damage that results in the inability of the penis to become or stay erect with sexual arousal (erectile dysfunction). Priapism is most common in boys between ages 5 and 10 years old and in men from ages 20 to 50 years.
Complications of Priapism
Ischemic priapism can cause serious complications. The blood trapped in the penis is deprived of its oxygen supply and becomes toxic to tissues. When the erection lasts for more than four hours, the oxygen-poor blood can begin to damage or destroy tissues in the penis. As a result, untreated priapism may cause:
Causes of Priapism
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. Blood vessels that control the flow of blood out of the penis contract, trapping blood. 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.
Blood-related diseases may contribute to priapism — usually ischemic priapism, a persistent erection caused by blood not being able to flow from the penis. These disorders include:
Sickle cell anemia, one of the most common causes of priapism, is an inherited disorder characterized by abnormally shaped red blood cells. These abnormally shaped cells can block the flow of blood. Sickle cell anemia is the most common cause of priapism in boys.
Priapism, usually ischemic priapism, is a known side effect of a number of drugs. The following drugs can sometimes cause priapism:
Illicit or recreational drug use
Some illicit drugs or the abuse of drugs can cause priapism, particularly ischemic priapism. Possible causes include:
A common cause of nonischemic priapism — a persistent erection caused by excessive blood flow into the penis — is trauma or injury to your genitals, pelvis or the perineum, the region between the base of the penis and the anus.
Other causes of priapism include:
In some cases, doctors are unable to identify the specific cause for priapism.
Signs & Symptoms of Priapism
Priapism causes abnormally persistent erections. Priapism symptoms vary somewhat depending on the type of priapism.
Ischemic, or low-flow, priapism is the result of blood not being able to exit the penis. Signs and symptoms include:
Nonischemic, or high-flow, priapism occurs when too much blood flows into the penis. Signs and symptoms include:
Stuttering, or recurring, priapism is a form of ischemic priapism that occurs off and on. A stuttering erection is usually painful but generally lasts fewer than three hours.
Diagnosis of Priapism
If you have an erection lasting more than four hours, you need emergency care. The emergency room doctor will determine first whether you have ischemic priapism or nonischemic priapism. This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to be done as soon as possible. Your answers to questions, a physical examination and a blood test are usually enough to determine what type of priapism you have. You will undergo additional tests to determine the underlying cause of priapism, which may need to be treated, usually in a nonemergency setting.
Medical history and exam
In order to determine what type of priapism you have, your doctor will likely ask the following questions:
Your doctor will also examine your genitals, abdomen, groin and perineum. He or she may be able to determine what type of priapism you have based on the rigidity and sensitivity of the penis. This exam may also reveal signs of injury or tumors that could be causing priapism. An injury, for example, would suggest that nonischemic priapism is more likely.
Diagnostic tests may be necessary to determine what type of priapism you have. Additional tests may identify the cause of priapism. In an emergency room setting, your treatment may begin before all test results are received if the doctor is confident about what kind of priapism you have. Diagnostic tests include:
Treatments of Priapism
Ischemic priapism — the result of blood not being able to exit the penis — is an emergency situation that requires immediate treatment. This treatment usually begins with a combination of draining blood from the penis and using medications.
Nonischemic priapism often goes away with no treatment. Because there isn't a risk of damage to the penis, your doctor may suggest a watch-and-wait approach. Putting ice and pressure on the perineum — the region between the base of the penis and the anus — may help end the erection. Surgery may be necessary in some cases to insert material that temporarily blocks blood flow to the penis. The body eventually absorbs the material. Surgery may also be necessary to repair arteries or tissue damage resulting from an injury.
Prevention of Priapism
Depending on the probable cause of the priapism, steps to prevent priapism may include:
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