Priapism - Medtick

Priapism

What is it?

When one has a long and painful erection.

  • It is the full or partial erection continues hours beyond or isn’t caused by sexual stimulation and last longer than four hours
  • The two main types of priapism are ischemic and nonischemic.
Ischemic priapism (low-flow priapism)
  • More common
  • Blood is trapped in the penis because it cannot flow out of the veins of the penis or there is a problem with the contraction of smooth muscles within the erectile tissue of the penis, therefore as a result of blood not being able to leave the penis.
  • The longer this is left untreated the more likelihood of erectile dysfunction.

  • The rate of subsequent erectile dysfunction with increases with the duration of the episode:
    • 50% if less than 24 hours
    • 50-90% if longer than 24 hours
    • 100% if longer than 36 hours

Tabibi A, Abdi H, Mahmoudnejad N. Erectile function and dysfunction following low flow priapism: a comparison of distal and proximal shunts. Urol J. 2010 Summer;7(3):174-7. PMID: 20845293

Muneer A, Zacharakis E, Ralph DJ. Diagnosis and management of priapism. Trends Urol Mens Health. 2016 May/June;7(3):19-22. Available at: http://onlinelibrary.wiley.com. Accessed August 30, 2021.

Ischemic priapism requires immediate medical care to prevent complications caused by not getting enough oxygen to the penile tissue.

Stuttering priapism (recurrent or intermittent priapism)

  • Uncommon condition
  • Form of ischemic priapism
  • It describes repetitive episodes of prolonged erections and often includes episodes of ischemic priapism.
  • It occurs more often in males who have an inherited disorder characterized by abnormally shaped red blood cells (sickle cell disease).
  • Sickle cells can block the blood vessels in the penis.
  • In some cases, the condition starts off with unwanted and painful erections of short duration and might progress over time to more-frequent and more-prolonged erections.
  • Stuttering priapism may begin in childhood.

Non-ischemic priapism

  • Nonischemic priapism (high-flow priapism)
  • Occurs when blood flow through the arteries of the penis isn’t working properly.
  • However, the penile tissues continue to receive some blood flow and oxygen.
  • Non-ischemic priapism often occurs due to trauma
Mayo Clinic
All conditions can lead to poor blood supply/purple to black skin to the glans part of the penis leading to death of penile tissue, this cannot be usually reversed. When large areas of tissue die due to a lack of blood supply, the condition is called gangrene in any case where one has poor blood supply this is a Medical Emergency

Cause

Illicit drugs

Medication

Symptoms

Ischemic priapism/Stuttering priapism

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation?
  • Rigid penile shaft, but the tip of penis (glans) is soft?
  • Progressively worsening penile pain?

Nonischemic priapism

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation?
  • Erect but not fully rigid penile shaft?
  • Usually not painful?

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

  • An erection longer than four hours (one hour in sickle cell anaemia condition), this lack of oxygen can begin to damage or destroy tissues in the penis. Untreated priapism can cause erectile dysfunction)
  • Poor blood to flow to the penis (penis tip will be purple in colour)
  • Skin infection
  • Necrotising Fasciitis
Ischemic priapism requires immediate medical care to prevent complications caused by not getting enough oxygen to the penile tissue.
All conditions can lead to poor blood supply/purple to black skin to the glans part of the penis leading to death of penile tissue, this cannot be usually reversed. When large areas of tissue die due to a lack of blood supply, the condition is called gangrene in any case where one has poor blood supply this is a Medical Emergency

Things one to do stop erection

  • Try to urinate
  • Have a warm bath or shower
  • Drink lots of water
  • Go for a gentle walk
  • Try exercises, such as squats or running on the spot
  • Take painkillers like paracetamol (if suitable)

Don’t

  • Do not apply ice packs or cold water to your penis – this can make things worse
  • Do not have sex or masturbate – it won’t make your erection go away
  • Do not drink alcohol
  • Stop smoking

NHS Choices

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

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