Priapism - Symptoms, causes and treatment

Priapism is a condition when a man experiences a prolonged erection without sexual stimulation. Erections can last up to 4 hours and are often painful.

Causes of Priapism

In men with priapism, erections are not triggered by sexual stimulation. This condition occurs when there is an obstruction to blood flow to the penis. The exact cause of priapism is not known, but priapism is divided into two types, with different symptoms and treatment. The two types are ischemic priapism and nonischemic priapism.

Ischemic priapism

Ischemic priapism occurs when the blood vessels of the penis become blocked, so that blood is unable to flow and accumulates in the penis. This type of priapism is the most common type of priapism and can recur, especially in patients with sickle cell anemia.

Some conditions that can trigger ischemic priapism, namely:

  • Suffering from diseases, such as sickle cell anemia, leukemia, thalassemia, and multiple myeloma.
  • Taking drugs, such as:
    • Blood thinning drugs, eg warfarin and heparin.
    • Antidepressant drugs, such as fluoxetine, bupropion, and sertraline.
    • Medications for prostate enlargement, such as terazosin, doxazosin, and tamsulosin.
    • Erectile dysfunction drugs in the form of injections, such as papaverine.
    • Drugs to treat mental disorders, such as risperidone, olanzapine, and clozapine.
    • Hormone therapy, such as testosterone and gonadotropin-releasing hormone (GnRH).
    • Medications to treat ADHD, such as atomoxetine.
    • Excessive alcohol consumption and drug abuse.

Nonischemic priapism

Nonischemic priapism occurs when a blood vessel in the penis is torn or ruptured, causing too much blood to flow into the penis. This condition can be caused by injuries to the penis, pelvis, and perineum, the area between the penis and anus.

In addition, there are several other factors that are thought to trigger nonischemic priapism, namely:

  • Metabolic disorders, such as amyloidosis.
  • Nerve disorders.
  • Cancers that are located close to the penis, such as prostate cancer and bladder cancer.
  • Spider or scorpion bites.

Symptoms of Priapism

Symptoms that appear depend on the type of priapism experienced by the patient. If the patient has ischemic priapism, the symptoms may include:

  • Gradually increasing pain in the penis.
  • Erections that last for more than 4 hours.
  • The shaft of the penis is stiff with a soft tip.

Non-ischemic priapism has almost the same symptoms as ischemic priapism. However, the difference is that patients with nonischemic priapism do not feel pain and the shaft of the penis is not completely rigid.

If the erection lasts for more than 4 hours, see a doctor immediately for emergency treatment because this condition can cause permanent complications.

Diagnosis of Priapism

Priapism can be an emergency, so the doctor will check quickly and take action to prevent complications that may occur. If necessary, examination of blood gas analysis directly taken in the veins of the penis or ultrasound of the penis is needed to determine the type of priapism.

If the temporary priapism has been resolved, the doctor will find out the factors that trigger the occurrence of priapism. Investigations will be needed to detect the cause of priapism and further treatment steps to be taken, to prevent recurrence. The types of supporting examinations that can be carried out include:

  • blood test, to measure the number of red blood cells and platelets. Through this examination, the doctor can identify abnormalities or diseases that are suspected to be the underlying cause of priapism, such as sickle cell anemia.
  • toxicology test, to detect the content of drugs that cause priapism through a urine sample.
  • penis ultrasound, In addition to measuring blood flow in the penis and determining the type of priapism, penile ultrasound can detect injuries or abnormalities that cause priapism.

Priapism Treatment

The steps for treating priapism are carried out based on the type of priapism experienced by the patient. Non-ischemic priapism generally heals on its own without going through certain medical procedures. Initial treatment to relieve erection can be done alone at home. The initial treatment steps include:

  • Increase fluid consumption.
  • Trying to pee.
  • Soak in warm water.
  • Do light exercise, such as a leisurely walk or run in place.
  • Take pain relievers, such as paracetamol, if needed.

If the erection does not subside, consult a doctor immediately, you may experience ischemic priapism, which needs to be treated by a doctor.

If priapism is the result of an injury, surgery is sometimes performed to repair damaged blood vessels or penile tissue. In addition, surgery can also be performed by inserting a material, such as a gel, to temporarily block blood flow to your penis.

For ischemic priapism, the treatment measures taken are:

  • Drug therapy. Nervous system stimulant drugs that regulate blood vessels, such as phenylephrine. This drug is given by injection directly into the penis and the dose may be repeated, if needed.
  • Removes blood that has accumulated in the penis. Using a small needle, the accumulated blood will be expelled until the erection subsides. After the procedure is complete, the penis will be cleaned with sterile fluid.
  • Operation. Surgery is performed by changing the route of penile blood flow. Surgery is performed if other therapies are deemed ineffective to treat ischemic priapism.

Priapism complications

Ischemic priapism can lead to serious complications if not treated promptly. Blood trapped when the penis has an erection for a long period of time, will experience a lack of oxygen. Blood deprived of oxygen can damage or destroy penile tissue. If left untreated, this condition can lead to erectile dysfunction.

Penile or pelvic injuries that cause nonischemic priapism can also lead to infection of the deep tissues of the penis.

Priapism Prevention

The main preventive measure of priapism is to treat the disease that causes priapism, for example, treatment of sickle cell anemia. In addition, there are several types of drugs that can be used to prevent recurrent attacks of priapism, namely:

  • Phenylephrine tablets or injections.
  • Take erectile dysfunction drugs, such as sildenafil or tadalafil.