While maintaining an erection for a certain amount of time is desirable from a sexual functioning standpoint, when it goes on too long it can be detrimental. Find out all about priapism.
Priapism is characterized by a permanent erection, not always completely rigid, and sometimes painful. May be due to venous outflow obstruction or excess arterial flow.
The causes may be associated with drugs for the treatment of erectile dysfunction, substance use (alcohol or drugs) or some pathologies and injuries.
Although it is rare, In certain cases it constitutes an emergency that requires immediate attention.. If not resolved timely, it leads to permanent erectile dysfunction.
What is priapism?
It is called priapism to one prolonged erection that exceeds four hours. It may be related to sexual stimulation, but not necessarily.
This term comes from a god from Greek mythology: Priapus, son of Dionysus and Aphrodite. According to legend, Priapus was born with a huge member. He was considered the symbol of fertility or male sexuality.
Priapism is not a very common condition. It is more likely in men over 30 years of age.. Although it can manifest in children suffering from sickle cell disease.
Its incidence is estimated at 1.5 cases per 100,000 people per year. In men older than 40 years, the proportion increases a little, reaching 2.9 cases per 100,000.
According to some investigations, this problem has increased in recent years, due to the excessive or inappropriate use of drugs for the treatment of erectile dysfunction, such as sildenafil.
Types and symptoms
The symptoms of priapism vary according to the type. In this regard, it is noted that it can be ischemic or non-ischemic, depending on whether there is difficulty in draining or emptying the corpora cavernosa, or excess blood flow to the penis.
1. Ischemic priapism
Ischemic priapism, also called veno-inclusive o low flowis the most frequent. It is produced by the inability or difficulty of the venous blood to leave the penis, due to an obstruction or a contraction problem of the smooth muscles.
At the same time, the inflow of arterial blood is also reduced, which can lead to ischemia of the corpora cavernosa (hence its name). And if it is prolonged over time, it leads to fibrosis, since the accumulated blood loses oxygenation and acidosis is greater.
Symptoms of ischemic priapism include the following:
- prolonged erection
- Pain that is getting worse.
- Body of the penis rigid with a soft glans.
2. Non-ischemic priapism
Also called high flow priapism; it is less frequent. Unlike the previous one, it is due to the excess of blood that flows into the cavernous bodies, which is greater than the outflow.
Can occur as a result of trauma. But because the blood that pools is richer in oxygen, there is no risk of ischemia.
Its symptoms include the following:
- prolonged erection
- The shaft of the penis is not completely rigid.
- It is less painful.
Causes of priapism
priapism it is usually secondary to an alteration of the hemodynamic mechanisms that contribute to the decrease in blood volume within the corpora cavernosa or detumescence. In turn, the problem may be related to blood vessels, muscles, or nerves.
And although in some cases it is not possible to know the root cause, there are several factors, and even conditions, that can have an impact on this problem. Among them it is worth mentioning the following.
Pathologies
Recurrent priapism occurs frequently in men with sickle cell disease and, to a lesser extent, with other blood disorders: leukemia, multiple myeloma, and thalassemia.
Among the pathologies that can be associated with priapism are also the following:
- Cancer of the penis, bladder, prostate or rectum.
- Neurological diseases: encephalopathy, multiple sclerosis.
- Infectious pathologies: mumps, malaria.
- Inflammations: prostatitis and thrombophlebitis.
- Other disorders: gout, amyloidosis, Fabry disease.
Medicines
An episode of priapism can be triggered as a side effect of some medications used to treat various pathologies and disorders. In this regard, the following are mentioned:
- Blood thinners, such as warfarin and heparin.
- Other drugs used in the treatment of erectile dysfunction.
- Anxiolytics, antidepressants and medications for psychotic disorders.
- Androgens and other hormones: testosterone, gonadotropin-releasing hormone.
- Injection of vasoactive substances: it is pointed out in studies as one of the first causes of priapism.
- Antihypertensives, including calcium antagonists, which can cause a veno-occlusive effect, and alpha-blockers.
injuries
Trauma and injury to the penis, perineum or pelvis, in some cases they originate fistulas, causing an abnormal flow of arterial blood towards the corpus cavernosum. Likewise, spinal cord injuries can affect the mechanisms of erection, causing the bulbocavernosus reflex to be lost.
other causes
They can also cause priapism:
- Excessive alcohol consumption.
- Drug use, such as cocaine and heroin.
- Spider bites and other arachnids, such as scorpions.
Diagnosis and treatment
For the diagnosis of priapism, the doctor will look for differences in symptoms. For example, in ischemic priapism, the erection is painful. Also, the patient may appear agitated. On the other hand, in the non-ischemic patient, the penis appears in a state of incomplete erection.
Through questions, the background of the situation will be known. And other studies will complement the diagnosis. This includes gasometry, to find out if the cavernous space is filled with arterial or venous blood, and if there is hypoxia and acidosis or not; Likewise, Doppler ultrasound and selective arteriography can be performed.
Although the purpose of treatment for one or another type of priapism may be similar, the mechanisms of action differ. Even the urgency of attention. The veno-occlusive or ischemic ones require immediate action and slightly more invasive measures.
In this order of ideas, to promote blood flow from the cavernous bodies, a powerful analgesic can be administered, together with the application of local cold. Subcutaneous terbutaline is also administered.
If the tumescence persists, aspiration will be performed., with a puncture in the distal portion of a corpus cavernosum. It is drained until bright red arterial blood comes out.
If the blood does not come out, due to its thickness, washes with physiological saline will be done. And if the erection reappears, in addition to a new aspiration, an alpha-adrenergic agonist will be injected intracavernosally. When the erection has persisted for a long time, it is recommended to open fistulas that allow drainage.
In some cases of non-ischemic priapism, treatment may not be required., since it does not usually give rise to complications. At most, it is a matter of reducing the flow by selective embolization or other procedures, in order to achieve detumescence.
When to go to the doctor?
Sometimes an episode of priapism resolves on its own. But it can also constitute an emergency. Depending on the severity, it will leave sequelae, such as permanent erectile dysfunction.
When an erection lasts for several hours, you should go immediately to an emergency care center. The doctor will determine what type of priapism it is and what actions are required.
On the other hand, if these episodes are recurrent, treatment should be started to prevent them. As a measure, the doctor may advise suspending any medication. In the same way, the person must avoid consuming drugs or substances that may affect them.
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