All Questions about Priapism

Definitions

Known also as Hulseyism, is a potentially harmful and painful medical condition in which the erect penis or clitorisdoes not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

Priapism is considered a medical emergency, which should receive proper treatment by a qualified medical practitioner. Early treatment can be beneficial for a functional recovery.

It can occur in all age groups, including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years.

Categories of priapism

  • Low flow: This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.
  • High flow: High flow priapism is more rare than low-flow and usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.

What causes priapism?

Sickle cell anemia

Some adult cases of priapism are the result of sickle-cell disease and approximately 42% of all adults with sickle-cell will eventually develop priapism.

Medications

A common cause of priapism is the use and/or misuse of medications. Drug-related priapism includes drugs such as Desyrel used to treat depression or Thorazine, used to treat certain mental illnesses. For people who have erectile dysfunction, injection therapy medications to treat the condition may also cause priapism.

Other causes of priapism include:

  • Trauma to the spinal cord or to the genital area
  • Black widow spider bites
  • Carbon monoxide poisoning
  • Illicit drug use, such as marijuana and cocaine

In rare cases, priapism may be related to cancers that can affect the penis and prevent the outflow of blood.

How is priapism diagnosed?

If you experience priapism, it is important that you seek medical care immediately. Tell your doctor:

  • The length of time you have had the erection
  • How long your erection usually lasts
  • Any medication or drugs, legal or illegal, which you have used. Be honest with your doctor, illegal drug use is particularly relevant since both marijuana and cocaine have been linked to priapism.
  • Whether or not priapism followed trauma to that area of the body.

Your doctor will review your medical history and perform a thorough physical examination to determine the cause of priapism. This will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer.

After the physical exam is complete, the doctor will take a blood-gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, some of the blood is drawn and then it is sent to a lab for analysis. This provides a clue as to how long the condition has been present and how much damage has occurred.

How is priapism treated?

The goal of all treatment is to make the erection go away and preserve future erectile function. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may act to decease blood flow to the penis, may be very helpful. Other treatment options include:

  • Ice packs: Ice applied to the penis and perineum may reduce swelling.
  • Surgical ligation: Used in cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.
  • Intracavernous injection: Used for low-flow priapism, during this treatment drugs known as alpha-agonists are injected into the penis that cause the veins to narrow reducing blood flow to the penis causing the swelling to subside.
  • Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
  • Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you suspect that you are experiencing priapism, you should not attempt to treat it yourself. Instead seek emergency as soon as possible.

What is the outlook for people with priapism?

As long as treatment is prompt, the outlook for most people is very good. However, the longer medical attention is delayed, the greater the risk of permanent erectile dysfunction.

For more detailed information about priapism I really recommend you to visit the references below.

References:

  1. http://my.clevelandclinic.org/disorders/priapism/hic_priapism.aspx
  2. http://en.wikipedia.org/wiki/Priapism

About yuan ade sukma, MD

I'm an Indonesian doctor. I Believe that science and knowledge do not belong to anyone in the world. Science and knowledge is meant to be shared to make the world a better place to live. But if you find any material posted here is violating any copyrights, feel free to contact me and I will delete that. I believe that someday my blog can change the world. I BELIEVE in the POWER of WORDS! Do you..?
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9 Responses to All Questions about Priapism

  1. Simbah198 says:

    I am a sickle cell patient who suffers from nightly priapism episodes in differing forms. I am writing because your article is recent, but moreover to provide additional information as well as obtain information. Some have listed some additional treatments below:

    Pseudoephedrine’s has been a successful treatment for me. I’m not sure how it works but taken before bed it decreases the amount of pain and the duration of the episode. Furthermore, if taken throughout the day it becomes more effective. The only problem is the increased amount of regulation here in The States due to it’s connection with meth addicts. Therefore a doctors prescription is advised.

    The other treatment that works well is the asthma medication Brethine also known as Trebutaline. This taken at the onset of priapism helps decrease pain and also the duration of the episode. This medication is much more potent when a physician injects it into fat tissue (preferably the stomach), but they also have it in pill form and the pills work well too.

    These treatments have increased potency when done in combination with otc pain medication, prescription pain meds, video games, and/or light exercise.

    Thank you for allowing me to share said information and please email me if you have any information that is of aid for me. These may be successful treatments, but over time my condition is slowly deteriorating and they are becoming less effective for me personally. I’m 27 years of age and would like many more years of enjoyable sex in the future. Anyway, thank you again.

    With Respect,

    Simbah198

    • dear Simbah198
      thank you for asking

      Priapism is fairly common in SCD patients. The type of priapism is usually low-flow, which is considered a medical emergency and require immediate treatment in order to prevent any damage or fibrosis in the penis. While highflow type is usually present in penile trauma. The low flow type requires pharmacologic agent and the highflow type reguires arterial ligation or embilization.

      it is most likely your type of priapism is the low-flow type. Medications used to treat that condition is vary. Here i list it for you,

      1. Adrenergic Agents.
      Various adrenergic agonists have been used in the treatment of priapism, including pure α-agonists (e.g., metaraminol), mixed α- and β-agonists (e.g., etilefrine, phenylephrine, and epinephrine), and pure β-agonists (e.g., terbutaline). However there is debate over which type of agent should be used. Alpha-agonists act as vasoconstrictors and are thought to induce contraction of the smooth muscle of the penile helicine arteries of the corpora cavernosa, forcing blood out of the corpora cavernosa and into the venous return.[6] Beta-agonists, on the other hand, act as vasodilators by blocking β-receptors, resulting in smooth muscle relaxation of the vasculature. This allows oxygenated arterial blood to enter the cavernosa, washing out stagnant, already damaged sickle cells. Randomized, controlled studies have not been conducted to confirm the use of one type of agent over the other.

      2. Gonadotropin-releasing Hormone Analogues
      Other therapeutic alternatives that have been used with some success are gonadotropin-releasing hormone analogues. When given on a scheduled basis, these substances act to reversibly inhibit gonadotropin secretion. In men, this results in a reduction of testosterone levels to the castrate range within two to four weeks after the initiation of therapy.[15] It is thought that, by reducing levels of circulating androgens, episodes of priapism will be decreased or stopped altogether.[16,17] The two agents most commonly used are goserelin, a solid injected subcutaneously as an implant, and leuprolide, which is available as both a subcutaneous implant and a liquid (also injected subcutaneously).

      3.Diethylstilbestrol
      Diethylstilbestrol is one of the few agents for which placebo-controlled trials exist. Its primary use has been in aborting and preventing attacks of SP. The exact mechanism by which diethylstilbestrol works is unknown, although existing theories suggest a neutralizing effect on male hormones or a direct effect on erythrocyte characteristics.[18]

      4. Hydroxyurea
      Hydroxyurea was used in a 25-year-old man with SCD who had AP and recurrent SP.[21] The patient had received hydralazine, piracetam, and pentoxifylline, but the AP and SP episodes continued over the next six months. The patient was then given oral hydroxyurea 1000 mg daily. After four weeks, the dosage was increased to 1500 mg daily. The patient reported no further episodes of priapism for seven months. The patient discontinued his use of hydroxyrurea for three months, and the AP and SP episodes recurred. After resuming treatment, no additional episodes were reported. No significant adverse effects were reported.

      5. Other Treatments
      There have been case reports describing the isolated but successful use of other pharmacologic agents to induce detumescence in patients with prolonged erection. One report described the use of ketamine and physostigmine in an 18-year-old patient positive for sickle cell trait and a 25-year-old patient.[23] Both patients received ketamine to a total dose of 0.5 mg/kg followed within five minutes by physostigmine to a total of 1.5 mg. Partial detumescence was noted within 10 to 15 minutes in both patients, and complete detumescence was achieved in 90 minutes in the 25-year-old and 110 minutes in the 18-year-old. The 18-year-old patient was readmitted two months later and received the same treatment, with complete detumescence occurring within 45 minutes.

      The use of hydralazine was described in a 16-year-old patient with SCD.[24] The patient was instructed to take hydralazine 10 mg orally upon awakening with painful priapism. Three episodes occurred over the ensuing month, and hydralazine use resulted in pain relief within 15 to 30 minutes and complete detumescence within 45 minutes in all instances. Methylene blue injected intracavenously has also been reported to be effective in the treatment of priapism.[4,25,26] However, another report found that the use of methylene blue has resulted in necrotic abscess.[27] The use of erythrocyte transfusions for six months, followed by pentoxifylline for six months, in a patient with SP has been documented.[28] Both simple and exchange transfusions have been used in attempts to increase the hemoglobin and hematocrit, decrease the number of sickled red blood cells, decrease hemoglobin S levels, and increase the number of oxygenated, normal erythrocytes.[2,3] However, transfusions for priapism have been associated with ASPEN syndrome, a syndrome characterized by the association of SCD, priapism, exchange transfusion, and neurologic events.[2] The most serious event associated with this syndrome is cerebrovascular accident. Other therapies reported in the literature include calcium-channel blockers, such as verapamil, diltiazem, and nifedipine; hyaluronidase; and anticoagulants.[2,10,22,28]

      All I can show you here is lists of medications usually used to treat low flow priapism. I hope its useful for you.
      You MUST consult with your doctor and discuss what is the best option for your condition.

      Best Regards

      PS: and where are you from, your name is quite unique ^^

  2. danindima chow says:

    please,i want to know if there is any current or recent medical breakthrough in the treatment of this disease(priapism)?is there any confirmed age one gets to and see less of the symptoms or experiences it throughout life?im a 24year old with scd.been having this recurrent priapism mostly at night.Thanks

    • Dear Chow, currently the latest treatment is what I write in the comment above your question, you may want to discuss it with the doctor who treats your SCD for the best treatment for your condition. I hope the best for you,

  3. knowhow1234 says:

    Dear Mr. Yuan Ade Sukma!

    I had priapism several times (i think six). I remeber the first time, it was very painfaul. Also i remember the last time, it was less painful. The priapism was always treated within the recommended time (within 4 hours). Because the first priapism was very painful and the last one was not i’m thinking that i lost sensitivity in my genitals. Also sex and masturbation doesn’t feel as good as before the priapisms (at least i think so, can be presumption too!). Is it possible to lose sensitivity in the penis because of priapism? I asked a doctor a he sayed yes but i’m in doubt because his explaination was a bit vague. I also checked a lot of websites with information about priapism and nowhere was written that losing sensitivity can be a result of priapism.

    So what is the explaination for losing sensitivity as a result of priapism (in case this is possible)?

    If i lost sensitivity i would like to know what happend with my penis.

    I would be very thankful if you could write some words to this because i’m pretty depressed because of this case and noone has an satisfying answer for me.

    Thank you!

    • hello, if i may know what is the cause of your priapism?

      • knowhow1234 says:

        Dear Mr. Yuan Ade Sukma!

        Thank you for your answer.

        The cause of the first 3 or 4 Priapism was a side effect of a drug called Leponex (Clozapine). I took this drug from 2007 – 2008. The first priapism 2007 was very painful, the following priapisms i can’t remeber. I don’t take this drug anymore.

        Priapism also was a side effect of Dominal (Prothipendyl). I took this drug from 2009 – 2011 when required (agitation or sleeplessness). I don’t rember these priapisms very painful.

        I don’t think that a different drug (Leponex or Dominal) or a different dosage makes the priapism different painful. In 2011 i took Leponex again for one night and i don’t remeber this priapism very painful.

        Also it’s not sure that if i take a pill (Leponex or Dominal) before sleep that priapism will occour during night. Somestimes it occours, sometimes not.

        It never occoured without taking drugs.

        The problem is, that i can’t remeber how my penis felt during sex or masturbation before i got the problem with priapism. So it’s hards for me to tell if i lost sensitivity or not. All i definitely know is that the first priapism was very painfaul while the last one was not.

        • Dear Knowhow 1234, well, it seems that you have hipersensitivity to those drugs, better not to consume those drugs anymore. As far as I know, if the treatment of priapism is quick enough, it wont cause any nerve or vascular damage. But if there are many episodes of priapisms and not treated fast enough it can cause a hypoxia and even scarring and will cause vascular damage which will affect the erection and also nerve damage which will reduce the sensitivity of the penis.

          But the reducing of sensitivity of the penis also can be caused by other means such as circumcision or excessive masturbation.

          Maybe you can contact your doctor to perform Fine-Touch sensitivity test to measure the sensitivity of your penis, to differentiate whether its psychological or if it is actually sensitivity reduce

          Also the same with every cell in our body, they capable of healing themselves. So neurotropics such as vitamin B complex will help the nerves to heal it self. Hope it helps,

  4. Dear Knowhow 1234, well, it seems that you have hipersensitivity to those drugs, better not to consume those drugs anymore. As far as I know, if the treatment of priapism is quick enough, it wont cause any nerve or vascular damage. But if there are many episodes of priapisms and not treated fast enough it can cause a hypoxia and even scarring and will cause vascular damage which will affect the erection and also nerve damage which will reduce the sensitivity of the penis.

    But the reducing of sensitivity of the penis also can be caused by other means such as circumcision or excessive masturbation.

    Maybe you can contact your doctor to perform Fine-Touch sensitivity test to measure the sensitivity of your penis, to differentiate whether its psychological or if it is actually sensitivity reduce

    Also the same with every cell in our body, they capable of healing themselves. So neurotropics such as vitamin B complex will help the nerves to heal it self. Hope it helps,

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