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Priapism Causes and Treatments

Table of Contents

Benign prostatic hyperplasia

Definition of Priapism

» This is a contra-volitional erection not connected with arousal and protracting more than four-six hours. Penis erection of such endurance is inevitably followed by discomforting symptoms, such as soreness and penis discoloration which do not subside after sexual intercourse. Coitus causes a man suffering. This condition shouldn’t be taken as a sign of hypersexuality and occurs because of circulation failure in the area of male genitalia. It may occur at any age, but is met more often among children of five-ten years old and men of twenty-fifty years old. This is quite a rare disease infecting about 0.2 per cent of all patients with sexual frustrations. Priapism requires emergency medical care.

Types of priapism

This disease causes a disorder of blood circulation wherein blood supply through the arteries may become enhanced, as well as blood outflow through veins may be difficult.

In accordance with abovementioned priapism is divided into the following types:

  • High-flow (arterial, pain-free). In this case, pathological erection occurs because of enhanced blood supply through arteries of penis, whereas veins need more time to take away blood from cavernous bodies. This form is not frequent and occurs more often after injuries or perineoplasty; nevertheless it is favorable for therapy.
  • Low-flow (veno-occlusive, sickly). It’s the most frequent case. This type is caused by venous malperfusion resulting from higher-viscosity blood or its congestion and small thrombosis. Suh blood supply is hard to avoid thin canals of cavernous bodies and go through veins against gravity. As a result of malperfusion there occurs tissue swelling and vessels become even more coarctated causing further hemoconcentration. Sexual organ becomes disconnected with blood circulation. Long-term erection and blood congestion may cause damage to the tissues of penis right up to its functions loss and sometimes necrosis or gangrene.

What Causes Priapism

An immediate cause of this condition is malperfusion in cavernous bodies of penis.

According to its causes priapism is divided as follows:

  • idiopathic priapism is generally met among sound teenagers and men not having any health or sexual issues;
  • psycho-traumatic priapism takes place as a result of stressful shocking situation, for example sudden interruption of sexual intercourse because of explosion, harsh sounds or disasters. There will be thus enacted a mechanism of sharp spasm of penis vessels while blood filling at the brain level;
  • priapism accompanied by neurological and psychic diseases, e.g., epilepsy, neurosis and schizophrenia may be attended by painful erection. People who underwent brain or spine injuries, encephalitis and neuroma suffer from priapism;
  • priapism occurring as a result of blood problems (when viscosity of blood and coagulation suddenly go wrong), blood cancer, sicle-cell form of anemia, some forms of allergy.
  • intoxicating and drug form of priapism takes place in case of poisoning by scorpions or spiders and psychopharmaceuticals, alcohol or drug abuse as well. Sometimes priapism is a side-effect of therapy with antidepressants, medicines for erectile dysfunctions, psychostimulants.

Medicines which may cause priapism:

  • medicines for erectile dysfunctions (sildenafil (Viagra), vardenafil (Levitra));
  • medicines introduced directly into penis for erectile dysfunction treatment;
  • antidepressants – bupropion (Wellbutrin), Prozac;
  • indirect anticoagulants – heparin, warfarin
  • antianxiety agents – diazepam (Valium);
  • psychotropic medication – risperidone (Risperidal), olanzapine (Zyprexa).

How Does It Happen?

True priapism starts abruptly and mostly in sleep. Sexual organ becomes maximally tense. Urination is usually intact, since only cavernous bodies are filled completely with blood, whereas urethra, glans penis as well as prostatic gland do not affect erection. Erection is followed by penis swelling especially of prepitium. Sensation of pain in the field of penis root and perineum occurs in several hours after the initial attack. Sexual excitement is not characteristic for priapism. Sexual intercourse doesn’t bring relief, since it doesn’t finish with emission of seminal fluid and doesn’t cause relaxation of erection, but strengthens pain.

Intermittent night priapism appears in a form of short-term erections during sleep. At the beginning erection with awakening happens rather seldom (for instance, once a week), but gradually it becomes more frequent (several times per night) and more sickly. As opposed to a true priapism erection relaxes after awakening, urinary bladder emptying or defecation, active movements, walking, taking of sleeping or seductive medication.

Symptoms of Priapism

You have to seek medical attendance immediately if:

  • you’ve had an erection for more than 4 hours
  • an erection lasts less than 4 hours, but it is sickly

Thus, priapism manifests itself as a long-term erection, which is subjectively unpleasant, sickly and has duration of more than 3-4 hours (sometimes up to 3-7 days).

The main indicators of priapism:

  • A penis head is not filled with blood. It is soft and seems to hang down above erected penis shaft. Penis curves in an arc towards abdomen.
  • In course of time pain starts resembling the feeling of “stiffening legs”. Intensity of discomfort grows; pain and tension last until erection is over.
  • Sharp piercing pain appears in the area of root of penis irradiating to pelvic area and straight intestine.
  • A man doesn’t feel sexual excitement but is out for coitus. If it is possible it doesn’t bring relief, emission of seminal fluid and reducing of tension in the area of penis. Sexual intercourse becomes painful.
  • For priapism urination is possible as opposed to sexual intercourse, but because of rising up of penis urine stream will be directed upwards which is problematic for urination.
  • Skin of penis reddens and as long as the process progresses it acquires bluish discoloration.

Diagnosis

In case of painful erection lasting several hours one has to seek medical advice. In spite of pronounced complaints very often men seek medical attendance too late. The main reason of it is sense of shame and not knowing which physician to consult.

Priapism diagnosis is determined by urologist, andrologist and surgeon after examination. You will be assigned a multipurpose survey because very serious diseases may lie behind this condition.

The priapism type may be determined by means of gases blood research – a needle is introduced into penis in order to sample blood. In case blood is dark, priapism’s type is low-flow, in case blood is light-red – priapism’s type is high-flow. Lab analysis of gases level in blood proves to more exact.

» For determination of disease form an ultrasound investigation of penis vessels may be conducted. Moreover, the main sign of veno-occlusive form is pain in penis.

Treatments of Priapism by My Canadian Pharmacy

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The earlier therapy is started the more efficient it will be. In the early stage of therapy a series of procedures is conducted: a puncture of cavernous bodies of penis by means of special needle under a local anesthesia, blood excess aspiration and injections with vasoactive agents. Since these agents are able to get into other vessels and cause arterial blood pressure fall along with faintness, treatment must be held in a clinical setting under constant control of arterial blood pressure.

If pharmaceutical therapy of priapism is unsuccessful, an urgent operative intervention is required. It lies in creation of draining vessel between veins of penis and other veins for blood supply acceleration. Even in case of effective therapy you have to be prepared that a temporary erectile dysfunction may occur after recovery. But there is nothing to worry about – a genital function will get back to normal in a while.

» Sometimes a high-flow type of priapism passes away itself without therapy. Since there is no risk of damaging tissues, a physician may choose a watch-and-wait approach. Application of cold compress to penis root and perineum may help to get penis back to normal.

Phenylephrine For Priapism

For termination of priapism it is possible to use any sympathetic agent. Nevertheless a sympathomimetic injected in cavernous body gets into general circulation. There are several adrenergic agents: adrenalin, phenylephrine, ephedrine, mesatonum, metaraminol and norepinephrine. The most optimal agent of this group is phenylephrine, which causes minimal side-effects. Intralocular injection of phenylephrine may be very effective especially when priapism has developed as a result of intralocular injection of phentolamine, papaverine or alprostadil. Solution for injections is prepared by diluting of 1 ml of agent containing 10 mg of phenylephrine in 100 ml of natural saline solution. Then 3-5 ml of this solution is injected into cavernous bodies. This procedure is repeated every 10 minutes until erection stops. Phenylephrine may also be applied as ablution. Side-effects include arterial hypertension, headache, tachycardia and arrhythmia.

Complications

» In case a man feels shame, delays medical appointment and tries to eliminate the problem independently heavy complications may develop: erectile dysfunction, fibrosis of cavities of cavernous bodies, as well as life-threatening necrosis and penis gangrene. In these cases the organ may be amputated.