Priapism is a pathological permanent erection of the male member that lasts more than two hours and is usually painful. Priapism occurs independently of sexual arousal; orgasm and/or ejaculation does not occur in this state.
What is priapism?
Sometimes an initially normal penile erection does not subside after sexual activity, e.g. B. after taking or overdosing erection-enhancing drugs or injury to the penis erectile tissue during sexual intercourse or masturbation. See healthknowing for What is the Definition of Femoral Head Fracture.
Priapism is always a urological emergency that should be treated by a doctor as soon as possible. If this does not happen, there is a risk of permanent damage to the cavernous bodies of the penis and thus erectile dysfunction (ED, impotence).
The disease is named after the Greek god of fertility, Priapus, who is regularly depicted in art with an oversized, erect penis.
In most cases (90%), priapism is the direct result of a greatly reduced or completely interrupted outflow of venous blood from the cavernous bodies of the penis (low-flow priapism). Due to the associated lack of oxygen supply to the smooth muscles of the penis, there is an acute risk of permanent damage to the erectile tissue with the result of erectile dysfunction.
In addition, in about 10% of cases, a significantly increased blood flow into the penis is responsible for the permanent erection (high-flow priapism).
However, the risk of oxygen deficiency is lower here. Occasionally, this form of priapism is even painless, but requires immediate medical treatment.
The exact reasons for priapism are unknown or cannot be determined with certainty in about 50 to 60% of cases.
However, priapism is often accompanied by the following behaviors or clinical pictures:
- Accidental or intentional overdose of erection-enhancing drugs, especially so-called PDE-5 inhibitors (Viagra, Levitra, Cialis),
- Injuries to the cavernous bodies of the penis, trauma to the penis (e.g. after an operation, an accident, but also due to penis rings that are too tight and inflexible, which can no longer be removed when the member is fully erect and block the blood flow and thus the oxygen supply to the penis,
- Injuries to the spine, the spinal cord and/or the nerve tracts that conduct stimuli from the brain to the genitals,
- Substance abuse (e.g. cocaine, marijuana, ecstasy),
- multiple sclerosis (MS),
- diabetes mellitus,
- consumption of certain aphrodisiacs,
- side effects of certain antidepressants,
- Allergic reactions when using erection-promoting preparations that are injected into the cavernous bodies of the penis (cavernosal autoinjection therapy, abbreviated: SKAT),
- the bite of the “black widow” and related spiders, which release the neurotoxin alpha-latrotoxin and prefer to web under toilet seats. The same applies to the even more poisonous Brazilian wandering spider.
Symptoms, Ailments & Signs
The symptoms that occur with priapism depend on what is causing the priapism. A distinction is made here between the symptoms of low-flow priapism and the symptoms of high-flow priapism. Low-flow priapism is primarily manifested by a persistent erection.
This lasts for more than two hours and sometimes leads to very severe pain. The glans area turns increasingly blue and then loses color. There is an insufficient supply of oxygen to the tissue and thus tissue damage with increasing duration of the erection. The pain often increases as the erection lasts longer. The spongy bodies are maximally erect because the blood return is impeded. This form of priapism accounts for about nine out of ten cases.
The remaining ten percent of cases show symptoms of high-flow priapism. Here, too, there is a persistent erection, which is rarely painful. Instead, the erection is often throbbing and the member still has some elasticity.
Also, consistent with the causes of high-flow priapism, there is pain and swelling at the possible site of injury. In women, a permanent erection of the clitoris is called clitorism. It also comes with pain. However, unlike male priapism, no distinction is made between the forms here.
Diagnosis & History
Priapism can usually be recognized by the fact that although the erectile tissue of the penis is maximal, the glans remains soft and relatively small compared to a healthy erection.
A curvature of the limb upwards is typical.
If the condition lasts longer, the foreskin turns blue, then the glans and finally the entire penis, which is an alarming indication of a lack of oxygen that is threatening the existence of the affected tissue.
The medical diagnosis is usually made in a patient consultation and is backed up by laboratory analysis of a blood sample from the cavernous bodies of the penis. Examination of the penis using ultrasound (duplex sonography) makes it possible in particular to detect and precisely localize injuries to the erectile tissue, blood vessels or other causes of priapism.
Priapism at any stage should be considered a medical emergency and treated promptly. The treatment of low-flow priapism should be started no later than four to six hours after the onset of permanent erection in order to avoid long-term effects. If priapism is not treated, it can lead to a permanent loss of potency.
Complications, despite timely treatment, are to be expected above all if an operation becomes necessary because a puncture of the penis and a flushing of the erectile tissue with saline solution was unsuccessful. In the case of an operation, the penis and the surrounding areas can be injured. Heavy bleeding, secondary bleeding and bruising are just as possible as nerve damage to the glans, which can impair sexual sensitivity. Other possible complications are infections and wound healing disorders. Abnormal scarring is also possible.
Irrespective of the treatment method, the shape of the penis can change permanently after priapism, with curvature in particular being to be expected. In this case, psychological complications often arise. The affected men feel disfigured and develop complexes, often also towards their partner, which is associated with a considerable reduction in quality of life and may require psychotherapy.
When should you go to the doctor?
If an erection lasts longer than two to three hours and is accompanied by severe pain, a doctor should be consulted as soon as possible. Priapism is usually a medical emergency and, if left untreated, can lead to erectile dysfunction. Those affected are best treated immediately to avoid permanent damage. If the swelling persists overnight or is associated with physical symptoms such as chills and fever, a doctor’s visit is recommended.
People suffering from blood diseases, tumors, thrombosis, metabolic diseases or damage to the nervous system are particularly at risk of suffering from priapism. Anyone who belongs to the risk groups should consult their family doctor with the symptoms described. Other contact points are the urologist or an internist. The treatment usually takes place in a specialist clinic, although under certain circumstances drug treatment is also possible, which can be carried out in the doctor’s office. If the therapy is carried out early, permanent damage to the organ can be avoided in up to 90 percent of cases.
Treatment & Therapy
In the treatment of priapism, the first priority is pain control. Only the rare high-flow priapism is sometimes painless. An attempt is then made to reduce the swelling in the limb by administering special medication. If this is not successful, the amount of blood in the penis is reduced by taking blood from the cavernous bodies with a syringe/cannula. Vasodilating injections are used to restore or improve blood flow from the limb to the body.
Finally, as a last resort, an operation may be indicated. In this case, either the blood supply to the penis is inhibited or the blood flow from the member is improved by creating an artificial connection between the venous and arterial system, “relieving” the penis and ending the priapism (shunt surgery).
Essentially, effective prevention of priapism consists of consciously avoiding causes that are within a man’s control, such as responsible use of erection-enhancing drugs and aphrodisiacs, avoiding substance abuse, and exercising caution in the use of various sex toys.
The follow-up of priapism depends on the effects that such a permanent erection has caused in the patient. In acute treatment, it is important that the cause of the priapism can be found and remedied as quickly as possible, or that the patient has undergone specialist treatment quickly enough.
Consequences of priapism such as erectile dysfunction cannot be ruled out and must be treated by a urologist during follow-up care. Subsequent or late effects usually occur if the treatment was only started many hours after the onset of priapism.
In very bad cases, there can also be long-term consequences such as penile deviation, in which the penis is bent. Very rarely there are also forms of tissue necrosis, in which tissue of the penis dies off. Immediately after the acute treatment, which sometimes also requires surgical intervention, follow-up care must be added. Here it must be ensured that none of the long-term effects occur in the patient and that the function of the organ could be properly preserved.
If the first signs of long-term effects appear, the patient must be presented to the urologist immediately, who can plan further measures as required. If the priapism could be treated quickly and completely, it can be assumed that the patient was completely cured and no extensive follow-up care is required.
You can do that yourself
Priapism can usually be stopped by exercising. If these measures are ineffective, an operation must be performed. Those affected who repeatedly suffer from permanent erections that only subside after two or more hours and are associated with severe pain should consult their family doctor.
It is often enough to do relaxation exercises regularly, do moderate exercise and, if necessary, take blood-thinning medication. An adjusted diet can also regulate blood flow. If the symptoms persist, a urologist must be consulted. In the case of severe symptoms, we recommend a visit to the hospital or a discussion with the medical emergency service. Since the permanent erection often occurs in unfavorable situations, underwear with a tight waistband should be worn. However, the penis must not be forcibly moved as this can lead to tissue damage. If the symptoms occur in connection with alcohol, drugs and medication, the triggering agent can be discontinued first.
In the case of chronic complaints, a surgical intervention is necessary in any case. Rest, bed rest and various hygiene measures apply after an operation. It is best for those affected to contact a urologist or the medical emergency service.