Do you know about Priapism (Prolonged Erection)?

What is priapism (Prolonged Erection)?

A priapism is a prolonged erection of the penis (more than 4 hours) that occurs without any sexual stimulation.

There are two types of priapism.

• Ischemic priapism (low blood flow)

• Non-ischemic priapism (high blood flow)

Persistent erectile dysfunction is rare. However, some cases are more common in certain groups of men.

PEF is thought to occur in about 1 in 100,000 men every year 1. In men who use penile injections to treat erectile dysfunction, the incidence of prolonged erection is about 2 in 100,000. With sickle cell disease, 3 to 4 out of 1 will have erections that last a lifetime.

Ischemic prolonged erection is much more common (more than 95% of cases) than non-ischemic priapism (less than 5%).

Symptoms of Priapism (Prolonged Erection)?

Persistent erectile dysfunction is defined by the presence of prolonged erections (lasting more than 4 hours) in the absence of sexual stimulation. These symptoms are very common to all types of prolonged erection.

In ischemic priapism, the shaft of the penis is very hard, but the head of the penis is soft. This condition is usually painful, and the pain gets progressively worse.

In non-ischemic priapism, the penis is usually not hard enough.

What Causes Priapism (Prolonged Erection)?

Persistent erectile dysfunction is caused by abnormal blood flow to the erectile tissue of the penis. When excited, the arteries in the pelvis and penis relax and expand, allowing more blood to flow through the spongy tissue of the penis. After that, the blood is trapped under high pressure, causing an erection. When not aroused, blood flows out of the penis and returns to a relaxed state.

In ischemic priapism, blood flow to the tissues builds up over time because blood flow to the erectile tissues is impaired. There are many causes of poor blood circulation, but there are many unknown causes.

The most commonly known cause of ischemic priapism is sickle cell disease, which causes abnormal shape and function of red blood cells. Drug use (especially drugs used for erectile dysfunction like Cenforce 200 mg and cenforce 150 mg, especially when used with other drugs) or use of entertainment or illegal drugs can affect long-term erections. Cancer or conditions that increase clotting factors in the blood can increase the risk of developing prolonged erection.

Non-ischemic prolonged erection is most often caused by trauma that damages the arteries that supply blood to the penis.

Diagnosis of priapism (Prolonged Erection)?

Your doctor will ask your questions to help identify possible causes of prolonged erection, including:

• Drugs and medication use by you
• Other health problems you may have
• Presence or absence of pain
• If you have suffered an injury for which you are responsible.

A physical exam helps doctors assess the severity of prolonged erection, whether the head of the penis is affected, and identifies signs of injury.

Testing a sample of blood taken with a needle can help determine if you have ischemic or non-ischemic priapism, but it’s not always necessary. Ultrasound imaging can also be used to assess blood flow.

Other tests may be needed depending on the possible cause of the prolonged erection.

Priapism Treatment

Ischemic priapism

Ischemic priapism requires blood drainage as it can cause irreversible damage to the penis due to lack of blood flow. Medications taken in pill form can be the first line of treatment, but they only work in 1 in 3 cases in 42.3. If medication fails, a needle and syringe can be used to draw blood, but alone they are only effective in about one-third of cases3.

The standard treatment for ischemic prolonged erection involves drawing blood with a needle and syringe, then injecting a drug that changes blood flow to the penis. This treatment is effective in 4 to 8 cases out of 102.

If these treatments do not relieve ischemic prolonged erection, surgery is needed to prevent irreversible damage to penile tissue. There are several surgical procedures that can be used to divert blood from the corpora cavernosa to allow it to flow out of the penis.

If all treatments to relieve ischemic priapism, including surgery, fail, the resulting damage to penile tissue can lead to erectile dysfunction in the future. If this happens, a penile prosthesis (implant) can be inserted to allow an erection.

Non-ischemic priapism

If you have non-ischemic priapism, ice packs or compressions may be used.

Another treatment for non-ischemic priapism is to block the blood vessels that supply blood to the penis. This can provide immediate relief and is effective in 1 out of 1 case. However, since non-ischemic attacks recur in 3-4 out of 10 cases and 1-2 out of 10 experience erectile dysfunction as a side effect, you should discuss with your doctor if this treatment is right for you.

Treatments used for ischemic priapism are not recommended for treating non-ischemic prolonged erection.

Recurrent ischemic priapism

Rarely, some people may experience recurring prolonged erection. There are several medical options for treating recurrent ischemic priapism. For men with sickle cell disease, treating the underlying problem with medication or blood transfusions can help.

What to do with priapism (Prolonged Erection)?

If you have pain during an erection, you should consult your doctor.

If erection pain persists, see a doctor immediately, as the sooner you treat it, the better the results.

If you have sickle cell disease, talk to your doctor about what to watch out for and how to minimize the risk of prolonged erection.

What questions should I ask my doctor about prolonged erection?

• What effects should I expect from prolonged erection?
• Can anyone tell me about the effect of prolonged erection on my mental health and relationships?
• What treatment do you think could help my sexual function after prolonged erection?
• What signs and symptoms should I watch out for?
• How can I avoid prolonged erection and other complications of sickle cell disease?

References

[1] Eland et al., 2001. The incidence of prolonged erection in the general population. urology

[2] Broderick et al., 2010. Pyrism: etiology, epidemiology and management. sexual medicine journal