High-Flow Priapism

A persistent erection, lasting much longer than normal, is called priapism. This happens when the penis stays firm even when there's no sexual interest or activity. A prolonged erection can be either partial or complete. There are two main types: ischemic and non-ischemic.

Ischemic priapism is a serious medical problem that needs immediate attention. It's important to get help quickly because if left untreated, it can harm the tissues of the penis, potentially leading to erectile dysfunction (trouble getting or keeping an erection in the future).

While priapism isn't a very common problem in general, it does happen more often in certain groups of people, like those with sickle cell disease. Early treatment is key to preventing long-term problems.

Priapism typically affects men in their 30s and older, but it can also affect younger males, especially those with sickle cell disease, even during childhood.

Priapism is a persistent and painful erection that lasts longer than four hours. The symptoms of priapism can differ depending on the cause. There are two main types: ischemic and nonischemic priapism.

Ischemic priapism happens when blood flow is trapped in the penis, which can lead to pain and stiffness. This happens because the blood vessels in the penis don't open and close properly. The trapped blood is a key reason for the painful erection.

Nonischemic priapism, on the other hand, is often less painful. It's caused by something other than a blocked blood vessel in the penis. This could be due to medical conditions like leukemia or some blood disorders, or other factors like certain medications. The lack of pain is sometimes a symptom that distinguishes it from ischemic priapism. It's important to remember that both types of priapism require prompt medical attention to avoid possible long-term problems.

A prolonged erection lasting more than four hours is a medical emergency. This is a serious situation that requires immediate attention. A doctor at the emergency room will determine if the erection is caused by a lack of blood flow (ischemic priapism) or another reason (nonischemic priapism). Either way, prompt medical care is crucial.

If you have painful erections that happen repeatedly and go away on their own, you should see a doctor as soon as possible. This is important because the doctor can figure out why these erections are happening and recommend treatment to prevent them from happening again. It's important to get professional advice to avoid future problems.

An erection happens when you're physically or mentally aroused. This arousal signals some muscles in your penis to relax, which lets more blood flow into the spongy tissues. This makes the penis fill with blood and become hard. When the arousal stops, the blood drains away, and the penis goes limp again.

Priapism happens when something goes wrong with this process. Maybe the blood flow is too much, the blood vessels are acting strangely, or there's a problem with the muscles or nerves in the penis. This causes an erection that won't go away. Sometimes doctors can't figure out why priapism happens, but several health issues can be connected to it.

A persistent erection, lasting more than four hours, can be a serious problem. This condition, called ischemic priapism, happens when blood gets trapped in the penis, and that blood doesn't get enough oxygen. Without enough oxygen, the tissues in the penis can start to get damaged or even die. If ischemic priapism isn't treated quickly, it can lead to long-term problems with getting and maintaining an erection, a condition known as erectile dysfunction.

If you've had a prolonged, painful erection (stuttering priapism), your doctor will likely suggest steps to prevent future episodes. These might include:

• Treating any medical conditions: Sometimes, priapism is a symptom of an underlying health problem. If this is the case, treating the underlying condition, like sickle cell disease, is crucial to prevent further episodes.

• Medications to help shrink the blood vessels: Your doctor might prescribe phenylephrine, either taken by mouth (orally) or injected, to help constrict the blood vessels in your penis. This can help resolve the erection.

• Hormone-blocking medication (for adults only): In some cases, hormone imbalances can contribute to priapism. For adult men, hormone-blocking medications might be prescribed to address any hormonal issues.

• Medications for erectile dysfunction (ED): If ED is a factor, medications designed to treat erectile dysfunction (ED) might be considered. These medications can sometimes help manage future episodes.

If your erection lasts more than four hours, seek immediate medical attention. This is a serious situation that needs urgent care.

Doctors in the emergency room will figure out if you have a type of priapism called ischemic priapism or nonischemic priapism. These are different conditions, and treatment for ischemic priapism needs to start quickly.

To tell the difference, the doctor will ask questions and examine your penis, stomach area, groin, and the area between your legs (perineum). The doctor might be able to tell which type of priapism you have based on whether it hurts and how firm your penis is. The exam can also help find any possible tumors or signs of injury.

Sometimes, additional tests are needed to pinpoint the exact type of priapism. These tests can also help identify the underlying cause. Treatment often begins in the emergency room even before all test results are available.

Here are some tests that might be done:

• Penile Blood Gas Measurement: A very small needle is used to draw a sample of blood from your penis. If the blood looks dark, meaning it's low on oxygen, it's more likely ischemic priapism. Bright red blood suggests nonischemic priapism. A lab will measure the levels of certain gases in the blood to confirm the diagnosis.

• Blood Tests: A sample of blood from your arm can be checked for the number of red blood cells and platelets. This can reveal if you have conditions like sickle cell disease, other blood disorders, or certain cancers that might be causing the priapism.

• Ultrasound: A non-invasive test called Doppler ultrasound uses sound waves to measure blood flow in your penis. This helps determine if the blood flow is abnormal, which can indicate ischemic or nonischemic priapism. The test can also find injuries or problems in the blood vessels that might be causing the issue.

• Toxicology Test: A blood or urine test might be done to check for drugs that could be causing the priapism.

Priapism is a medical emergency where the penis stays erect for an extended time due to a problem with blood flow. There are two main types: ischemic and non-ischemic.

Ischemic priapism is a serious condition where blood can't leave the penis. This needs immediate attention. Treatment usually starts with relieving any pain, and then draining the extra blood from the penis. Medications are often used alongside this.

If the person has sickle cell disease, additional treatments targeting the underlying disease might also be needed to resolve the episode.

Non-ischemic priapism often resolves on its own without treatment. Since there's no risk of permanent damage to the penis, a "wait and see" approach might be recommended. Applying ice packs and pressure to the area between the penis base and anus (the perineum) might help.

In some cases of non-ischemic priapism, or if other methods fail, surgery might be necessary. This could involve inserting a temporary material (like an absorbable gel) to block blood flow, which the body will eventually absorb. Surgery may also be needed to fix damaged arteries or tissues if an injury is the cause.

Here are some common treatment options for both types of priapism:

• Aspiration Decompression: A small needle and syringe are used to remove excess blood from the penis (aspiration). Sometimes, a saline solution is used to flush the penis. This can ease pain, remove blood that's low in oxygen, and potentially stop the erection. This procedure may need to be repeated.

• Medications: A medicine like phenylephrine might be injected into the penis. This medicine narrows the blood vessels that bring blood into the penis and widens the vessels that take blood out. This helps more blood leave the penis. The treatment may need to be repeated, and the person will be carefully watched for side effects, especially if they have high blood pressure or heart conditions. Possible side effects include headaches, dizziness, and high blood pressure.

• Surgery or Other Procedures: If other treatments don't work, surgery might be needed to drain blood from the penis or to correct blood flow problems. This is usually a last resort.

It's crucial to seek immediate medical attention for any prolonged erection, as prompt treatment can help prevent long-term problems with the penis.