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What is Priapism?

By Dr Kizito Lubao

Priapism is a potentially painful medical condition, in which the erect penis or clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours.

The two types of Priapism are the low-flow and high-flow Priapism. 80 per cent to 90 per cent of clinically presented Priapisms are low flow disorders. This involves the blood not adequately returning to the body from the organ. High-flow involves a short-circuit of the vascular system partway along the organ.

Treatment is different for each type. 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. The duration of a normal erection before it is classifiable as Priapism is still controversial. Ongoing penile erections for more than six hours can be classified as priapism.

The name comes from the Greek god Priapus, a fertility god often represented with a disproportionately large and permanent erection.

Contrary to popular belief, this condition is not associated with sexual thoughts or sexual desire, even though the etymology of the word itself comes from the Greek male fertility god, Priapus.

What causes Priapism?

Common causes of Priapism include:

•     Alcohol or drug abuse (especially cocaine)

•     Certain medications, including some antidepressants and blood pressure medications

•     Spinal cord problems

•     Injury to the genitals

•     Anesthesia

•     Penile injection therapy (a treatment for erectile dysfunction)

•     Blood diseases, including leukemia and sickle cell anemia

How and why does Priapism occur?

In the normal erection process, blood flows into the penis and stays until after an orgasm, when it drains out of the penis without discomfort. When Priapism occurs the blood is unable to drain as it would normally. Because there is little room in the penis for blood to circulate, it becomes stagnant and begins to lose oxygen. Without oxygen, red blood cells become stiff, making proper penis drainage even more problematic.

While priapism can occur without an obvious cause, most cases of Priapism have clear medical explanations. Penile drug injections — sometimes used to treat erectile dysfunction — can lead to Priapism, especially if more of the drug is used than is recommended. Certain psychiatric medications, like anti-depressants, can also lead to Priapism, though it is not totally understood why.

There are also some medical conditions that can cause painful and prolonged erections. Any bodily ailment that causes blood to thicken or causes red blood cells to lose their flexibility and mobility can lead to Priapism. Having sickle-cell anemia or leukemia or suffering a ruptured spine or paralysation can exacerbate Priapism.

Priapism can scar the penis and lead to impotence if not treated in a timely fashion, usually within four to six hours.

How is Priapism treated?

Treatment for Priapism is a medical emergency, because a prolonged erection can scar the penis and result in a long term complication of erectile dysfunction if not treated. The goal of treatment is to relieve the erection and preserve normal penile function.

In most cases, treatment involves draining the blood using a needle placed in the side of the penis. Medications that help shrink blood vessels, which decreases blood flow to the penis, also may be used.

In rare cases, surgery may be required to avoid permanent damage to the penis. If the condition is due to sickle cell disease, a blood transfusion may be necessary. Treating any underlying medical condition or substance abuse problem is important to preventing priapism.

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