Priapism and Its types, Treatment

What is Priapism?

Erections are all about proper blood flow to the penis. Normally it appears when a man is sexually stimulated. The arteries and blood vessels in the pelvis and penis relax and expand. Certain reactions based on sexual excitement ensure more blood to the spongy tissues in the penis. And at the same time, the veins' valves close and trap the blood in the penis to cause an erection. Consequently, you experience a hard erection, and your penis suspects stiffness. And, once your sexual stimulation ends, the vein valves open, the blood flows out, and the penis returns to its usual state. 

But blood flow that is not normal may result in Priapism, an erection that may last for more than 4 hours and can be painful. And another thing to note is that it may happen without sexual arousal. 

Priapism may appear in males of all ages, also including newborns.

What are the types of Priapism?

Two main types of Priapism may affect males' erectile function:

Low-flow or ischemic priapism

During a Low-flow or ischemic Priapism, blood gets trapped in the erection chambers. Most of the time, the exact cause of this kind of Priapism is unknown. But, males having sickle-cell disease, leukemia or malaria are more likely to face it. If you do not get treatment right away, it may lead to the risk of scarring and may cause permanent Erectile dysfunction(Ed). 

High-flow or nonischemic Priapism

Compared to ischemic Priapism, nonischemic Priapism is rare and usually less painful. It may appear due to an injury to the penis or in the areas between the scrotum and anus, known as the perineum. Or rupturing an artery that may prevent the normal movement of blood flow in the penis and may cause high-flow or nonischemic Priapism. 

What causes Priapism?

Here are some leading causes of Priapism:

Blood disorders

These are some blood-related diseases that might contribute to Priapism. Usually, you may see ischemic Priapism due to a blood disorder when blood can't flow out of the penis. These disorders include:

Sickle cell disease

Leukemia

Other blood diseases, such as multiple myeloma and thalassemia 

According to scientists, about 42% of men with sickle cell anemia face problems like Priapism at some point. 

Medications

Use or misuse of certain medications may also result in conditions like Priapism. According to a review posted in 2021, drug-induced Priapism is the most common cause of Priapism in most men. Here are some prescription medications that may affect the blood flow in the penis and may result in conditions like Priapism.

• Medications used to treat Erectile dysfunction(Ed)
• Alpha-blockers
• Antidepressants
• Medications for anxiety disorders
• Blood thinners
• Drugs used to treat attention deficit hyperactivity disorder(ADHD)
• Hormone therapy drugs

Other factors causing Priapism:

Here are some other conditions that may cause complications like Priapism:

Alcohol and drug use: 

Drinking alcohol and using illegal drugs, including cocaine, can lead to ischemic Priapism. 

Injury:

Physical injury or trauma to the penis may cause High flow or nonischemic Priapism.

Spider bites:

Black widow spider bites and scorpion stings may cause toxins resulting in ischemic Priapism.

Carbon monoxide poisoning: 

According to the research, carbon monoxide plays a role in priapism pathophysiology. As a result, high levels of carbon monoxide in the blood may cause Priapism. 

Metabolism disorders:

A metabolism disorder may cause Priapism, including problems like amyloidosis and gout.

Neurogenic disorders:

Priapism can cause by spinal cord injuries and lumbar spinal stenosis(spinal canal narrowing). 

Cancer:

Certain types of cancer may lead to complications like Priapism. It can occur due to leukemia, melanoma, prostate, bladder, or kidney cancers. 

Covid-19:

According to some studies, Priapism can be a possible complication of Covid-19, but still, more research is needed. 

Getting a Diagnosis

If you suspect complications like Priapism, you might need medical care immediately. These are some questions that your doctor may ask to start a diagnosis:

• How long have you had an erection?
• How long does your erection usually last
• Any legal or illegal drugs that you used
• If you have this problem after an injury

A doctor will ask about your medical history and do a physical examination to determine the cause of complications like Priapism. They may also check your rectum and belly to ensure no signs of cancer. Also, a urologist may perform screening tests such as:

• Blood tests
• Doppler ultrasound: An imaging test called a color Doppler ultrasound. It helps to show how blood is flowing in your penis. 
• Arteriogram: It's a kind of imaging test that uses X-rays and a special dye that helps to see inside the arteries.

Treatments for Priapism

Treatment depends on the type of Priapism you face, whether low-flow or high-flow Priapism.

Low-flow or Ischemic priapism

If you suffer from Ischemic Priapism, a doctor may use a needle and syringes to remove excess blood from the penis. Doing this can help relieve the pain and stop involuntary erections. 

Another treatment method includes injecting medications into the penis. These medicines help to shrink the blood vessels that carry blood into your penis and expand the blood vessels that carry blood out of your penis. It may help reduce an erection. 

If neither treatment method works for Low-flow or Ischemic priapism, a doctor may recommend surgery to help blood flow through your penis.

High-flow or Nonischemic priapism

If you suffer from High-flow or nonischemic Priapism, immediate treatment is unnecessary. This type of Priapism can often resolves on its own. 

A doctor may check the underlying the before prescribing you a treatment. To eliminate an involuntary erection, a doctor may suggest cold therapy with ice packs. Sometimes, a doctor may suggest surgery to help stop blood flow to the penis. Or it may repair the arteries damaged by an injury to your penis. 

Frequently asked questions associated with Priapism:

What is the main cause of Priapism?

The use of certain medications, including drugs like antipsychotics, may lead to Priapism. Men facing diseases like sickle cell anemia and other blood disorder are more likely to have complications like Priapism. Physical injuries to the penis and the use of alcohol or illegal drugs are also seen as leading causes of Priapism in some males. 

How do you fix Priapism at home?

High-flow or nonischemic Priapism can often be treated at home. Treatment methods like placing ice packs and pressure on the perineum can help ease symptoms of high-flow Priapism. 

However, you may need immediate medical attention if you face ischemic Priapism. It would be best to discuss with a doctor if erections last longer than 4 hours, especially if the symptoms persist, and cold therapy may not work. 

Can Priapism be cured?

High-flow or nonischemic Priapism may often go away without any treatment. During a high-flow priapism, there isn't a risk of damage to your penis. Putting ice packs and pressure on the perineum in the region between the base of the penis and the anus can help end an erection. 

Can 50 mg Viagra cause priapism?

However, the use of Viagra can sometimes cause Priapism in some men. It may appear as a side effect of Erectile dysfunction drugs like Viagra. Seek immediate medical attention if you experience a long-lasting erection lasting 4 hours after taking an Ed drug like Viagra.