Understanding Priapism

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t’s been alluded to on television emergency-room dramas, laughed at in the movies and cited as a warning for those taking popular medications. But it is unlikely that you have ever heard the real medical name of this condition and the serious impact it can have on a man’s life.

Priapism is a condition that causes a prolonged erection that can result in pain and discomfort. While many make jokes about this condition, it can be very dangerous and medical attention needs to be sought immediately. 

The good news is that priapism is incredibly rare, but it does occur more often in certain high risk populations, such as in people with sickle cell anemia and those who take particular medications.

What causes priapism?
This disease can occur at any age, even in infants, but is generally seen in two distinct populations: between the age of 5 to 10 and between 20 to 50. While priapism itself is always identified as an erection that lasts for at least four hours, there are various causes of priapism, and none of them stem from sexual activity.

For children, the most common causes of priapism are leukemia and sickle cell anemia. In the case of leukemia, white blood cells block the outflow of blood from the penis, causing it to form an erection. Sickle cell anemia, on the other hand, causes priapism because the abnormally-shaped blood cells can prevent blood flow out of an erect penis. In fact, “42 percent of all sickle-cell adults and 64 percent of all sickle-cell children will eventually develop priapism,” writes Dr. Christopher Steidle, author of The Impotence Sourcebook.

Other, rarer causes of priapism in children include trauma to the groin area, side effects from certain medications and spinal cord injuries.

In adults, priapism may be caused by unknown reasons. But, when a cause can be diagnosed, it usually stems from sickle-cell disease and drug injections to treat erectile dysfunction. Other legal drugs, such as some that treat High Blood Pressure or mental disorders can also cause the condition, as well as illicit substances, like marijuana and cocaine. Occasionally, priapism is tied to rare abdomen or rectal cancers.

How is priapism treated?
If you experience an erection for four hours or more, be sure to seek medical treatment immediately. Your doctor has several treatment options to pick from depending on the cause of your condition.

It is important to be honest with your doctor about any medications or drugs you took earlier in the day, as well as when the erection began.

Most likely, your doctor will first get a blood-gas measurement by taking a small sample of blood from your penis. This will help the doctor figure out the cause of the condition.

The first line of treatment is often a drug that relaxes the muscles and walls of the arteries, such as terbutaline or albuterol. This drug may help the blood that is in the penis to escape and provide some relief. However, once the condition lasts for several hours, this treatment becomes much less effective. Therefore, a doctor often needs to remove the excess blood from the penis manually with a small needle. And fortunately, “if the treatment is done early in the course of the disease, this is all that is necessary,” writes Steidle.

If the priapism is recurring, however, a minor surgical procedure may need to be performed to drain the blood from the penis and create a shunt to prevent excess blood flow to the area.

Are there any side effects?
Steidle estimates that about 50 percent of men who experience priapism will develop some degree of erectile problems. Additional problems include infections, bleeding and skin irritation.

In extremely rare cases, especially if a shunt is placed in the penis, a blood clot may form in the area, blocking blood flow and forcing doctors to surgically remove the affected area. 

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