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Priapism

Priapism is an uncommon condition that causes a prolonged and often painful erection, which occurs without sexual stimulation. In a third of the cases, the cause is unknown. The remaining cases are caused by an associated condition, including sickle cell disease, pelvic tumors, pelvic infections, leukemia, genital trauma or spinal cord trauma, and medications or recreational drugs.

Priapism is classified into two types — ischemic (no-flow) or non-ischemic (high-flow).

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  • Ischemic Priapism — This is the most common form of priapism and usually occurs with several hours or days of a painful erection. It is caused by an obstruction in the penis' venous drainage, which results in a buildup of poorly oxygenated blood in the corpora cavernosa, the tissue that forms the bulk of the erectile body of the penis.

    Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function, by causing extensive scar tissue build-up and impotence.
  • Non-ischemic Priapism — This type of priapism is not as common or painful. It is usually caused by an injury to the penis or perineum, the area between the scrotum and anus. The injury causes the artery within the erectile body to rupture, and thus pump large amount of blood to the penis continuously.
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Symptoms of priapism include a prolonged and often painful erection without sexual stimulation.

Diagnosis of Ischemic Priapism

Diagnosis involves a medical history and examination to determine any underlying medical causes and the duration of the condition. During the medical examination, your doctor will assess the severity of pain, the rigidity of the penis and lack of involvement of certain parts of the penis. This also will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer. In addition, a sample of your blood will be analyzed to exclude sickle cell disease, thalasaemia major and leukemia.

Diagnosis of Non-ischemic Priapism

Diagnosis of non-ischemic priapism also involves a medical history and examination to determine any underlying medical causes and duration of the condition. In addition, your doctor will conduct a Doppler examination, which measures the blood flow of your penis.

When in doubt, a small needle may be placed in the penis to draw some blood, which is then sent to a lab for analysis. This will help determine which type of priapism the patient is experiencing.

Treatment for all forms of priapism aims to eliminate the erection and pain and preserve normal erectile function. Doctors recommend that anyone experiencing an erection lasting four hours should seek medical evaluation and treatment.

Treatment of Ischemic Priapism

Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function.

In the early stages of ischemic priapism, a cold shower or ice pack may relieve symptoms. Exercise in the form of climbing stairs also may help. Medications, such as analgesics and opiates to control pain, may be recommended as well.

Other treatments for the condition include:

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