Priapism

What is priapism?

Priapism is a state of continued painful erection of the penis for more than four hours, without any sexual stimulation. It is a condition in which the erection is due to an abnormal quantity of blood in the penis, which makes it swollen and tender, and does not improve after ejaculation.

When the condition is caused due to a decreased flow of blood to the penis, it is called ‘low-flow priapism’. When it is caused due to an injury to the region, it is called ‘high-flow priapism’.

The condition is more common in children in the age group of 5-10 years and adults between the ages of 20-50 years. Once initiated, priapism gets worse with time so immediate help must be sought by the patient.

What are the causes?

Priapism is mainly caused by an abnormal blood flow to the penile area. This blood becomes trapped in the penis causing it to swell. In children, this condition frequently occurs in those who have leukaemia. The white blood cells block the passage of blood out of the penis causing priapism. In another condition called sickle cell anaemia, the penis receives a reduced oxygen supply causes continued erection.

There are other conditions which increase the probability of developing priapism. These include:

• Injury to the penile area
  
• Injury to the spinal cord
  
• Side effects of certain drugs
  
• Damage to the nerves supplying blood to the penis
  
• Prolonged sexual activity
  
• Cancer of the abdominal region
  
• Sexually transmitted diseases

What are the symptoms?

The main symptom is erection of the penis for a long time without any sexual stimulation or desire. This is associated with pain and tenderness in the penis.

How is it diagnosed?

The person suffering from the condition is the first one to diagnose it.

What is the treatment?

Effective treatment of the condition depends on the time that has elapsed since its origin. The more time taken by the patient to seek treatment, the more difficult it is to treat the condition. In most cases, the doctor prescribes decongestant medications to help the excess blood to flow out of the penis.

The doctor may also evacuate the blood from the organ by a process called aspiration. In this procedure, a needle is inserted into the penis and excess blood is drained out. A similar procedure called shunting can also be performed, a minor surgical procedure. In this, holes are made in the penile tissue and blood is drained out into the surrounding veins.

What happens after the treatment?

The major complication after the treatment is that in about 50% of the patients some sexual ability is lost. This damage can be reduced if the treatment is started as early as possible. In some cases , there may also be a recurrence of the condition. Some complications that may arise are:

• Bleeding from the holes made during the shunting procedure
  
• Infections of the area
  
• Damage to the urethra - the urine tube
  
• In rare cases, loss of the penis due to infection.
  

The condition cannot be prevented but the risk can be reduced by avoiding drugs that cause the problem. Also excessive sexual stimulation should be avoided. Alertness towards the condition and emergency treatment are the only effective treatment measures.