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Priapism: causes, signs, treatment

If you have a painful erection lasting several hours, you should immediately see a doctor. Despite the expressed complaints, it is not uncommon for men to seek medical help too late.

Priapism is an involuntary erection not associated with sexual arousal that lasts more than 4-6 hours. An erection of this duration is inevitably accompanied by soreness, discoloration of the skin of the penis. She requires immediate medical attention!

Priapism can develop at any age, but more often in children 5-10 years old and in men 20-50 years old. This is a rather rare condition, patients with such a problem make up only 0.2% of all those who see a doctor for sexual dysfunctions.

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Causes of priapism
The immediate cause of priapism is a violation of blood flow in the cavernous (cavernous) bodies of the penis. In some cases, there is a significant increase in the flow of arterial blood, leading to overflow of the corpora cavernosa (more often this happens with injuries of the penis) – non-ischemic priapism. In other cases, there is a deterioration in venous outflow with stagnation of blood and a change in its properties – ischemic priapism.

Diseases in which priapism can occur:

neurological diseases (brain tumors, spinal cord injuries, consequences of traumatic brain injury, multiple sclerosis);
blood diseases (leukemia, sickle cell anemia);
diseases of the male genital organs (inflammation, swelling and trauma of the penis);
intoxication (taking cocaine or excessive amounts of alcohol, chronic renal failure);
trauma to the genitals, pelvic organs or perineum.
Other factors leading to priapism:

Spinal cord injury
Diseases of the nervous system – multiple sclerosis
Metabolic diseases – diabetes
Blood clots
Poisoning with poisons such as scorpion or black widow.
Medications that can cause priapism:

drugs used to treat erectile dysfunction (Siledenafil (Viagra), vardenafil (Levitra)).
drugs injected directly into the genitals for the treatment of impotence;
antidepressants – Prozac, buporpion (wellbutrin);
psychotropic drugs – risperidone (risperdal), olanzapine (zyprexa);
anti-anxiety drugs – diazepam (Valium);
indirect anticoagulants – warfarin, heparin.
What happens then?
True priapism begins suddenly, usually during sleep. The penis becomes as tense as possible. In this case, urination is usually not disturbed, since only the cavernous bodies of the penis are filled with blood, and the urethra, the head of the penis and the prostate do not participate in erection. An erection is accompanied by pain at the root of the penis and in the perineum, which occurs a few hours after the onset of an attack, sometimes by swelling of the penis, especially the foreskin.

Sexual arousal is uncommon for priapism. Sexual intercourse does not bring relief, since it does not end with ejaculation and does not lead to a weakening of erection, but only intensifies the pain.

Intermittent nocturnal priapism manifests as short-term painful penile erections during sleep. At first, erections with awakenings are quite rare (for example, once a week), but gradually become more frequent, occur several times a night and become more and more painful. Unlike true priapism, an erection weakens after waking up, emptying the bladder, rectum, active movements, walking, taking sleeping pills or sedatives.


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If you have a painful erection lasting several hours, you should immediately see a doctor. Despite the expressed complaints, it is not uncommon for men to seek medical help too late. The main reason is shyness, and often not knowing which doctor to go to. The universal advice is to call an ambulance.

Priapism is diagnosed by an andrologist, urologist or surgeon on examination. You will be scheduled for a comprehensive examination, since very serious diseases can be hidden behind priapism.

The type of priapism can be determined by testing blood gases – a thin needle is inserted into the penis to draw a small amount of blood. If the blood is dark, it is most likely ischemic priapism; if the blood is light red, it is non-ischemic. Laboratory tests of blood gas levels are more accurate.

The earlier treatment is started, the more effective it is. At the initial stage of treatment, puncture of the corpora cavernosa of the penis is performed using a special needle under local anesthesia, aspiration of excess blood and injections of vascular preparations. Since these drugs can enter other vessels and cause a drop in blood pressure and loss of consciousness, treatment should be carried out only in a hospital setting with constant monitoring of blood pressure.

If medical treatment for priapism is unsuccessful, urgent surgery is needed. It consists in creating a drainage vessel between the veins of the penis and other veins to accelerate the outflow of blood. Even in the case of effective treatment, you should be prepared for the fact that after healing, temporary impotence may occur. However, do not worry – after a while, sexual function will return to normal.

Non-ischemic priapism often resolves on its own without treatment. Since there is no risk of tissue damage with this type of priapism, the doctor may choose to wait and see. Applying cold to the perineum, the base of the penis, can help bring the penis back to normal.

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