Priapism is a disease characterized by a long painful erection, which does not arise from sexual arousal. Erection is one of the basic functions of the penis. The principal parts of the penis are three erectile bodies. Their structure resembles a sponge. Under a complex influence of the brain the blood flow through the penis is altered. The caverns of the erectile bodies fill with blood. The bodies increase their volume and the penis hardens. This is the principle of erection which enables the penis to be inserted into the vagina. If the man reaches an orgasm, the erection is followed by ejaculation. Ejaculation is a rapid expulsion of the sperm (or semen) from the penis. Subsequently the erection ceases, the penis shrinks and softens. These reactions are indispensable for a conception of an offspring.
Occurrence and causes of priapism
Priapism counts among the less common diseases. Nevertheless it is important to be aware of it for it might have serious consequences. In the developed countries priapism occurs with a frequency of 0.8-1.1 on 100 000 men. The peak incidence is in the age group of 40-50 years. We distinguish between the primary and the secondary priapism. The primary priapism does not have a clear cause. On the other hand the secondary priapism depends on numerous factors. For example it arises after application of medicaments into the erectile bodies in the treatment or diagnosing of erectile dysfunction. It is also a side effect of many drugs for example, the drugs interfering with nervous system, the drugs against hypertension etc. It occurs more often in the diseases of blood. It can also arise from an injury or a tumor of the penis or the perineal region. Prineum is a thick muscular area between the anus and the sexual organ.
How the priapism arises
The priapism may develop by two distinct mechanisms. The first is a chronically increased inflow of blood into the penis. This type of the disease is curable, has a better prognosis and is not so painful. The nature of the second mechanism is a chronically compromised drainage of blood from the penis. This type is very painful and has a worse prognosis. Throughout the course of an episode of priapism the oxygenation of blood in the penis decreases and the blood becomes denser. After 24 hours the erectile bodies are damaged. Small blood clots occur and they obstruct the vessels in the penis. There are many substances which contribute to development of priapism including alcohol and recreational drugs such as marihuana and cocaine.
Diagnosis of priapism
The information about the duration of the erection and the intensity of pain is essential for a correct diagnosis of priapism. It is also important to know if the patient have had the condition before and if he's been using medication which may cause priapism. The differentiation between the primary and the secondary priapism is necessary in search for the underlying cause. Only two of the erectile bodies are affected in priapism. The third erectile body located in the lower part of the penis and in the glans remains flaccid in this disease. Blood from the erectile bodies is usually taken for analysis. If the doctor suspects drug abuse a toxicological analysis of urine is required. An ultrasound examination of penile vessels is also important.
Treatment of priapism
The causes of priapism have to be known before the treatment commences. They determine the prognosis and the course of treatment. In the priapism arising from the compromised blood drainage the response to treatment is unpredictable. Therefore several methods are employed until a curative effect is reached. On the contrary in the high-blood-flow priapism careful observation and selective embolization are the methods of choice. The selective embolization is based on partial narrowing of the afferent vessel, which results in decreased blood-flow.
From the reasons stated above we sometimes use conservative and sometimes operative treatment. The conservative treatment consists of cooling of the penis by ice filled bags. Blood drainage from the erectile bodies by a syringe and a needle is another possibility. If the conservative methods are insufficient or the priapism reoccurs operative methods are used. If the priapism is treated within 36 hours, the treatment is usually successful and complications such as vessels damage do not occur.
Complications of priapism
Numerous complications may arise in priapism. Hypertension, bleeding, infection and damage to the urethra by a needle count among the common ones. Bruises and contusions are often. However the most feared complications are erectile dysfunction and a permanent loss of erectile function. It is a late complication of priapism. It is certainly a serious one and its probability rises with a delay in treatment. We therefore recommend to seek doctor's help immediately after you become suspicious about having a priapism.