What is Priapism?

Priapism can be briefly defined as a condition where the penis becomes fully or partially erect without any sexual stimulation, and this erection persists for hours. Although not very common, the risk of occurrence is higher in individuals with sickle cell disease compared to others. It can affect men aged 30 and over, as well as children with sickle cell disease. In this blog post regarding priapism, which has two distinct types as ischemic and non-ischemic, you can find answers to important questions such as "What causes priapism?", "What are the symptoms of priapism?", and "How is priapism treated?".

What is Ischemic Priapism?

Ischemic priapism, also known as low-flow priapism, is a type of priapism that occurs because blood cannot leave the penis due to issues with the contraction of smooth muscles in the penile vessels or erectile tissue. In summary, blood gets trapped inside the penis.

The distinguishing feature of ischemic priapism is that it requires emergency medical treatment. If left untreated, it can cause tissue damage in the penis because sufficient oxygen cannot reach the penile tissue.

Typical symptoms include an erection lasting 4 hours or more without sexual stimulation, the glans (head of the penis) being soft while the shaft is rigid, and progressively intensifying pain in the penis.

There is also a recurring type of ischemic priapism (often called stuttering priapism). This type, which is more common in males with deformed red blood cells (such as in sickle cell anemia), occurs as a result of red blood cells blocking the blood vessels. In some cases, erections may start as short and painful, becoming longer over time. Since recurring priapism can also be seen in childhood, it is beneficial for parents to be vigilant.

What is Non-Ischemic Priapism?

Non-ischemic priapism, also known as high-flow priapism, occurs as a result of the arteries in the penis not functioning properly. The main reason it does not require emergency medical treatment like the ischemic type is that in non-ischemic priapism, oxygen can still reach the penis, albeit less than normal.

Mostly, trauma to the penis leads to non-ischemic priapism. Men experiencing this problem also encounter penile hardness lasting 4 hours or more without sexual stimulation. During the erection, the penile shaft is not fully rigid, and this condition usually does not cause pain.

What Causes Priapism?

As I mentioned earlier, different causes can lead to the emergence of different types of priapism. Under normal conditions, an erection occurs in response to a physical and/or psychological stimulus. When stimulation occurs, blood reaches the spongy tissue in the penis, and the penis becomes erect. When stimulation ends, the blood that reached the penis during the erection and remained there until ejaculation returns to the body via veins. Thus, the penis loses its rigidity.

Priapism, on the other hand, is a result of problems experienced in the blood, vessels, nerves, or smooth muscles. The underlying cause may not always be determined. Nevertheless, blood disorders, certain medications used, alcohol consumption, trauma to the penis, toxic infections, and metabolic disorders can be considered potential causes.

How is Priapism Treated?

The diagnostic process is completed by listening to the patient's history, completing the physical examination, and performing additional tests. Subsequently, different treatment options may be resorted to depending on the type of priapism.

Emergency intervention is mandatory when ischemic priapism, which prevents oxygen from reaching the penis, is diagnosed. In this context, treatments such as aspiration (draining) of excess blood from the penis, medication injection (intracavernous injection), or surgical operations (shunt surgery) may be applied.

When the presence of non-ischemic priapism is determined, treatment may not always be necessary. Non-ischemic priapism is generally accepted as a condition that can resolve spontaneously; however, when it occurs due to trauma, surgical intervention may be required to repair the damage in the penile tissue or arteries.