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What Is Priapism?

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Priapism is probably not a commonly known male condition but any man who has ever experienced it will tell you he never wants to have it again. Priapism is when a man has an abnormal erection in which blood that engorges the penis fails to drain out. Every year emergency rooms see thousands of men with this painful condition that if an erection lasts too long - more than 4 hours - can do permanent damage to the penis.

Two types of priapism

There are two types of priapism - ischemic priapism and nonischemic priapism.
1. Ischemic priapism is the most common form and occurs when blood is not able to flow back out of the penis. The symptoms of this type include:

• An erection lasting more than four hours that is not due to sexual stimulation
• The penile shaft is very rigid but the glans or tip of the penis is soft.
• The pain becomes progressively worse with time

One main cause of this type of priapism is sickle cell anemia. This is an inherited disorder known for its abnormally shaped red blood cells or sickle cells. These cells block the blood vessels in the penis refraining blood to flow back out of an erect penis. Another possible cause is due to taking medication for achieving an erection such as Viagra but this is considered rare. Leukemia, Multiple Myeloma, and Non-Hodgkin Lymphoma have also been known to cause this type of priaspism.

Prescription medications are also associated with ischemic priapism which include:
• Antidepressants
• Medication injected directly into the penis to treat erectile dysfunction
• Blood thinners such as warfarin
• Hormones such as testosterone
• Medications to treat attention-deficit disorder (ADHD)

2. Nonischemic priapism is when penile blood flow isn't regulated normally. This type is usually painless with symptoms that include:

• Erection lasting more than 4 hours that is not due to sexual stimulation
• The penis is erect but not as rigid as in ischemic priapism.

Harmful effects of priapism

Ischemic priapism can lead to possible complications. An erection lasting more than 4 hours means blood trapped in the penis will be deprived of oxygen. When this happens tissues within the penis are at risk of being damaged or destroyed. If ischemic priapism is not treated, this can lead to erectile dysfunction.

When to see a doctor

Anytime an erection has lasted more than 4 hours and or a man is in excruciating pain, it is time to seek emergency care. At the ER, a doctor will determine if the prolonged erection is due to ischemic or nonischemic priapism. The reason for this is each type has a different treatment - ischemic priapism needs to be treated right away.

Treatment for priapism

If priapism is considered ischemic, there are several ways it can be treated:

• The excess blood can be drained from the penis using a small needle and syringe helping relive pain removing oxygen-poor blood.
• A sympathomimetic drug may be injected into the penis constricting blood vessels carrying blood into the penis.
• Surgery may be performed if other treatments do not help. This would involve rerouting blood flow so the blood flows into the penis normally.

Nonischemic priapism usually goes away on its own without treatment. This type of priapism does not cause any risk to the penis as ischemic priapism can. One treatment possibly used could be putting ice packs and pressure on the perineum which is found between the base of the penis and the anus to stop the erection.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team Learn more at Visit Dr. Samadi's blog at Follow Dr. Samadi on Twitter, Instagram, Pintrest and Facebook.