Priapism - Causes and Symptoms

Definition

Priapism is a painful and persistent erection, which does not depend on desire or sexual excitement. There are two main types of priapism: ischemic (low flow) and non-ischemic (high flow).

Ischemic priapism is the lack of detumescence of the penis due to insufficient venous blood outflow (the blood remains trapped in the organ). It is considered a medical emergency: possible consequences are the fibrosis of the cavernous bodies and the subsequent erectile dysfunction; if the episode lasts more than 4-6 hours, ischemic priapism can lead to penile necrosis and gangrene.

Non-ischemic priapism, on the other hand, is caused by an incorrectly regulated arterial flow; does not lead to necrosis, but may result in erectile dysfunction. Usually, it is the consequence of a trauma, which leads to the rupture of an internal artery of the penis, or depends on the formation of an arteriovenous fistula.

Priapism is a fairly rare condition that recognizes more predisposing factors. In adults, it is often related to the use of drugs to treat erectile dysfunction (eg alprostadil, phentolamine, papaverine and phosphodiesterase type 5 inhibitors). However, it can also be a symptom of hematologic diseases (sickle cell disease, leukemia, lymphoma and thalassemia), prostate cancer, neurological disorders and spinal cord trauma. Priapism is also a side effect of drugs (including ß-blockers, anticoagulants, antihypertensives, antidepressants and corticosteroids) and can be associated with drug abuse (eg amphetamines and cocaine).

Rarely, it can be a consequence of genital infections and inflammation (prostatitis, urethritis and cystitis), pelvic or metastatic tumors. In some cases, priapism may be idiopathic.