Is your penis erect for hours without any sexual stimulation, perhaps even with pain? This can be a bit embarrassing and uncomfortable to talk about. But it is not something to ignore. Because this can be a condition called Priapism that requires emergency medical treatment. So, let's talk about this openly without fear or shame.
Simply put, what is Priapism?
Priapism is the prolonged erection of the penis, usually lasting more than four hours , without any sexual stimulation or desire. This is not like a normal erection, and is often painful.
Think about it, normally the penis becomes erect when it is filled with blood. When sexual stimulation ends, that blood flows back into the body, and the penis returns to its normal state. But in Priapism, the blood that has filled the penis cannot flow back out and gets stuck inside. This is why the penis remains erect.
The most important thing is that this is a medical emergency. If not treated promptly, it can cause permanent damage to the penis. So if you experience something like this, don't be embarrassed and stay home and go to a hospital's Emergency Department (ETU) immediately .
What are the main types of priapism?
This condition can be divided into two main types. It is important to know the difference between the two, as the treatment methods may differ. Let's look at it this way to make it easier to understand.
| Type of priapism | Simply put, what happens? | Pain |
|---|---|---|
| Low-flow (ischemic) priapism | The blood that has entered the penis cannot return and becomes blocked . Old, oxygen-depleted blood collects. This is the most common and most dangerous type. | There is severe pain . The pain increases as time goes by. |
| High-flow (nonischemic) priapism | An injury to the penis or surrounding area causes an uncontrolled increase in blood flow to the penis. This is very rare. | There is usually no pain . |
| Recurrent (stuttering) priapism | This is a type of low-flow. Long periods of euphoria come and go, and each time the condition can get worse. | There is pain . |
What exactly are the symptoms of this condition?
The main symptom is that the penis remains erect for more than four hours. However, additional symptoms may vary depending on the two types we discussed earlier.
In low-flow (ischemic) priapism
- Even if the shaft of the penis is very firm, the head (glans) may be soft .
- The pain gradually increases as time passes.
In high-flow (nonischemic) priapism
- Although the penis is alive, it is not completely rigid .
- Usually there is no pain .
What are the causes of priapism?
Sometimes, the exact cause may not be found. But most of the time, it is influenced by certain medical conditions, medications, or other factors.
Underlying medical conditions
- Sickle cell disease: This is the main cause of priapism. This disease is closely related to priapism, especially in childhood.
- Leukemia: This condition can be caused by some types of blood cancer.
- Thalassemias: Another blood disorder.
- Malaria.
Medicines and drugs
- Some medications used for erectile dysfunction: especially when used incorrectly without the advice of a doctor. For example, things like `(intracavernous injection therapy)`.
- Some medications for mental illness: antidepressants and some medications for other mental illnesses (antipsychotics).
- Drug use: Drug use such as marijuana and cocaine can also be a cause of this.
Other reasons
- Injuries to the penis or surrounding area: This can be caused by an injury to the penis, testicles, or the area between the scrotum and anus (perineum).
- Spinal cord injuries.
- Bites from certain insects: For example, the bite of a black widow spider.
- Carbon monoxide poisoning.
How does a doctor diagnose this?
When you go to the hospital, the doctor will reassure you that there is nothing to be ashamed of and ask you a few questions about the condition.
- How long has it been since you were born?
- How long has it usually been since you last had a seizure?
- Do you have any other illnesses (especially sickle cell disease)?
- Has there been any recent injury to the penis or surrounding area?
- What medications do you use?
- Do you use drugs?
Then, a physical examination can be performed and several tests can be done to confirm the condition.
- Blood gas test: This involves taking a very small sample of blood from the penis using a very small needle and measuring its oxygen levels. This can help you determine whether you have low-flow or high-flow.
- Doppler ultrasound: This looks at the blood flow inside the penis. This can help determine if the condition is caused by an accident.
- Toxicology screen: This test can be performed if there is suspicion of drug use.
What are the treatments for priapism?
Remember, there are two main goals of treatment: one is to eliminate erectile dysfunction, and the other is to preserve erectile function in the future.
Important: Do not try to treat this yourself at home. Masturbation or sex usually does not cure this condition. Seek medical advice immediately.
Here are some of the treatments doctors use:
- Aspiration: In this procedure, the doctor numbs the penis and uses a small needle and syringe to remove the old, oxygen-depleted blood that is trapped inside the penis. This reduces pressure and swelling, and relieves the loss of vitality.
- Intracavernosal injection: A type of medication called alpha-agonists is injected directly into the penis through a small needle. This medication works by constricting blood vessels and reducing blood flow to the penis. This is an effective treatment for low-flow erectile dysfunction.
- Applying an ice pack: Applying an ice pack to the penis and surrounding area can help reduce swelling.
- Surgery: If other treatments have not worked or if an artery has been damaged due to an accident, surgery may be necessary. This involves creating an alternative route for blood to flow (shunt) or repairing the damaged artery (ligation).
What happens if left untreated?
This is the most dangerous part that we all need to be aware of.
When blood gets trapped inside the penis, the oxygen in that blood gradually runs out. When oxygen is lost, the delicate tissues in the penis begin to die. This can cause permanent damage .
The two main complications are:
1. Scarring inside the penis: When tissue is damaged and scarred, the shape of the penis can change and cause pain.
2. Permanent erectile dysfunction (ED): This is the most serious consequence. If treatment is delayed, the penis may never be able to function normally in the future.
If low-flow priapism is treated within 24 hours of onset, most men can maintain their ability to ejaculate in the future. However, if it is treated more than 36 hours later, the risk of permanent erectile dysfunction is very high.
Take-Home Message
- Priapism is not a normal erection, it is a medical emergency .
- If the penis remains erect for more than 4 hours without any sexual stimulation and is painful, do not be embarrassed and stay at home and go to a hospital's Emergency Department (ETU) immediately .
- Do not try to treat it yourself at home. This will not be cured by masturbation or sex.
- The sooner you seek treatment, the lower the risk of permanent damage to the penis (especially erectile dysfunction).
- Even though this may be a difficult thing to talk about, be open about it with your doctor. They are trained to help you.
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