Priapism, though an uncommon condition which only occurs in people with sickle cell anaemia is found to be the most common among men in their 30’s. It is a persistent and painful condition where blood flow to the penis is normal but prolonged without any sexual stimulation. It is drug induced or can be injury related but not by any sexual desire or stimulation. It is unlike normal erection which is inhibited after sexual activity ends as the blood in the penile shaft is immediately drained. Priapism, if not promptly managed can lead to permanent scarring of the penile tissues thereby making it difficult to achieve a normal erection. Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.
Priapism can be classified into two:
Ischaemic or Low Flow Priapism
Non-Ischaemic or High Flow Priapism
Ischaemic Priapism: This is a condition whereby blood flows into the penile shaft and doesn’t drain after a prolonged period. It is usually found among people with sickle cell anaemia. It is not accompanied with sexual stimulation or arousal. It is usually progressive and painful and can lead to scarring of the penile tissues due to the insufficient oxygen in the blood. If not promptly drained can lead to erectile dysfunction.
Non-Ischaemic Priapism: This is characterised by flow of blood into the penile shaft which occurs due to trauma or spinal cord injury which creates a connection between an artery and the corpus cavernosa, thereby making it difficult for blood to adequately drain from the penis. It is a rare condition and it is usually painless unlike the ischaemic priapism. In this case the blood drains slowly from penis after a short period.
Blood disorders: Deficiency in component or alteration in structure of blood especially in cases of sickle cell anaemia can cause blood to get clogged up in the penile tissues of the shaft making the valves expand and penis soft. This makes it difficult for the blood to drain. These blood diseases include sickle cell disorder, leukaemia, thalassemia and others. Scientists think 42% of men get priapism at a point.
Trauma: In a case of non-ischaemic priapism, injury to the penis, spinal cord or perineum at the scrotal region can lead priapism.
Medications: Certain medications have been discovered to put certain men at risk of priapism if used or abused, many of this medication used cause reactions when overused. The most common medications that cause priapism are intra-cavernous injections for treatment of erectile dysfunction (papaverine). Other groups reported are: anti-hypertensives, antipsychotics e.g. chlorpromazine, clozapine, antidepressant (most notably trazadone), anti-convulsant and mood stabilizer like sodium valproate and anti-coagulants.
Carbon monoxide poisoning: Hydrocarbon agents such as fumes and smoke can pollute the haemoglobin which is a blood protein that carries oxygen in the blood for various body functions. The oxy -haemoglobin in the blood is converted to de-oxyhaemoglobin when exposed to these agents thereby affecting certain body functions.
Bites: Snake or black widow spider can cause priapism.
Hard drugs: Consumption of hard drugs like marijuana, heroin and cocaine.
If any of the above signs is discovered, please seek medical intervention immediately to prevent erectile dysfunction.
History taking: The doctor asks questions about the onset, duration, frequency of the condition which must be provided accurately to arrive at a definite diagnosis.
Physical exam: A pelvic exam is carried out to detect discoloration due to the prolonged erection which can lead to erectile dysfunction or in extreme cases penile gangrene. The doctor checks the rigidity of the penis to ascertain the extent of blood flow
Color Doppler ultrasound: This imaging technique reflects the image of the penile shaft using waves to detect the extent of damage made especially in the case of trauma which is common in non-ischemic priapism.
Blood gas testing: This involves testing the blood in corpus cavernous of the penis which reveals a low flow priapism with low ph. while the high flow priapism reflected with a normal blood ph. value
The following are used as notable diagnosis for priapism as they help to differentiate the two types of priapism.
After diagnosis is made by the doctor, treatment is commenced.
Cold therapy: This is most applicable in a case of non-ischemic priapism, cold packs and compression are used to reduce pain and inflammation in the penile shaft. This further helps to decrease the sensation of pain caused by prolonged erection.
Medical therapy: In Ischemic priapism, this condition is such that requires an immediate treatment due to the blood which is not able to exit the penis. This treatment usually begins with a combination of draining blood from the penis and using medications. An alpha agonist medication is used to constrict the blood vessels in the penile shaft which helps the blood to exist the penis.
Aspiration technique is used by the doctor to drain excess blood from the penis with the use of a needle, this is accompanied with saline irrigation to flush the blood in the penis. This procedure can be done repeatedly until the desired result is attained.
Other medications: After the aspiration technique is carried out, if the erection persist, a sympathomimetic medication (phenylephrine) can be used. It is injected into the corpus cavernous of the penis this allows for vasoconstriction of the blood vessels to aid the exist of blood from the penis. After this procedure, adequate bed rest is advised especially in patient with heart conditions. Other medications like sedatives e.g. diazepam can be used to induce sleep thus relieve pain, anaesthetics can be used during the surgical intervention to decrease pain sensation, mild to moderate analgesics can be used to reduce pain.
Dorsal penile nerve block and ring penile block can be used to block pain signals from the nerve.
Surgical intervention: Surgeries are carried out to aid the exit of blood from the penis through shunts created at the corpus cavernosum with intracavernous tunnelling put in place to re-establish blood flow back into the circulation. If all interventions prove abortive, penile amputation is considered.