A priapism is a full hard erection that lasts more than 4 hours and is usually very painful.
Priapism Treatment Video: Cure Priapism, Side Effects, low-flow: Always want, always can: Many men imagine how wonderful it would be to have a “permanent stand”. In reality, however, priapism is anything but pleasant, rather painful – and in most cases, it needs to be treated promptly. But what exactly is it?
What is a priapism?
Priapism (permanent erection) is a prolonged erection of the penis, which also develops or lasts without any sexual stimulation. Doctors talk about priapism when the erection lasts more than four hours.
Incidentally, the name priapism derives from the Greek god Priapos. He is the son of Aphrodite – the goddess of love, sensual desire and beauty – and Dionysus, god of joy, grapes, wine, fertility, madness and ecstasy. Since Priapos is also considered the god of fertility, there are numerous representations that show him with an oversized erect penis.
For the first time in the history of medicine, the permanent erection was described in 1824 – in a case report. It was not until the twentieth century that the focus was on pathophysiology and the different types of priapism. Also in the field of therapeutic measures at this time appropriate investigations.
Incidentally, there is a female counterpart to male priapism, the so-called clitoris – but one has to be careful with this expression. Because it is also used when the female clitoris is overly developed.
Causes of a permanent erection (priapism)
The causes for developing priapism are many. On the one hand, there are various prescription drugs that can trigger priapism. These include, for example, drugs that are injected directly into the erectile tissue, such as papavarin or prostaglandin E1. Medications that act in the central nervous system (such as trazodone or benzodiazepines) may also lead to the development of priapism. But also drugs for the treatment of elevated blood pressure (eg prazosin or calcium blocker as hypertensive medications) occasionally trigger a chemical priapism. This is also described in the anticogulants such as heparin and Marcumar.
Apparently, hormones – such as the king’s hormone of man, the testosterone – but also the parenteral intake of dietary supplements can lead to a permanent erection. The same applies to some illegal drugs, such as cocaine or marijuana.
It also happens that infectious diseases such as malaria, syphilis or mumps trigger a “low-flow” -prolapism – diseases in the blood system – such as polycythemia Rubera Vera (hyperviscosity of the blood), but also changes in hemoglobin – such as Sickle cell anemia or thymic disease – and also immunological diseases – such as the autoimmune disease lupus – can lead to a permanent erection.
Other possible causes and triggers: Metabolic disorders such as nephrotic syndrome or diabetes, neurological disorders such as spinal cord injury or autonomic neuropathy. In addition: neoplastic diseases (eg leukemia), tumor infiltration of a prostate carcinoma or urethral carcinoma and metastases.
If none of these causes can be proven, physicians speak of an idiopathic “low flow” -tripism.
Possible causes at a glance
- Sexual stimulation
- Blood disorders (eg safe cell anemia)
- Medicines, eg antidepressants
- Erection-promoting drugs (especially locally administered injections)
- Injuries in the pelvis or penis area
- drug consumption
- excessive consumption of alcohol
Diagnosis of Priapism
If the permanent erection is longer than two hours, a doctor should be consulted immediately.
This initially requested the history of the patient. This includes, for example, whether the person concerned has previously had a permanent erection, suffers from certain illnesses or takes medication.
In addition, the doctor will examine the penis externally and possibly examine the perineal and genital area for injuries. In addition, he can take blood from the erectile tissue of the penis, in order to undergo a blood gas analysis. This makes it possible to distinguish between a low-flow or high-flow priapism.
If it is a low-flow priapism, the blood has a dark color and a low pH. If the patient suffers from high-flow priapism, the blood is colored brightred and has a near-normal pH.
In addition, the doctor can perform an ultrasound examinatio. The inflow and outflow of blood into the erectile tissue are examined. In low-flow priapism, there is hardly any blood drainage.
Finnish scientists have come to the conclusion that in Finland, 0.3 to 0.5 men (per 1000 people) present with priapism per year in the hospital. A Dutch study shows that on average 2 men (out of 100,000 men) are affected by a priapism.
If a man receives a permanent erection, he should immediately present himself in an emergency room. If a priapism persists for a long time, it can lead to erectile dysfunction (ED).Important
Background: To understand what priapism is all about, let’s take a look at a “normal” erection. Normally, erections (including nocturnal erections) are triggered by nerve impulses. The nerve impulses can be directly through stimulation of the genitals or they are routed over the head in the way.
An erection is initiated by allowing more blood to flow from the pelvis into the penis through the blood-supplying vessels (arteries). The penis is filled with blood, the blood is held and the outflow of blood is throttled. After orgasm or after sexual stimulation, the blood usually flows back from the penis back into the body.
The following can happen with priapism: too much blood flows into the erectile tissue or too little blood flows out of the penis. The most common form of priapism is ischemic priapism (low-flow priapism = disorder of the veno-occlusive system: the blood is held in the penis and does not drain properly). In normally less painful non-ischemic priapism (high-flow priapism), too much blood flows into the penis through the arteries – often a consequence of injuries in the vascular system.
In addition to a conversation and a physical examination should possibly be carried out laboratory tests – among other things, an aspiration of the blood from the erectile tissue is necessary. In order to clarify which type of priapism the differential diagnosis is, a blood gas analysis should be carried out in which the partial pressure of oxygen and the partial pressure of CO2 including the pH value are measured. In ischemic priapism, the blood gas analysis of penile blood usually shows abnormal values. It is also advisable to perform a Doppler duplex sonography of the penis in order to detect increased blood flow.
Therapy of priapism
Basically, it is important to soothe the patient and make sure that it is well hydrated. If necessary, a local block or a local anesthesia, occasionally a systemic sedation to calm the patient done. Subsequently, the patient is drawn blood from the penis – as the basis for a detailed analysis. If low flow priapism is present, sympathomimetic substances are injected. Furthermore, one tries to aspirate the blood from the penis in order to achieve a flacidity of the penis. In some cases, the basic dye methylene blue is used to soften the penis. If all this does not lead to the desired success, only the surgical intervention remains. Here, a so-called shunt between the blood-filled erectile tissue and the glans is placed. This ensures
In non-ischemic priapism (high flow priapism), the attending physician is not so much under time pressure. Because 62% of the cases take care of themselves without therapeutic measures. Otherwise, a selective embolization of the vessels must be carried out. Here, a catheter is usually placed over the groin, so that you can get to the arteries (supplying blood vessels) of the penis. After identifying the body responsible for priapism, it will be embolized accordingly. If the arterial supply of the penis is damaged here, there is a risk of long-term erectile dysfunction.
In particular, in the case of ischemic priapism, a therapeutic intervention should be carried out no later than 4 hours after the occurrence of this permanent erection. Otherwise, it can lead to massive tissue damage – and thus to a long-term erectile dysfunction. Conservative measures can sometimes cause this erectile dysfunction to be reversed. Other possible sequelae: penile curvature, in rare cases gangrene (tissue necrosis). This usually arises after a deficiency in oxygen deficiency of the corresponding tissue.
The different types of permanent erection (Priapism)
Basically, one differentiates between three types of permanent erection in medicine:
“Low flow” trinity
A chemical priapism (usually drug-mediated) is also known as “low flow” priapism, which is the most common form of priapism, occurring in 80 to 90 percent of cases – the particularly hard erection is usually very severe This is partly due to the fact that the blood that flowed into the erectile tissue during the erection can no longer flow away, hence the name “low flow”: there is hardly any blood flowing out of the erectile tissue.
“High Flow” -riapism
This non-chemical priapism is also called arterial conditional erection. As the name implies, in this comparatively “harmless” form of priapism, an extraordinary amount of blood flows into the erectile tissue. This can be caused, for example, by blood vessel fistulas, which pump in a great deal of arterial blood into the erectile tissue. However, the high-flow priapism can also occur after blunt or acute trauma in the perineal area (secondary cause).
This form of priapism is also called recurring priapism. It is a variant of chemical priapism, in which the painful erections occur again and again. So there are periods when the penis is soft (flaszide). This is followed by times when the man permanently has an erect penis.
Treatment of low-flow priapism
The treatment of the permanent erection should take place no later than four to six hours after stiffening has occurred in order to prevent consequential damage.
If it is a low-flow priapism, the therapy ensures that the blood can flow out of the erectile tissue again. For this, the jammed blood is sucked offby puncturing the penis with a syringe. In addition, the cavernous bodies are rinsed with a saline solution . In addition, the doctor may also inject a substance into the penis, which causes the muscles to contract and the blood to drain.
If these treatments do not produce the desired result, the affected person’s penis must be operated on. During surgery, a so-called shunt is placed between the blood-filled erectile tissue and the glans. The shunt is a short-circuit connection, which ensures that the blood can flow out of the penis again.
Treatment of high-flow priapism
The persistent erection of high-flow priapism usually ceases on its own.
In rare cases where this does not happen, the doctor can perform an angiography. On this he can recognize the blood vessels of the affected person after administration of a contrast agent. Subsequently, the damaged vessel is closed by embolization (artificial vascular occlusion). However, this method itself can lead to erectile dysfunction(erectile dysfunction).
Another option is medications that help to reduce the duration of the permanent erection.
What exactly happens with a chemical low flow priapism?
Essentially, there is an imbalance between constrictor activities and relaxing mechanisms. This leads to an oxygen depletion (hypoxia) as well as to acidosis (the environment in the penis becomes acidic) in the two penile bodies of the penis, which are responsible for the erection. A long-lasting chemical priapism has the result, for example, the smooth muscle cells in the penis, which are very crucial for good erections, irreversibly damaged. In the long term fibrosis of the erectile tissue occurs (poor tissue for erectile function).