Priapism

Priapism is a painful and potentially harmful medical condition in which the erect penis does not return to its flaccid state despite the absence of both physical and psychological stimulation within four hours. It is a medical emergency and needs proper treatment by a qualified medical practitioner.

It can occur to any age group including even the infants; nevertheless, it is more frequent between the ages of 5 to 10 years and 20 to 50 years. Priapism can be categorised into low-flow and high-flow based on two different reasons. When blood is trapped in the erection chamber of an otherwise healthy person without a known reason, it is low-flow Priapism. This type of Priapism may also be the result of sickle-cell disease, leukaemia (blood cancer) or malaria. High-flow Priapism is rare and less painful, generally caused by a ruptured artery from an injury to the penis or the area between scrotum and anus resulting in abnormal blood flow to the penis. Other causes of Priapism include trauma to the spinal cord or to the genital area, black widow spider bites, carbon monoxide poisoning, and illicit drug use, such as marijuana and cocaine, certain drugs like antidepressants, antihypertensives, anticoagulants and corticosteroids. The drugs which are used to treat impotency, particularly those given by injection in the penis like papaverine, prostaglandin E1 (alprostadil), phentolamine can cause this problem. One more significant class of drugs may have the potential of Priapism,that are, the phosphodiesterase type-5 (PDE5) inhibitors such as sildenafil, tadalafil and vardenafil, sold under the names of FDA approved Viagra, Cialis and Levitra consecutively.

Though the makers of erectile dysfunction drugs list prolonged, unwanted erections as a potential side effect, Viagra and other PED5 drugs have not been found to cause priapism unless combined with other medications like prostaglandin injections and a recreational drug called Ecstasy. All the PDE5 drugs requires sexual stimulation to get an erection, however, these type of drugs should be used with caution for patients who have conditions that might predispose them to priapism such as sickle cell anemia, multiple myeloma, high blood pressure and cardiovascular problems etc. Viagra, Cialis and Levitra should be taken as per doctor's prescription to avoid the possibilities of Priapism. Nevertheless, the instances are very rare where Viagra, Cialis and other PED5 drugs caused a prolonged and painful erection, but then those patients were found to have prior health conditions which were responsible for Priapism.

Priapism calls for immediate medical attention to avoid fatal consequences of permanent erectile dysfunction. The erection can be easily reduced if the person gets the treatment within 6 hours of erection and in a case where the erection has lasted less than four hours, decongestant medications may decrease blood flow to the penis. Ice applied to the perineum and the penis can reduce swelling in the pre-medication state. In serious situations, intracavernous injection, aspiration and surgery may be required to cure Priapism. But it should be keep in mind that the longer the medical attention is delayed, the greater are the risk of permanent erectile dysfunction The best way to avoid priapism is to be alert when it happens. When it occurs, go to an emergency room where there is a urologist present.

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