Priapism (pathological erection)

Priapism is pathological condition, characterized by occurrence of prolonged erection not associated with sexual arousal. Usually this condition is accompanied by painful sensations in penis root area. Unlike true erection, mainly cavernous bodies are strained, penis head remains relatively soft. Urination isn`t violated. Sexual intercourse doesn`t bring relief. Priapism usually begins at night during sleep.

The term itself originated after Greek God Priapus, God of gardens and fertility. He was also God of debauchery and his penis was in state of constant erection. Priapism can occur in both adult males and children – it doesn`t matter what the age is.

Main causes

Priapism causes can vary:

  • Priapism may be psychogenic. In this case, it occurs in patients with mental illness, epilepsy, and with neurosis.
  • Neurogenic priapism occurs in brain and spinal cord diseases – injuries, tumors, encephalitis.
  • Somatic priapism occurs in patients with blood disorders (leukemia, sickle cell anemia), in patients with malignant diseases, and in certain allergic diseases.
  • Intoxication priapism is consequence of alcohol, cocaine, psychotropic drugs usage.
  • Drug priapism develops with certain drugs usage (psychostimulants, antidepressants, drugs used to treat impotence).
  • Ideopathic priapism.

The cause of this disease type remains unknown. Necessary examination of such patients is:

  • In leukemia and other blood pathology exclusion (blood test is clinical).
  • In pathological processes exclusion in brain and spinal cord (establishment of neurological status, conducting computer and NMR tomography, x-ray, etc.).
  • Pelvic organs examination, ultrasound, prostate rectal examination with appropriate microscopy to exclude inflammatory process.
  • Most important tests are biochemical blood tests, of which coagulogram is fundamental.
  • Family history should include hereditary diseases exclusion (especially in persons of Mediterranean region and Africans).
  • Oncopathology (possibility of metastasis).
  • Allergic history allows not only to establish possible allergies cause, but also find out, which drugs patient is taking at present time. Among most dangerous are antihypertensives, antidepressants, anticoagulants, hormones, drugs and aphrodisiacs.
  • Detailed data collection allows you establish possibility of contact with household chemicals aggressive products.
  • Priapism examination plan requires tests to exclude syphilis, mumps, tuberculosis, brucellosis, and other rare specific infections (typhus, mild chancre). Often there is link between epidemiological history and tourism, military service abroad (sailors, soldiers, diplomats), visits to infection areas (Africa, Asia, Central Asia).

Priapism treatment

Priapism treatment must be started urgently. Therefore, in complaints event, you should immediately seek medical help and it is the best idea to call ambulance. Experience shows, that conservative treatment should be carried out in early stages of disease onset (up to 12 hours) and it should be short-term (no more than 2 hours).

If disease duration is more than 12 hours, it is advisable to perform surgical treatment, which prevents fibrous processes development in cavernous bodies of penis and contributes to erectile function preservation in postoperative period. Operation should be carried out no later, than 14 hours after prolonged erection onset.

If it isn`t possible to eliminate priapism by conservative methods, surgical treatment is carried out. Surgical treatment goal is to improve blood outflow from cavernous bodies. For this, message is created between cavernous bodies and other veins. With timely priapism treatment, results are good and erectile function is fully preserved after some time. In advanced cases, persistent impotence may occur. With gangrene and necrosis, penis has to be removed. In this case, after some time, plastic surgery and endoprosthesis replacement are performed.