What is priapism and how can a man treat it?

The disease associated with painful and persistent erection was first described in the early 17th century. He was given the name "priapism" in honor of the god of fertility Priapus. A characteristic feature is a phallus that is not erect. The condition belongs to diseases requiring prompt medical attention.

What is priapism?

The main feature that characterizes priapism in men is a stable erection, not associated with sexual arousal. It is impossible to cope with it through intercourse or masturbation. This condition is quite rare - less than 1% of urological patients.

The disease is classified depending on the mechanism of development:

• Non-ischemic, also called venous. It occurs due to a violation of the mechanism of blood inflow and outflow. Excessive arterial flow leads to accumulation of fluid in the corpora cavernosa of the penis. Most often develops against the background of damage to the penis or perineum;
• Ischemic, or veno-occlusive. It is associated with defective venous blood excretion due to the high viscosity of the composition, stagnation or the presence of blood clots. Causes tissue damage called ischemia. It is characterized by high soreness.

Acute and chronic course of the disease can be observed. In addition, clinicians identify a condition called nocturnal priapism, or pseudopriapism. The main diagnostic signs are the occurrence of an erection several times during the night. Sometimes it manifests itself in the daytime, if a man has a habit of sleeping during this period. It is accompanied by a feeling of heaviness and severe pain, which prevents sleep.

Reasons

The prerequisites for the condition of painful and persistent erection are still not fully understood. However, some causes of priapism have been clearly identified and associated with drug therapy.

In particular, an attack can provoke:

• Treatment of sexual dysfunction with Viagra and analogues;
• Injection of medical solutions into the penile area;
• Taking psychotropic and sedative drugs;
• Taking medications that reduce blood clotting.

Also, a rather large list of ailments and pathologies is ranked among the factors leading to priapism:

• Anemia and leukemia;
• Fractures of the spinal column, compressing the spinal cord;
• Traumatic brain injury;
• Diseases of the brain;
• Diabetes mellitus;
• Disorders of the genitourinary system;
• Inflammatory processes or tumors of the genital organ;
• Melanoma;
• Gout;
• Multiple sclerosis;
• Neoplasms in the brain, prostate, kidneys, bladder;
• Intoxication with carbon monoxide or poisonous substances;
• Increase in blood viscosity;
• Neuroses, neuropsychiatric disorders, mental illness.

In addition, it has been proven that excessive addiction to alcohol or drugs can also provoke prolonged erections.

Symptoms and Diagnosis

Exhausting potency, accompanied by excruciating pain in the penis area, bowel and perineum in ischemic form, is an unequivocal sign that the patient has priapism. Symptoms, which also indicate an ailment and distinguish it from a normal erection, are expressed as follows-

• The cavernous bodies are filled with blood, while the head remains soft, the prostate is also excluded from the process;
• Occurs spontaneously and does not depend on excitatory factors;
• The attack does not affect the separation of urine, but the stream is directed upward or sideways;
• The penis bends towards the abdomen due to strong blood pressure;
• After the sexual intercourse, the erection does not go away, but only intensifies, the painful sensations also increase.

It is important to remember that if you do not take emergency measures and wait in the hope that the attack will pass on its own, a serious inflammatory process leading to tissue gangrene may develop. It is necessary to seek help within 8 hours; after this period, irreversible pathological processes occur.

It is recommended to immediately contact a surgeon, andrologist or urologist if an erection is noted that causes discomfort for more than 4 hours. An exception is the intake of selective inhibitors, Viagra and analogues, which are accompanied by an erect state for 3-4 hours. However, unlike priapism, intercourse after taking the pills ends with orgasm.

Diagnostics includes visual inspection and additional examinations:

• Study of the composition of blood obtained from the corpus cavernosum;
• Penis tissue biopsy;
• Doppler ultrasonography of veins and arteries;
• X-ray with contrast medium;
• Consultation with a proctologist, hematologist, and neurologist.

How to treat priapism in a man?

By contacting a doctor in the first hours of the development of the disease, you can quickly diagnose priapism. In this case, treatment is prescribed conservatively, without the use of surgical intervention. The non-ischemic form is best treated with puncture under local anesthesia:

• Cavernous bodies are pierced;
• Excess blood is removed;
• Rinsing is carried out until the water turns scarlet.

An attack of ischemic priapism immediately after the onset is sometimes relieved by sitting baths or cold compresses. It is also possible to use hirudotherapy (treatment with leeches).

Drug treatment includes intravenous and intramuscular administration of Relanium or drugs intended to improve the blood count. In some cases, they resort to blockade with novocaine. If more than 6 hours have passed after the onset of an erection, then injections of Mezaton or Phenylephrine are necessary, which reduce swelling and reduce pressure in the vessels. The remedies will work if the injection is given within the first 24 hours after the onset of the attack.

If an incessant erection was the result of a somatic disease, then therapy of the underlying disease begins at the same time. In the case of late treatment, conservative methods are ineffective. In this case, an operation is required, which is also prescribed if the ailment reappears. To eliminate the pathological condition, they resort to one of the surgical techniques:

• Shunting between the corpus cavernosum and corpus cavernosum, unilateral and bilateral;
• Opening additional blood flow between the vein and the corpora cavernosa, a similar technique is used in exceptional cases.

An important point in the treatment of the disease is rehabilitation, especially for adolescents who have had an attack once. It is possible to develop a stable complex of fears and anxious reactions associated with the intimate side of life. It is important to provide the young man with the support and advice of an experienced psychologist specializing in sexual trauma as soon as possible.

One of the unpleasant consequences of surgery is temporary impotence lasting up to several months. In some cases, priapism can cause long-term erectile dysfunction, both organic and psychological.

Nocturnal Priapism

Therapy of a form of the disease, called intermittent priapism in clinics, or nocturnal, is mostly different from the treatment regimen for other types of ailment. The very first step is to cover the genital organ with cold heating pads, but this approach only helps to relieve a momentary attack without affecting the root cause.

According to studies, nocturnal priapism is a consequence of the developed depression and, accordingly, the reasons lie exclusively in the field of psychology and neurology. Thus, the impact on the prerequisites of the disease is carried out using:

• Antipsychotics and antidepressants;
• Attendance at psychotherapy sessions;
• Carrying out auto-training.

In some cases, hypnosis is indicated to eliminate neurotic disorders.

Disease Prevention

It is difficult to carry out full-fledged prevention of the disease, because the prerequisites for the development of an attack are not fully understood. However, there is a small list of recommendations to help reduce the risk of the disease:

• Avoid injuries to the genitals, spine, perineum;
• Timely undergo a course of therapy for inflammatory diseases of the genitourinary system;
• Regularly visit a urologist for early diagnosis of tumors and subsequent treatment;
• Treat neurological and hematological ailments;
• Stop using alcohol and drugs;
• Take medications strictly according to medical prescription, and immediately report any negative changes to your doctor.