Priapism – Diagnosis and Treatment

Diagnosis

Patient Background and Physical Check

Doctors begin by asking detailed questions about the patient’s symptoms, including how long the erection has lasted, whether there is pain, and if there are underlying conditions such as sickle cell anemia or recent injuries to the pelvic area.

They examine the genitals, lower abdomen, and groin region to look for signs of trauma, tumors, or any abnormalities.

The firmness and discomfort level of the penis help the doctor figure out if the erection is ischemic (painful, rigid) or nonischemic (less pain, less rigid). These details help determine the next steps.

Laboratory Evaluations and Imaging

Medical teams may use different tests to help confirm the diagnosis and determine the best steps. The main tests include:

• Penile Blood Gas Analysis: A small needle draws blood directly from the penis. A dark color can point to ischemic priapism, while redder blood suggests nonischemic priapism. Special tests measure oxygen, carbon dioxide, and acid levels to clarify the type.

• Routine Blood Tests: Blood drawn from a vein helps check for conditions like leukemia, sickle cell disease, or other blood disorders. Abnormal results can connect priapism to medical problems outside the penis itself.

• Ultrasound Scan (Doppler): Sound waves show how fast and well blood flows inside the penis. Doctors look for blocked blood vessels, unusual patterns, or hidden injuries such as perineal trauma. This check is painless and gives quick results about blood flow and any blockages.

• Drug Screening: Blood or urine samples may be checked for certain medications or illegal substances that can cause a prolonged erection.

Sometimes, doctors use other tools like MRI, especially if they suspect tumors or spinal cord injuries.

Test Type	What It Checks For	Why It’s Important
Blood Gas	Oxygen/Carbon dioxide levels	Distinguishes type of priapism
Blood Tests	Blood disorders, sickle cell, cancer	Finds underlying causes
Ultrasound	Vessel problems, blood flow	Identifies blockages/trauma
Drug Testing	Drugs/medications	Causes from substances

Additional Details and Considerations

Rapid identification of priapism, especially the ischemic type, is crucial to protect long-term erectile function. People with sickle cell anemia, cancer, or certain blood vessel problems have a higher risk and require close monitoring.

In some cases, the cause of priapism (called idiopathic priapism) can’t be found. Specialists in urology or andrology may advise on treatment, follow-up, or check for recurrent episodes.

Treatment

Treating Low-Flow (Ischemic) Priapism

Ischemic priapism, or low-flow priapism, happens when blood cannot leave the penis. This is a medical emergency and needs immediate treatment. The main aims are to relieve pain, stop the erection, and lower the risk of damage.

1. Blood Drainage (Aspiration Decompression):
   • A doctor uses a small needle and syringe to draw out blood from the penis. Saline solution may be flushed through to clear out trapped blood.
   • The doctor may repeat this method until the erection ends.
2. Medication (Injection Therapy):
   • Doctors inject medicines called sympathomimetics directly into the penis. These drugs help shrink blood vessels supplying the penis, letting blood flow out more easily.
   • If needed, doctors repeat this process and monitor patients closely for side effects like headaches or high blood pressure.
3. Surgical Options:
   • If other steps do not work, surgical treatment may be necessary.
   • A surgeon may create a shunt to help drain excess blood or perform other procedures to restore normal blood flow.
   • In cases of repeated or stuttering priapism, or after long-term damage, a penile prosthesis might be suggested as a last option.
     

Care for High-Flow (Nonischemic) Priapism

This type, also known as high-flow priapism, is less risky and often does not require immediate steps.

• Watchful Waiting:
  • Many cases resolve on their own without active treatment.
  • Cold packs and light pressure on the area between the penis and anus can sometimes help the erection go away.
• Embolization:
  • For cases that do not fix themselves, a doctor may use surgery to temporarily block an artery using gel or other material. The body later absorbs this.
  • Rarely, more invasive surgery is needed to fix any damaged arteries or tissue.

Getting Ready for Your Visit

Steps to Take Before Seeing the Doctor

• Write down any symptoms. List all symptoms, even if they do not seem related to erections or sexual health. Include when they started and how long each one lasted.

• List all medications and substances. Note all prescription drugs, over-the-counter medicines, supplements, vitamins, and any herbal treatments currently used. Be honest if using blood thinners, psychotropic medications, alcohol, cocaine, marijuana, or other substances.
• Prepare questions. Bring a list of questions for the doctor. Below are some ideas:
  • What could be the cause of these symptoms?
  • Will I need any tests or exams?
  • What treatments are available, and which one is best for me?
  • Can this increase the risk of erectile issues later?
  • Should I avoid certain activities like sex or sports?
  • Are there non-brand-name (generic) alternatives for medications?

• Track any triggers. Track any potential triggers. Note if symptoms appeared after sexual stimulation or following the use of substances such as alcohol, cannabis, stimulants, or other recreational drugs.

Questions the Doctor May Ask

Doctors often ask detailed questions to get a better understanding. Some topics the doctor might discuss include:

• When did symptoms begin, and how long did any episodes last?
• Was the erection painful, or did it go away on its own?
• Has there been any injury to the genitals or groin?
• Were drugs, including recreational ones like cannabis or stimulants, used before an episode?
• Are there any other health conditions, such as high blood pressure or blood thinners in use?

Be prepared to answer these questions. Tests may be needed for a correct diagnosis.