Priapism is defined as a persistent and painful erection that lasts for more than four hours without any sexual stimulation. It occurs due to the disturbances in the mechanism of controlling penile sexual arousal and maintaining penile flaccidity. This condition can arise due to the excessive release of contractile neurotransmitter, blockage of draining venules or prolonged relaxation of intracavernous smooth muscles. This is a serious condition that can’t be ignored as, during this condition, blood continuously accumulates in the cavernous sinusoids and causes a painful erection. Corpora cavernosa, which is the main erectile tissue, becomes rigid and painful.
Types of Priapism
1. Ischemic Priapism
Ischemic priapism or low flow priapism is the most common type of priapism and it is characterized by the persistent painful erection and rigidity of the corpora cavernosa. It is caused by a disorder of venous blood flow from the tissue mass. It is a non-sexual erection that is characterized by the little or no cavernous blood flow. With time it can lead to corporal tissue damage and requires immediate action as if it is left untreated, it can lead to complete erectile dysfunction. Numerous researchers have suggested that psychiatric medications, leukemia, alpha-blockers, malignant lymphoma, and malignancies can lead to the development of ischemic priapism.
2. Non- Ischemic Priapism
Non-ischemic priapism or high flow priapism is a non-sexual persistent erection which is painless and partially rigid. It is caused by the excessive blood flow from the arteries into the corpora cavernosa. Non-ischemic priapism is said to be the result of an antecedent trauma of the penile region. Arterial damage leads to arterial corporal fistula and it contributes to excessive unregulated arterial flow. The unregulated flow in the persistent erection occurs through the mechanism that involves the stimulation of endothelial nitric oxide. Non-ischemic priapism is comparatively less prevalent than ischemic priapism.
Stuttering Priapism is also known as recurrent or intermittent priapism and it is characterized by a recurrent and intermittent erection. Stuttering priapism is categorized as self-limiting ischemic priapism. Sickle cell disease is considered to be the biggest cause of stuttering priapism. It is a recurrent form of ischemic priapism and causes unwanted painful erections which occur repeatedly.
Causes of Priapism
The cause of priapism is divided into primary, secondary and idiopathic. In priapism with primary cause, a disorder is not responsible for a prolonged erection. In priapism with a secondary cause, several factors directly or indirectly affect the penile erection. And the Idiopathic cause is not known yet. Priapism can be associated with various disorders such as
- Sickle Cell Disease - It is an inherited blood disorder that results in an abnormality in the hemoglobin, an oxygen-carrying protein which is found in the red blood cells. It blocks the flow of blood and oxygen to the body and these blockages cause severe pain, organ damage, and serious infections. This disease occurs when a person inherits the abnormal copies of the hemoglobin gene and inherits one from each parent.
- Leukemia - The Blood contains different types of cells such as white blood cell, red blood cell and platelets which are controlled by the bone marrow. When any disturbances occur in controlling white blood cell, it leads to the development of Leukemia. It is a type of cancer that usually begins in the bone marrow and causes many abnormalities in the white blood cell. The exact cause of this disease is still unknown but it is believed that both genetics and environmental factors play a key role in causing leukemia.
- Fabry’s disease - It is a rare and life-threatening genetic disorder. It is associated with a wide range of complications and symptoms such as extreme full-body pain and gastrointestinal tract pain is common among people who suffer from Fabry’s disease. This disease also throws serious effects on the kidneys and the heart and can cause kidney insufficiency or kidney failure. Cardiac complications are normally observed in this disease.
- Thalassemia - It is an inherited blood-related disorder and it occurs due to the reduced production of hemoglobin. Thalassemia is of two types, alpha-thalassemia and beta-thalassemia and the severity of this condition depends on the number of genes missing. The symptoms of this disease vary from person to person as it depends on the type of thalassemia.