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November 29, 2011

Causes Of Priapism

Causes of Priapism
What is Priapism?
Priapism is one type of male sexual disorder where penile erection occurs continuosly for 6 hours or more even without sexual stimulation. It is very painful; can damage the penile tissue permanently.
In general practice, the usual recommendation to seek medical emergency for help is painful erection that persists for more than FOUR hours.

Causes of Priapism
Normally, erection results from relaxation of the muscles inside the penis. It makes an increase in arterial blood flow towards the penis. Priapism occurs when blood inside the penis is trapped and unable to flow seamlessly. This condition can occur at all age groups, and even newborn! If it is not properly treated, permanent damage may happen.

Causes of priapism are:
  • Drugs/medical treatment: psychiatric drugs (CPZ, trazodone), antihypertensive drugs (nifedipine, prazosin), anticoagulants (heparin, warfarin), miscellaneous (metoclopramide, omeprazole, tamoxifen)
  • Alcoholism
  • Trauma (accidental, surgical)
  • Nervous system damage, such as: spinal cord injury, chronic diabetes mellitus, multiple sclerosis.
  • Blood disorder, such as leukemia, sickle cell anemia, myeloma, thalassemia.
  • Injection into the penis to treat impotence, such as papaverine, prostaglandin E1 (alprostadil), Viagra (R), phentolamine, etc.
  • Unknown causes, approximately 35% of the priapism cases.
Treatment of Priapism
Many priapism cases resolve spontaneously after physical activity and repeated ejaculation. In emergency practice, oral terbutaline or salbutamol may help in acute onset. Next step is removing blood by inserting a needle into the penis (often followed by small amounts of heparin to reduce clotting). In persistant cases, metaraminol (a reversing agent) may be injected into the penis. Surgery is rarely performed, but its purpose is to avoid persistant damage of the penis muscle.

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