Priapism Causes: What You Need to Know
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Updated on 03 November, 2023
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Priapism is a medical condition where a man’s penis becomes erect and stays that way for greater than four hours without any sexual stimulation – i.e a persistent erection. This condition can be classified into two types: low-flow priapism and high-flow priapism.
Low-Flow Priapism Vs High-Flow Priapism
Low-Flow Priapism
Low-flow priapism, also known as ischemic priapism, is the most common type of priapism. It occurs when blood becomes trapped in the penis, leading to a prolonged and painful erection, that gets more painful as the time passes. This type of priapism is often caused by medical conditions that affect blood flow, such as sickle cell anemia and leukemia.
The prolonged erection can cause damage to the tissues of the penis, which can lead to erectile dysfunction if left untreated. It is important to seek medical attention immediately if you experience symptoms of low-flow priapism.
High-Flow Priapism
High-flow priapism, also known as non-ischemic priapism, is a less common type of priapism. It occurs when there is an abnormality in the blood vessels that supply the penis, leading to an erection that is not painful and does not last as long as low-flow priapism.
High-flow priapism is often caused by trauma to the penis or pelvic area. It can also be caused by a medical condition called a fistula, which is an abnormal connection between an artery and a vein in the penis.
Nitric Oxide: Role In Priapism
Nitric oxide is a gas that is produced by the endothelial cells lining the blood vessels, and it plays a crucial role in regulating the blood flow throughout the body. Nitric oxide is produced in response to various stimuli, including sexual arousal, physical exercise, and mental stress. Nitric oxide causes the blood vessels to dilate, allowing more blood to flow through them. This increased blood flow is necessary for penile erection.
However, when nitric oxide is produced excessively or when its production is not properly regulated, it can cause priapism. Excessive nitric oxide can cause the smooth muscles in the penis to relax too much, leading to an erection that does not go away.
Nitric oxide is produced by the enzyme nitric oxide synthase (NOS), which is found in many tissues throughout the body, including the endothelial cells lining the blood vessels. There are three isoforms of NOS: neuronal NOS (nNOS), endothelial NOS (eNOS), and inducible NOS (iNOS). Each isoform has a different distribution and regulation within the body.
The nNOS isoform is found primarily in the nervous system, and its activity is regulated by calcium ions. The eNOS isoform is found primarily in the endothelial cells lining the blood vessels, and its activity is regulated by shear stress and other factors. The iNOS isoform is induced by inflammatory stimuli and produces large amounts of nitric oxide.
When the release of nitric oxide happens excessively or when its production is not properly regulated, it can cause priapism. In some cases, priapism can be caused by a genetic mutation that affects the regulation of nitric oxide production. In other cases, priapism can be caused by medications that increase nitric oxide production, such as sildenafil (Viagra) or other phosphodiesterase type 5 inhibitors.
Causes Of Priapism
Idiopathic priapism
Idiopathic priapism is ones of the types of priapism that occurs without any identifiable cause. This condition is relatively rare and occurs in approximately 20% of priapism cases. It is essential to note that idiopathic priapism is not related to sexual arousal or stimulation and can occur at any time, including during sleep.
Medications
Certain medications can cause priapism as a side effect. These include drugs used to treat erectile dysfunction, such as Viagra, Cialis, and Levitra. Other medications that can cause priapism include antidepressants, antipsychotics, and blood-thinning medications. If you are taking any medications and experience priapism symptoms, you should consult your doctor immediately.
Medications That Can Trigger Priapism
Erectile Dysfunction Medications
Erectile dysfunction (ED) medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), are commonly used to treat ED. These medications work by increasing penile blood flow, which helps men achieve and maintain an erection. However, in rare cases, they can also cause priapism. This is because these medications can cause blood to remain trapped in the penis, leading to an erection that does not go away.
Antidepressants
Antidepressants are medications that are used to treat depression and other mental health conditions. Some antidepressants, such as trazodone and amitriptyline, have been known to cause priapism as a side effect. This is because they can affect the levels of neurotransmitters in the brain that are involved in sexual arousal.
Antipsychotics
Antipsychotics are medications that are used to treat mental health conditions such as schizophrenia and bipolar disorder. Some antipsychotics, such as chlorpromazine and haloperidol, have been known to cause priapism as a side effect. This is because they can affect the levels of dopamine in the brain, which can lead to increased sexual arousal.
Blood Thinners
Blood thinners, such as heparin and warfarin, are medications that are used to prevent blood clots. These medications can cause priapism because they can interfere with penile blood flow. This can lead to an erection that does not go away.
Alpha-blockers
Alpha-blockers, such as terazosin and doxazosin, are medications that are used to treat high blood pressure and other conditions. These medications can cause priapism because they can affect penile blood flow. This can lead to an erection that does not go away.
Hormonal Medications
Hormonal medications, such as testosterone replacement therapy, can cause priapism as a side effect. This is because they can affect the levels of hormones in the body that are involved in sexual arousal.
Recreational Drugs
Recreational drugs, such as cocaine and marijuana, can also cause priapism as a side effect. This is because they can affect blood flow to the penis, leading to an erection that does not go away.
Blood Disorders
Blood disorders such as sickle cell disease, leukemia, and thrombocythemia can cause priapism. These disorders cause the blood to clot and restrict the flow of blood to the penis, leading to an unwanted and prolonged erection.
Priapism Causes: Types of Blood Disorders
Sickle Cell Anemia
Sickle cell anemia is an inherited blood disorder that affects the red blood cells. In this condition, the red blood cells become rigid and sticky, which can cause blockages in the blood vessels. This blockage can occur in the small blood vessels that supply blood to the penis, leading to priapism in sickle cell.
Thalassemia
Thalassemia is a genetic blood disorder that affects the production of hemoglobin. Hemoglobin is a protein found in red blood cells that carries oxygen throughout the body. In thalassemia, the body produces abnormal hemoglobin, which can lead to a shortage of healthy red blood cells. This shortage can cause priapism by reducing blood flow to the penis.
Leukemia
Leukemia is a type of blood cancer that affects the white blood cells. In leukemia, the body produces abnormal white blood cells that do not function properly. These abnormal cells can accumulate in the blood vessels, including those that supply blood to the penis, leading to priapism.
Polycythemia Vera
Polycythemia vera is a rare blood disorder that causes the body to produce too many red blood cells. The excess red blood cells can thicken the blood and cause blockages in the blood vessels, including those that supply blood to the penis. This can lead to priapism.
Multiple Myeloma
Multiple myeloma is a type of blood cancer that affects the plasma cells. Plasma cells are a type of white blood cell that produces antibodies to fight infections. In multiple myeloma, the abnormal plasma cells can produce proteins that thicken the blood and cause blockages in the blood vessels. This can lead to priapism.
Trauma
Trauma to the penis, pelvis, or perineum can cause priapism. This type of priapism is called traumatic priapism and is most commonly seen in men who have suffered a pelvic or perineal injury.
Priapism Causes: Understanding the Types of Traumas that can Lead to this Condition
Trauma-induced priapism is a rare but serious medical condition that can be caused by a variety of factors. The most common cause of priapism is related to sickle cell anemia, where the sickle-shaped red blood cells can get trapped in the penis and prevent blood from flowing out. This condition can also be caused by various other factors, including medications, spinal cord injuries, and nerve damage.
Here are some of the types of traumas that can lead to priapism:
Penile Trauma
Penile trauma is the most common cause of priapism. This can occur due to a direct blow to the penis, which can cause bleeding inside the penis, leading to an erection. Additionally, injuries during sexual activity can cause penile trauma that can lead to priapism.
Pelvic Trauma
Pelvic trauma can cause priapism in several ways. An injury to the pelvic area can cause damage to the blood vessels or nerves that supply the penis, leading to a prolonged erection. In some cases, pelvic fractures can cause damage to the nerves that control the blood flow to the penis.
Spinal cord injury
Spinal cord injuries can cause priapism due to the disruption of the nerve signals that control the blood flow to the penis. Injuries to the spinal cord can occur due to accidents or medical conditions such as multiple sclerosis.
Medications
Certain medications can also cause priapism as a side effect. These include medications used to treat erectile dysfunction, antidepressants, and antipsychotics.
Blood Disorders
Blood disorders such as sickle cell anemia and leukemia can cause priapism. In sickle cell anemia, the sickle-shaped red blood cells can get trapped in the penis and prevent blood from flowing out, leading to priapism. In leukemia, the abnormal white blood cells can interfere with the blood flow to the penis, leading to priapism.
Other medical conditions
Other medical conditions such as liver disease, diabetes, and hypertension can also increase the risk of priapism.
It is essential to seek medical attention if you experience priapism. Delayed treatment can lead to long-term erectile dysfunction or permanent damage to the penis. The medical treatment options for priapism depends on the underlying cause of the condition. In some cases, medication can be used to help reduce the blood flow to the penis and relieve the erection. In other cases, surgery may be necessary to correct the underlying concern.
Drug use
Drug use, especially intravenous drug use, can cause priapism. Drugs such as cocaine, methamphetamine, and marijuana can restrict blood flow to the penis, leading to priapism.
Types of recreational drugs that can cause priapism
Cocaine
Cocaine is a powerful stimulant drug that is known to cause priapism. The drug can cause blood vessels in the penis to constrict, reducing blood flow and causing an erection that lasts for hours. In addition, cocaine use can cause damage to the penile tissue, which can lead to permanent erectile dysfunction.
Amphetamines
Amphetamines, such as crystal meth, are also known to cause priapism. These drugs can cause blood vessels in the penis to constrict, leading to a prolonged erection. The use of amphetamines can also cause damage to the penile tissue, which can result in permanent erectile dysfunction.
Marijuana
Marijuana, or cannabis, is a drug that is known to cause priapism in some individuals. The drug can cause blood vessels in the penis to dilate, increasing blood flow and causing an erection that lasts for hours. While priapism caused by marijuana use is relatively rare, it can occur in some individuals.
Ecstasy
Ecstasy, or MDMA, is a drug that is known to cause priapism in some individuals. The drug can cause blood vessels in the penis to constrict, leading to a prolonged erection. In addition, ecstasy use can cause damage to the penile tissue, which can result in permanent erectile dysfunction.
Heroin
Heroin is a drug that is known to cause priapism in some individuals. The drug can cause blood vessels in the penis to constrict, leading to a prolonged erection. In addition, heroin use can cause damage to the penile tissue, which can result in permanent erectile dysfunction.
Viagra
While not technically a recreational drug, Viagra is a medication that is often used recreationally to enhance sexual performance. However, the drug can cause priapism in some individuals. Viagra works by increasing blood flow to the penis, which can lead to a prolonged erection. In rare cases, priapism caused by Viagra use can lead to permanent erectile dysfunction.
Infections
Infections of the penis, prostate, or urinary tract can cause priapism. These infections cause inflammation and swelling, leading to an unwanted and prolonged erection.
Priapism Causes: Types of Infections
Bacterial Infections
Bacterial infections can cause priapism by leading to inflammation and tissue damage in the penis. One such bacterial infection is tuberculosis. Tuberculosis can lead to priapism by causing inflammation and scarring in the penile tissue, which can lead to an extended erection. Another bacterial infection that can cause priapism is syphilis. Syphilis can cause damage to the blood vessels in the penis, which can lead to an extended erection.
Viral Infections
Viral infections can also cause priapism by leading to inflammation and tissue damage in the penis. One such viral infection is HIV. HIV can cause damage to the blood vessels in the penis, which can lead to priapism. Other viral infections that can cause priapism include hepatitis B and C.
Fungal Infections
Fungal infections can also cause priapism by leading to inflammation and tissue damage in the penis. One such fungal infection is candidiasis. Candidiasis can cause inflammation in the penile tissue, which can lead to an extended erection. Other fungal infections that can cause priapism include aspergillosis and cryptococcosis.
Parasitic Infections
Parasitic infections can also cause priapism by leading to inflammation and tissue damage in the penis. One such parasitic infection is malaria. Malaria can cause damage to the blood vessels in the penis, which can lead to priapism. Other parasitic infections that can cause priapism include schistosomiasis and filariasis.
Neurological Disorders
Neurological disorders such as spinal cord injuries, multiple sclerosis, and Parkinson’s disease can cause priapism. These conditions affect the nerves that control blood flow to the penis, leading to priapism.
Neurological disorders are a group of conditions that affect the brain, spinal cord, and nerves that control the body’s movements and functions. When these neurological disorders affect the nerves that control the penis’s blood flow, it can lead to priapism. The types of neurological disorders that cause priapism are as follows:
Spinal Cord Injuries:
A spinal cord injury is a type of neurological disorder that occurs when the spinal cord is damaged, resulting in the loss of sensation and movement in the body below the site of injury. When the nerves that control the blood flow to the penis are damaged, it can cause priapism. This type of priapism is known as ischaemic priapism, which is caused by the lack of oxygenated blood flow to the penis.
Multiple Sclerosis:
Multiple sclerosis is a neurological disorder that affects the central nervous system, causing damage to the myelin sheath that covers the nerves. This damage can disrupt the signals that control the blood flow to the penis, leading to priapism. Multiple sclerosis-related priapism is known as non-ischaemic priapism, which is caused by the unregulated blood flow to the penis.
Parkinson’s Disease:
Parkinson’s disease is a progressive neurological disorder that affects the motor system, causing tremors, stiffness, and difficulty in movement. This disorder can also affect the nerves that control the blood flow to the penis, causing priapism. Parkinson’s disease-related priapism is also non-ischaemic priapism.
Brain Tumors:
Brain tumors are abnormal growths that develop in the brain and can cause neurological symptoms, such as headaches, seizures, and difficulty in movement. When a brain tumor affects the nerves that control the blood flow to the penis, it can cause priapism. Brain tumor-related priapism can be ischaemic or non-ischaemic, depending on the location of the tumor.
Sickle Cell Anemia:
Sickle cell anemia is a genetic disorder that affects the shape of the red blood cells, causing them to become crescent-shaped and rigid. These abnormal blood cells can block the blood vessels that supply the penis, leading to priapism. Sickle cell anemia-related priapism is ischaemic priapism.
Cancer
Types of Cancers that Cause Priapism
While it is relatively rare, some types of cancers can cause priapism. The most common types of cancer that are associated with priapism include:
Prostate Cancer
Prostate cancer is the most common cancer in men and the second leading cause of cancer deaths in men. It is a type of cancer that develops in the prostate gland, which is a small gland that produces the fluid that carries sperm during ejaculation. In some cases, prostate cancer can lead to priapism.
The underlying cause of priapism in prostate cancer is not well understood, but it is thought to be related to the spread of cancer cells to the penis. When cancer cells spread to the penis, they can disrupt blood flow and cause an erection that does not go away. Priapism in men with prostate cancer is usually a sign that the cancer has spread to other parts of the body.
Penile Cancer
Penile cancer is a rare type of cancer that develops in the tissues of the penis. It is most common in men over the age of 50 who are uncircumcised. The exact cause of penile cancer is not known, but it is believed to be related to certain risk factors, such as poor hygiene, smoking, and human papillomavirus (HPV) infection.
Penile cancer can cause priapism when cancer cells block blood flow to the penis. In some cases, priapism may be the first sign of penile cancer.
Bladder Cancer
Bladder cancer is a type of cancer that develops in the bladder, which is the organ that stores urine. It is more common in men than in women and is most often diagnosed in people over the age of 55. The exact cause of bladder cancer is not known, but it is believed to be related to certain risk factors, such as smoking, exposure to chemicals, and chronic bladder inflammation.
Bladder cancer can cause priapism when cancer cells spread to the penis and disrupt blood flow. Priapism is not a common symptom of bladder cancer, but it can occur in some cases.
Testicular Cancer
Testicular cancer is a type of cancer that develops in the testicles, which are the male reproductive organs that produce sperm and testosterone. It is most common in men between the ages of 15 and 35. The exact cause of testicular cancer is not known, but it is believed to be related to certain risk factors, such as a family history of the disease, an undescended testicle, and HIV infection.
Testicular cancer can cause priapism when cancer cells spread to the penis and disrupt blood flow. Priapism is not a common symptom of testicular cancer, but it can occur in some cases.
Renal Cell Carcinoma
Renal cell carcinoma is a type of kidney cancer that develops in the cells that line the small tubes within the kidney. It is more common in men than in women and is usually diagnosed in people between the ages of 50 and 70. The exact cause of renal cell carcinoma is not known, but it is believed to be related to certain risk factors, such as smoking, high blood pressure, and obesity.
Renal cell carcinoma can cause priapism when cancer cells spread to the penis and disrupt blood flow. Priapism is not a common symptom of renal cell carcinoma, but it can occur in some cases.
Multiple Myeloma
Multiple myeloma is a type of cancer that affects plasma cells, which are a type of white blood cell that produces antibodies to fight infection. It is more common in men than in women and is usually diagnosed in people over the age of 65. The exact cause of multiple myeloma is not known, but it is believed to be related to certain risk factors, such as age, family history, and exposure to radiation.
Multiple myeloma can cause priapism when cancer cells disrupt blood flow to the penis. Priapism is not a common symptom of multiple myeloma, but it can occur in some cases.
Understanding Prolonged Erection and Its Underlying Factors
Prolonged priapism is a severe form of priapism that can result in permanent damage to the penis. When an erection lasts for more than four hours, it is considered a medical emergency. Prolonged priapism can cause damage to the tissues and blood vessels in the penis, leading to erectile dysfunction and other complications.
There are two types of prolonged priapism: ischemic and non-ischemic.
Ischemic priapism occurs when blood flow to the penis is restricted, leading to a lack of oxygen and nutrients to the tissues. This type of priapism is usually caused by an underlying medical condition or medication. Symptoms of ischemic priapism include a painful erection that lasts for hours, swelling of the penis, and a decrease in the firmness of the erection over time.
Nonischemic priapism occurs when blood flow to the penis is not restricted, but the blood is unable to exit the penis. This type of priapism is usually caused by trauma or injury to the penis. Symptoms of non-ischemic priapism include a painless erection that lasts for hours, and the erection remains firm and does not decrease in size over time.
Priapism can have many causes, and it is essential to seek emergency care immediately if you experience any symptoms. Understanding the causes of priapism can help you prevent this condition and get the proper treatment if you develop priapism. If you are experiencing priapism, consult your doctor immediately, as early treatment can prevent permanent damage to the penis.
