Priapism: When Penile Erection Refuses To Go Down

For six days, Adekunle Mathew’s (not real name), sex organ refused to go down — a critical urologic emergency!

Erections are normal healthy body functions, but this one was abnormal. On this account, Mathew became disturbed! The thought of ‘having fun’ was not even in his head, rather he was in severe pain.

The medical name for having an erection that will not go down is priapism, and with this disorder, a man is in danger of permanent erectile dysfunction.

A medical doctor, Ogbonna Janet Chizoba, said that in April, she witnessed Mathew, a new-diagnosed sickler, aged 30, who has no previous crisis, experience priapism for six consecutive days.

"This was his first clinic episode, and it was priapism," Dr. Janet told this reporter. "There is a risk of impotence. The way to manage it is to make sure it comes down, but priapism that exceeds three days increases the risk of impotence."

Priapism does not affect only men: women could be sufferers too. If their clitoris does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours, priapism might be suspected. The disorder is a rare condition with an overall incidence of 1.5 cases per 100,000 person-years.

AllNews' research showed that priapism symptoms vary depending on its type. Its two main kinds are ischemic and nonischemic priapism.

Ischemic priapism, also called low-flow priapism, is the result of blood not being able to leave the penis. It is the more common type of priapism. Signs and symptoms include: Erection lasting more than four hours or unrelated to sexual interest or stimulation; rigid penile shaft, but the tip of the penis (glans) is soft; and progressive penile pain.

Recurrent priapism, a form of ischemic priapism, is an uncommon condition. It is more common in males who have an inherited disorder characterized by abnormally shaped red blood cells (sickle cell anemia). Sickle cells can block the blood vessels in the penis. Recurrent priapism describes repetitive episodes of prolonged erections and often includes episodes of ischemic priapism. In some cases, the condition starts off with unwanted and painful erections of short duration and might progress over time to more frequent and more prolonged erections.

On the other hand, nonischemic priapism, also known as high-flow priapism, occurs when penile blood flow is not regulated appropriately. Nonischemic priapism is usually less painful than ischemic priapism. Its signs and symptoms include an erection lasting more than four hours or unrelated to sexual interest or stimulation; and an erect but not fully rigid penile shaft.

The major cause of priapism is not exactly known, but there are predisposing factors: antipsychotic drugs, local aphrodisiacs; hematologic malignancies, and congenital vascular disorders.

Some people might have erection problems already and may have resorted to drugs and injections to get them hard. But a nurse, Mojirade Akintayo, says things like that should be used moderately and with medical direction. Akintayo said she has witnessed patients who had Caverject overdose, developed priapism, and “did not make it through the surgery”.

If priapism persists, one “may need a shunt surgery for one’s penis”, according to Silas Joy, a Ghanaian TelePhysician.

Priapism management

Hemoglobinopathies constitute the major cause of priapism in countries where Sickle Cell Disease (SCD) is endemic. As priapism is common among people with SCD, they are advised to drink a lot of water. "For diagnosed sicklers, it is important that they stay hydrated, at least three litres per day. It aids the free flow of blood,” Dr. Janet told AllNews. "I’d also advise that people repeat their genotype so they know if they are at risk. Because the dude that had it, he was 30 years [old], and that was his first episode. If he had known previously that he was a sickler, he would have been counselled on what to do.

"Priapism can be managed by an early presentation."