What is Priapism?

Priapism is a condition that affects men, causing prolonged and painful erections that can last for hours or even days. While this might seem like a good thing at first, it can actually be quite dangerous and even lead to permanent damage if not treated promptly. This is a medical emergency that, if left untreated, can result in permanent damage to the penis. Experiencing it even once can impact your ability to achieve erections in the future.

How does it happen?

There are two main types of priapism: low-flow and high-flow. Low-flow priapism is caused by blood not being able to flow out of the penis properly, leading to a build-up of pressure and swelling. This type of priapism is often associated with sickle cell anaemia, but can also be caused by certain medications such as sildenafil or tadalafil, drug use, or other medical conditions.

What causes priapism?

Physical causes

Men with a genetic predisposition for blood thickening and stickiness are more likely to experience this condition. This can manifest in inherited illnesses like sickle cell disease, as well as acquired conditions like lymphoma and myeloma.

Spinal injuries, whether congenital or acquired, can impact the nervous system and disrupt the regular flow of blood. Similarly, injuries to the area surrounding the anus or growths like bladder and prostate cancer can also affect blood circulation.

Prescription medicines

While the risk remains low, some prescription medications, including Sildenafil (Viagra), tadalafil (Cialis), avanafil (Spedra), and vardenafil (Levitra), as well as topical treatments for erectile dysfunction containing alprostadil, such as Vitaros cream, have been linked to an increased risk of priapism. It’s important to note that this risk is still considered to be low.

There are several other treatments that have the potential to cause priapism, including antidepressants like Prozac, anticoagulants such as warfarin and heparin, and blood pressure medications known medically as calcium channel blockers.

Recreational drugs

Taking recreational drugs, especially when combined with medication for erectile dysfunction, can lead to priapism. Drugs such as cocaine, ecstasy, crystal meth, and cannabis are commonly associated with this condition. It is important to seek medical attention if experiencing priapism as failure to do so can result in permanent damage, which is more likely to occur if drugs and alcohol are also involved.

What do the studies say about the incidence of priapism?

Phosphodiesterase type 5 inhibitors, commonly used to treat erectile dysfunction, have only caused a few reported cases of priapism. In a study conducted in 2020, it was found that since 1998, there were only 411 reported cases of drug-induced priapism linked to Viagra, Cialis, or Levitra reported to the Food and Drug Administration. This number is significantly lower than the cases associated with second-generation antipsychotics (1065) and trazodone (817). However, the author of the study noted that the actual number of cases may be higher, especially in men who use the drug recreationally without the proper warning from widespread TV ads on PDE5i.

If you’re ordering medication for erectile dysfunction, it’s important to talk to your doctor about priapism if you’re also taking antipsychotics or trazodone.

Conclusion

Although rare in healthy men, priapism is a medical emergency that requires immediate attention to prevent permanent damage. It is important to visit the hospital in such cases. There are treatments available for priapism, but they can have severe consequences and may even worsen erectile dysfunction. I must stress you must provide accurate answers to your medical history when filling in the consultation. This will help the clinician make a safe decision and prescribe you the correct medication.

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