What is Priapism?

Priapism is one of the main complications that is associated with Sickle Cell disorder.  It is a condition that is considered to be a painful and persistent erection of the penis without any sexual desire.  It has been stated that between 10 – 40 % of men with Sickle Cell will at some time experience Priapism and these attacks can become tremendously painful.

What causes Priapism?

This is caused by a blockage of blood vessels in the penis by the sickling cells, resulting in failure of blood flow back to the body.  Blood therefore remains trapped in the tissue of the penis causing severe pain.

Attacks may be triggered by;

  • An unusually full bladder, such acute attacks often start during sleep.
  • Dehydration is a common factor when you do not drink enough fluids.
  • Alcohol consumption.
  • Sexual activity
  • Frequently there is no apparent cause.

Priapism may be short in duration or it may even be prolonged and it presents itself in three main ways;

  1. Recurrent Acute Priapism

This is the most common form of Priapism in which the patient gets short attacks that subside spontaneously.  The patient usually copes with the problem and may not seek any medical advice.  Most patients will continue to get these types of attacks throughout their lives.

  1. Acute Prolonged Priapism

This is a painful erection that does not subside after several hours (4 – 6 hours) and is an emergency requiring urgent medical treatment.

  1. Chronic Priapism

This is a rare form of presentation that may follow an acute episode.  In this condition the penis remains in a semi erect position and there is no pain.

What measures can I take during an attack?

Many patients tend to manage the short term episodes at home.  Different patients have reported that they use different methods to overcome acute episodes whilst at home, these range from emptying the bladder, warm baths, ice packs, avoiding consumption of alcohol late in the night and regular exercises.
While it is important to empty the bladder frequently once the attack has begun, it is also vital that the individual increases the oral intake of fluids to offset any possible contribution of systemic dehydration.  If the episode does not resolve within 3 hours then medical attention is needed immediately.

Medical treatment and follow up reviews

Medical intervention is needed in an emergency situation to assist with emptying the blocked blood vessel in the penis to relieve the patient’s pain and discomfort.

Individuals with severe or recurrent attacks are at risk of developing impotence (failure to have an erection) in the future.  This happens as a result of damage from the muscle of the penis due to repeat episodes.  This patient group might need to be on regular medication which will help prevent the onset of priapisms.

It is therefore very important to see your Doctor and attend out patient appointments for regular reviews.

Other treatment options

Patients that do develop impotence can have an implant inserted into the penis which could assist in achieving an erection.

What are some of the challenges?

The onset of Priapism is a frightening experience and often associated with embarrassment and/or guilt.  There is no need to suffer in silence because help is just a call away…..

Important: Avoid activities which precipitate acute attacks!