Some may think that priapism, also known as permanent or persistent erection, is just an embarrassment for a man in his daily life. But the effects of priapism go far beyond that. If a person with priapism or permanent erection does not take steps to address the problem immediately, he may face more complex and serious health and social problems. In this report, we will review in Dalili Medical the definition of priapism and its causes, in addition to methods of treating permanent and recurrent erection, and we will also discuss the experiences of people suffering from this condition and the possibility of using herbs as a treatment.

What is priapism?

 

Priapism is a condition of persistent erection that occurs for a long time without sexual arousal or stimulation. It is often accompanied by pain and may last for more than four hours. This occurs when blood collects in the penis and the person is unable to ejaculate, which requires urgent treatment. If this condition is left untreated, it can lead to permanent damage.

How common is priapism?

 

Priapism is relatively rare, but some people may be more susceptible to it under certain circumstances. Studies suggest that priapism occurs in 30% to 45% of people with sickle cell disease.

Is priapism contagious?

 

Priapism is not contagious. It is not a sexually transmitted infection, nor is it a symptom associated with any such infection.

Who is affected by priapism?

 

Anyone with a penis can get priapism, and it occurs in all age groups, including (very rarely) newborns. However, it most commonly affects two different age groups:

- Children ages 5 to 10

- Adults ages 20 to 50

How long does priapism last?

 

High-flow priapism can go away on its own within hours to weeks without treatment. Low-flow priapism does not go away without treatment.

What is the course of priapism?

 

The prognosis for priapism is good for most people, provided they receive prompt treatment. About half of people with low-flow priapism can still achieve an erection if treated within 24 hours. If low-flow priapism lasts longer than 36 hours, scarring and permanent erectile dysfunction are likely.

When should you see a doctor?

 

A person should consult a health care professional if they have recurrent painful erections without sexual arousal or stimulation, and they do not go away on their own. It is important to schedule a follow-up appointment with a doctor after treatment. If the condition returns after treatment, contact your doctor immediately.

When should you go to the emergency department for priapism?

 

Priapism is a medical emergency. People who have an erection that lasts for several hours without sexual arousal or stimulation should contact the emergency department immediately. The longer you wait, the greater the risk of permanent damage to the penis.

Causes of persistent erections?

 

There are several causes and factors that may lead to priapism, the most prominent of which are:

1. Repeated exposure to sexual stimuli ** When a man is exposed to a large number of sexual stimuli, he may have repeated erections.

2. High levels of testosterone**High levels of testosterone can increase the chances of having an erection continuously, and in some cases, these high levels may indicate a health problem or endocrine dysfunction.

3. Eating foods that enhance erection**Some foods contribute to enhancing erection in men, such as fish rich in phosphorus. Therefore, increasing the consumption of these foods may improve this condition.

Sickle cell anemia.

Some blood diseases, such as thalassemia, high blood pressure, and leukemia.

Some neurological diseases.

Metabolic disorders.

Use of toxins and drugs, such as hashish, cocaine, and marijuana.

Exposure to injury or wound in the sensitive area of ​​​​the man or in the spinal cord.

Exposure to a bite or sting from some insects, such as spiders, especially the black widow.

Cancer, especially cancers that affect the sensitive area and the reproductive system in males.

Taking certain medications, such as:

Blood thinners.

Some medications for depression.

Some medications used to treat erectile dysfunction.

High blood pressure medications.

Insomnia medications and some other psychiatric medications.

Some hormone therapies.

**Evaluation of persistent erection** The following information can help individuals decide whether to see a doctor and what to expect during the evaluation.

**Warning signs** For boys and men with priapism, there are some symptoms and characteristics that should cause concern, including:

- Severe pain

- Age less than 10 years

- Recent injury to the penis or groin area

- Fever and night sweats

**When to see a doctor**

All children and men with priapism should see a doctor right away for appropriate treatment. If warning signs are present, additional evaluation may be necessary to determine whether the cause of priapism is an abnormal or serious condition.

**What the doctor does**

Doctors begin by asking patients about their symptoms and medical history, and then perform a physical examination. The results of these inquiries and examinations often indicate the cause of priapism and the tests that may be needed.

Doctors ask about the following:

- Duration of erection

- Pain

- Injury to the penis or groin area

- Medical conditions (such as sickle cell disease) that may cause priapism

- Medications used, including erectile dysfunction medications and recreational drugs

Although doctors focus on the genitals during a physical examination to detect any signs of injury or cancer, they also examine the abdomen and perform a rectal examination.

**Symptoms and Types**

Symptoms of priapism varyIt will vary depending on the type.

1. **Permanent erection due to non-drainage** Persistent erection due to non-drainage occurs when blood is unable to leave the penis, and this type is the most common.

Symptoms and signs include:

- An unwanted erection that lasts for more than four hours.

- The shaft of the penis is hard, while the tip of the penis (glans) is usually soft.

- The erection is not related to sexual arousal or persists after arousal ends.

- The penis is often painful or sensitive.

**2- Persistent erection due to increased blood flow**Permanent erection due to increased blood flow, or force of flow, occurs when too much blood flows into the penis.

Symptoms and signs include:

- An unwanted erection that lasts for at least four hours.

- The penis is erect but not hard.

- The erection is not related to sexual arousal or persists after arousal ends.

- It is usually painless.

3- Intermittent persistent erection**Another type of persistent ischemic erection is known as intermittent or recurrent persistent erection, which appears and disappears repeatedly. This type of erection is often painful and lasts for several hours.

**Risks of priapism and harms of persistent erection**

A person who experiences an erection that lasts for four hours or more should seek emergency medical care immediately. Blood retention in the penis leads to a lack of oxygen, which deprives the tissue of the penis of oxygen, and thus can be damaged. If the condition of persistent erection is not treated quickly, permanent nerve damage can occur, in addition to erectile dysfunction. Tissue damage usually begins 4-6 hours after the onset of persistent erection, so it is important not to delay seeking emergency help, as any damage to the sensitive tissues of the penis will be permanent and irreversible or treatable.

What tests are performed to diagnose priapism?

 

After performing a physical examination, the doctor measures the level of oxygen in the blood in the penis. This test involves inserting a small needle into the penis to take a small sample of blood, which is then sent to a laboratory for analysis. The laboratory results will help the doctor determine:

- The type of priapism the patient has.

- How long the person has had priapism.

- The extent of damage to the tissues in the penis as a result of priapism.

If an injury is the cause of priapism, the doctor may order a Doppler ultrasound. This type of imaging uses sound waves to determine the location and speed of blood flow in the blood vessels, which helps confirm that an injury is the cause of priapism. In some cases, the doctor may also order a drug test (toxicology screen) to determine the substances present in the person’s body and their approximate amounts.

**Permanent erection: What to do and what to avoid**

There are a set of guidelines that the patient is encouraged to adhere to, in addition to some things that should be avoided. Here are the most important:

**1. Tips to follow**

Here are some steps that may help relieve the condition when it occurs:

- Try to go to the bathroom to urinate.

- Drink plenty of water.

- Walk a little.

- Do some light exercise, such as jogging in place.

- Take a warm bath.

- Take painkillers if you need them.

**2. Things to avoid**No matter what the circumstances, try to avoid the following when the condition occurs:

- Avoid applying cold compresses directly to the penis, as this may make the problem worse.

- Avoid drinking alcohol.

- Do not resort to sexual intercourse or masturbation, as this will not relieve the severity of the erection as you may think.

- Avoid smoking.

**Tests and Diagnosis**Your answers to the questions, along with a physical examination and blood tests, are usually enough to determine the type of priapism you have. Additional tests may be performed to determine the underlying cause of this condition, which may require treatment.

**Medical History and Examination**

To determine the type of priapism you have, your doctor will likely ask some questions and examine your genitals, abdomen, groin area (thigh bone), and perineum. Your doctor may be able to determine the type of priapism based on the hardness and sensitivity of your penis. This test can reveal signs of injuries or tumors that may be causing your priapism.

**Diagnostic Tests** Diagnostic tests may be needed to determine the type of priapism you have.

In an emergency, treatment may begin before all test results are available if your doctor is confident that you have priapism. Diagnostic tests include:

**Blood gas test:** In this test, a fine needle is inserted into your penis to take a sample of blood. If the blood is dark, it indicates that it is deoxygenated, which may indicate a priapism caused by blood not being able to exit the penis. If the blood is bright red, it may indicate a priapism caused by increased blood flow. Laboratory tests that measure certain amounts of gases in your blood can also confirm the type of priapism.

**Blood tests:** A blood test may be done to measure the number of red blood cells and platelets. The results may provide clues to certain diseases, such as sickle cell anemia, other blood disorders, or some types of cancer.

**Ultrasound:** An ultrasound may be performed using color Doppler technology, which uses sound waves to create images of internal organs. This test measures blood flow within the penis, which can help determine whether a priapism is ischemic or nonischemic. The test can also reveal injury, tumors, or abnormalities as possible causes of priapism.

**Toxicology Testing.** Your doctor may recommend a testToxic bar to detect the presence of prescription drugs or illegal substances that may be behind the occurrence of persistent erection. This test can be done by taking a blood or urine sample.

**Types of permanent erection and its symptoms**

There are two main types of priapism:

. Ischemic permanent erection ** occurs as a result of poor blood flow to the penis and its retention, which prevents blood from returning to the body during an erection. The most prominent symptoms are:

- Pain in the penis.

- Hardening of the penis.

- Softness at the tip of the penis.

- An erection that lasts for more than 4 hours.

. **Non-ischemic permanent erection** occurs as a result of large amounts of blood flow to the penis, and may be the result of an injury to one of the blood vessels in the area, which leads to increased blood flow. This type is less common compared to the previous type.

It is important to note that the symptoms of this type are similar to those of the first type, with a slight difference, which is the absence of pain

Does masturbation affect priapism?

 

Masturbation or sexual intercourse usually does not relieve priapism, even if ejaculation occurs.

How long does it take for a person to feel better after treatment?

 

If treatment is effective, priapism should begin to improve immediately. A person may feel relief after the first session of treatment, but it may take more than one session if the priapism does not go away at first. After priapism is treated, the penis may feel sore and swollen, but it should not be stiff. It is important to remember that every body is different, so recovery time may vary. Follow your doctor’s instructions for managing pain or discomfort during recovery.

**Treatments and Medications**

**Prurigo**—which occurs when blood cannot exit the penis—is an emergency that requires immediate treatment. Treatment usually begins with draining the blood from the penis along with medication.

**Aspiration**: After the penis is numbed with a local anesthetic, blood is drawn from it using a small needle and syringe. As part of this procedure, the veins in the penis may be flushed with saline. This treatment helps relieve pain and clears the tissues of deoxygenated blood, and can help end the erection. This treatment can be repeated until the erection stops.

**Medications**: An alpha-adrenergic medication, such as phenylephrine, can be injected into the spongy tissue of the penis. This medication constricts the blood vessels that carry blood to the penis, limiting the amount of blood flowing into it, and allows the blood vessels that carry blood out of the penis to open, increasing the amount of blood flowing out of it. This treatment can be repeated several times over a period of hours as needed. However, there is a risk of some side effects such as headache, dizziness, and high blood pressure, especially if you have certain health conditions.

**Surgery**: If other treatments are unsuccessful, your surgeon may implant a shunt, a device that aims to reroute blood flow to normal in the penis.

**Additional treatments**: If you have sickle cell anemia, you may need other treatments aimed at treating the attacks associated with the disease, such as supplemental oxygen or intravenous fluids to improve your body's hydration.

**Præmonal erection due to increased blood flow:** This type of priapism usually goes away without treatment, as it doesn’t cause damage to the penis. Your doctor may suggest a “watch and wait” approach. Applying ice to the perineum — the area between the penis and anus — and applying gentle pressure can help end the erection.

In some cases, surgery may be necessary to insert a substance that temporarily blocks blood flow to the penis. The body eventually absorbs this substance. Surgery may also be needed to repair damage to arteries and tissues from an injury.

**Ice packs:** Ice packs can help reduce swelling caused by increased blood flow to the penis, which helps end priapism by constricting blood vessels.

-**Blood removal**: After the doctor numbs the penis, he or she uses a needle to drain blood from the area to relieve pressure and swelling.

**Treatment for priapism:**

-**Medications:** Priapism occurs as a result of increased blood flow to the penis and its retention in the tissue. In this case, the doctor may use injections of alpha agonists into the penis to constrict the blood vessels and control the persistent erection, which helps relieve congestion and swelling. There are also oral alternatives to these injections. However, medications may not be effective if the erection lasts for more than four hours, which requires resorting to other treatment options.

- **Artery embolization:** In some cases, the doctor blocks the blood vessels responsible for the problem, a procedure known as arterial embolization, and is used in cases of high-flow priapism.

- **Surgical artery ligation:** If the persistent erection is caused by a torn artery, the doctor performs a surgical procedure to tie it off, a method also used to treat high-flow priapism.

- **Surgical shunt:** This procedure involves creating a passage in the penis that allows blood to exit, and is considered the best option for cases of low-flow priapism, although there is a significant risk of injury.

**Herbal treatment for permanent erection**

To date, there is no herbal treatment for recurrent and persistent erections, and no effective alternative for priapism. Consulting a specialist doctor is considered the essential step, as some cases may require emergency intervention. However, in the context of searching for ways to deal with persistent erection with herbs, some preventive tips can be provided that may help avoid worsening the condition before visiting a doctor, including:

- Avoid taking herbs and drinks that may lead to increased blood flow or stimulate erection, such as ginseng, ginger, fenugreek and other herbs known to enhance erection.

- Stay away from popular recipes used to treat erectile dysfunction, regardless of their source.

- Do not take erectile dysfunction medications or sexual enhancers without consulting a doctor.

- Do not follow advice related to treating permanent erection with herbs, and instead, go to the nearest hospital or specialized clinic.

You should also avoid thinking about masturbation or having sex as a way to get rid of persistent erection, as this condition is not related to sexual stimulation.