Let’s get this over with…

Kara Martina, B. Sc. Biopsychology
A sensitive subject, given its relation to sexuality, an Ischemic priapism is a condition that male Sickle Cell patients may encounter. This prolonged erection results from lack of adequate blood circulation through the penis resulting in a painful and unwanted condition that may last for more than four hours. Even when stimulation is gone, the irregular shape of sickle cell blood can prevent it from leaving appropriately. It is very important that an Ischemic priapism is diagnosed properly, not mistaken for nonischemic priapisms, a mistake which may alter treatment plans. Without the restoration of arterial inflow to the cavernosal tissue, this sponge-like tissue will be deprived too long of oxygen resulting in interstitial edema, corporal smooth muscle fibrosis, and clinical erectile dysfunction (1).A single prolonged erection may cause these more serious consequences, with alterations at the structural and molecular level in the corpora cavernosa, the tissue necessary for proper erections. Edema of the cavernous tissue and its delicate framework at 4 hours is followed by a stripping of the capillary walls at 24 hours, followed by smooth muscle cell death and transformation into fibroblastic-like cells at 48 hours. These dire changes can lead to progressive fibrosis and erectile dysfunction of the penis in the future. If you or a loved one experiences this condition, treatments include:

At home remedies {Beginning/non-severe condition}

 A cold shower or ice pack may relieve symptoms along with exercise in the form of climbing stairs (2). However, given the unwanted consequences of an Ischemic priapism, seeing your doctor outweighs the convenience of a shower. 

Medication to take

Doctors may administer pain relief via an epidural (3). Also prescription drugs such as Vazculep and Vicodin reduce its pain.
You may also receive treatments that are commonly used to treat SCD-related episodes, such as supplemental oxygen or an intravenous solution to keep you hydrated (2). 

In the hospital   

Both a combination of draining and injection of alpha-adrenergic sympathomimetic drugs may be administered (1). These drugs mimic the action of the sympathetic nervous system, constricting the blood vessels that carry blood into the penis. This then allows blood vessels that carry blood out of the penis to open.

• The first step called ‘aspiration’ (the draining), proceeds after the penis is numbed with local anesthetic, using a small needle and syringe to rid it of excess blood (3). Also, the penile veins may be flushed with a saline solution. This treatment relieves pain and  removes oxygen-poor blood. It may stop the erection but also might be repeated until the erection ends.
  

• After the draining, the penis may be injected with alpha-adrenergic agonist agents including epinephrine, norepinephrine, or phenylephrine which cause the veins to re-open. As a result, the blood circulation to the penis is re-established. 
  

There are some potential side effects such as headaches, dizziness and high blood pressure, particularly if you already have high blood pressure or heart disease (2). Lastly, surgery may be considered if other treatments aren’t successful. A surgeon may implant a shunt that reroutes blood so that it can move through your penis normally (2).


References

1. Bassett, J., Raifer, J. Diagnostic and Therapeutic Options for the Management of Ischemic and Nonischemic Priapism. Rev Urol. 2010 Winter; 12(1): 56–63. 


 2. Mayo Clinic. (2014). Priapism: Prolonged Erection. Retrieved November 15, 2014 from http://www.mayoclinic.org/diseases-conditions/priapism/basics/treatment/con-20029378

3. UCSF Medical Centre. (2014). Priapism Treatment. Retrieved November 15, 2014 from http://www.ucsfhealth.org/conditions/priapism/treatment.html