16 March 2020
Although rarely confronted, the sexologist must be aware that a “priapiform” erection, i.e. conscious > 15 minutes, outside any sexual context, is abnormal and may become potentially dangerous after one hour. Until proven otherwise, any priapism is a therapeutic emergency due to the risk of ischemic erectile sequelae (if not treated before the 24th hour) specific to the acute venous type (95% of cases). The three key points of treatment are to precise the duration, the pathophysiological mechanism and the etiology. In the majority of cases, the clinic and, if necessary, the blood gas distinguish the chronic, subacute or acute (the most dangerous) venous type from the very rare arterial type. The treatment is always adapted to the arterial or venous type and to hypoxic suffering (blood gas role). Medical treatment is almost always effective before the 24th hour for the acute venous type. Surgery is only indicated if medical treatment has failed or cases seen after 24th hour. The sexologist may be in the 1st care line in case of chronic venous priapism or especially, iatrogenic one caused by an intracavernous injection of proerectile drugs. After evaluating the emergency degree, he should not hesitate to start first-line medical treatment before referring, if necessary, to the emergency room or to the urologist. In fact, the best prevention of post-priapism erectile sequelae involves educating all both concerned health professionals and at-risk subjects about these dangers as well as prompt treatment of priapiform erections.
Bondil, P. & Carnicelli, D. (2020). Priapiform erections: What should a sexologist know and do? Sexologies. DOI: 10.1016/j.sexol.2020.02.003
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