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Sickle Cell and Priapism

It is often said that sickle cell disease does not kill. This series will focus on breaking down and understanding each of the complications that might develop from sickle cell, so that you can know how to prevent this, catch it early and deal with it. Knowledge is power!

Priapism refers to a prolonged penile erection (e.g., lasting longer than 4 hours) unrelated to sexual stimulation or desire.  There are 2 types of priapism: Low flow priapism [LFP]) results from reduced venous outflow from the erectile tissue (usually due to sickle cells clumping up the penile artery), and this is the most common type that affects sickle cell patients. High flow is usually unrelated to sickle cell, so I won’t bother going into it.

Risk Factors: 38-42% of men with sickle cell (or any variance eg thalassemias) will have LFP at least once during their lifetime. LFP usually peaks between the ages of 5-10 and 20-50. Use of recreational drugs like Cocaine, Marijuana and alcohol further increase your risk.

How do I know if I have Priapism?

If you have an erect, rigid, painful penis and no feelings of arousal, then you probably have priapism.

Besides the fact that priapism is uncomfortable, if left untreated, LFP can result in hypoxia (lack of oxygen to cells) and acidosis (increase of lactate acid in cells), tissue damage, and permanent erectile dysfunction (Eek!) and is considered a urologic emergency. So please, if you do have priapism, visit your doctor or go to the ER to get it treated! If you have priapism for 24 hours, you will become permanently impotent!

Treatment:

The first treatment option is to  place ice packs to the penis and perineum to reduce swelling.  With SCD patients, blood transfusions or exchange transfusions are given to increase the hematocrit value to greater than 30%. Hydration through IV fluids is given to thin out the blood. If this does not resolve LFP, the next step is an injection of Terbutaline, and if this is unsuccessful, another drug called Phenylephrine could be administered. In some cases,  the doctor can draw out the blood from the penis with a needle, followed by a saline irrigation (water follows salt which is then excreted by the kidneys reducing the pressure). If these treatment strategies fail, you might have to have surgery to create a shunt that diverts the blood or a bypass of the blockage.

There are adverse effects related to the medications that will be injected. Report to your doctor if you have a headache, hypertension, dizziness, slow heart beating, fast heart rate, palpitations in the chest, signs of infection, bleeding from the site, or any changes to your penis.

How do I prevent Priapism?

There is very little you can do to prevent LFP. The best tips are to avoid triggers of your LFP (certain medications like anti-anxiety pills, Viagra, Levitra, and Cialis, anticoagulants, antihypertensives, antidepressants, antipsychotics, tranquilizers, antihistamines, cocaine, marijuana and alcohol). Drink at least 2 liters of water a day. Hydration works both ways to prevent crises and prevent cells from clumping together. For some reason, Glutamine and Arginine have caused some people to have LFP, even though in some it has the opposite affect. You might have to learn how to give yourself injections in the penis if this becomes a permanent recurrent problem.

Okay warriors, that is a brief synopsis of priapism. It is not something to be scared of, and many males with sickle cell have had it and will have it. So just follow these tips, put some ice on it, and if it doesn’t go away in a couple of hours, head to the ER/doc to get it taken care of.

Remember, knowledge is power. Be well.

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About Author

Sickle Cell Warrior

Sickle Cell Warrior

Tosin is dedicated to perpetuating healthy and positive messages about sickle cell. Although sickle cell is a subject often taboo in the communities this condition is most prevalent, Tosin’s message is that sickle cell is not something to be ashamed of and you can live a rich and fulfilling life with sickle cell. Sickle cell warriors are the most amazing people in the world, with a great fortitude for compassion, willpower and strength.

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9 Comments

  1. Lolade
    Lolade June 19, 21:59

    I just feel like crying right now. So many things are going on in my mind. My daughter is 22, in her final year in university and a sc warrior. When she’ in crisis, I’m practically in crisis with her, and I can assure you I know what warriors go through. But what pains me most now is that I have never told her how brave she is but rather, I’ve been concentrating on asking God to heal her or transfer the pain to me. I strongly believe in the power of the Lord Jesus to heal, and now I thank Him for leading me to this site;now i can deal with a lot of question I struggle with. My older son is a warrior too, his geneotype being sc. His crisis is not often as his sister’s, never the less, it breaks my heart to see my children suffer so. I feel much better now haven poured out my mind. God bless you for the great work you’re doing.

  2. Sickle Cell Warrior
    Sickle Cell Warrior Author June 20, 22:44

    @Lolade, thank you for telling me about your wonderful children. Sickle cell warriors are the most powerful and brave people I know, with a hard inner core and indomitable spirit. My mother often stated that she prayed for the pain to be transferred, and as much as it hurts, I know that God has a plan for everything, and that my purpose in life is pre-printed in my DNA even before I was formed in my mother’s womb. So think the same of your offspring…there is a reason they are here on this Earth, and their purpose is greater than sickle cell, you or I. I’m grateful that you have gleaned some gems from this site, and I hope that it will continue to enrich your life and many others. You are blessed to have amazing children and congratulations on all their successes now and in the future.

  3. Victor Steve
    Victor Steve January 12, 21:11

    I thought i would share this with the warriors who may be struggling with this. There is new research coming out of the United kingdom, that has shown a two/three times daily dose of oral pseudoephedrine 60mg, may significantly reduce priapism episodes in young men. previous studies have also contraindicated antidepressants, however Paroxetene which is an SSRI used to treat depression has been prescribed to patients who suffered priapism; they have reported reduced and much less painful episodes.

  4. Keenan
    Keenan December 26, 22:08

    I went through this EVERYDAY from when I was 14-17 then it chilled out for a couple years then started back everyday from age 20 up till now, which im 22 now and I still deal with it practically every single day, the doctors tried everything prescribed me everything under the sun including anti deppresants… i really didnt like thos I slept practically all day it made me different, inactive i wasnt interested in doin anything at all besides laying on the couch… the only thing I could do was treat it myself n my self treatment was… dancing, anytime I have an episode I immediately get my blood pumping by doin push ups sit ups n dancing I’ve done this since I was maybe 16 n thats the ONLY thing thats has helped me in any kind of way, not even the hydroxyurea i take everyday will keep it at bay like I said nothing has helped me besides dancing, it leaves me exhuasted in the mornings but I do what I have to do because when it first started it was agonizing physically and mentally it literally drove me crazy I was afraid to sleep cuz i knew when I woke up I’d be in extreme pain, but anyways maybe some exercise will help you too its worth a try…

  5. Gilbert Konadu Owusu
    Gilbert Konadu Owusu March 12, 11:56

    my name is gilbert now 28yrs and i’am SS,now am facing priapism each and every night i sleep,have taken it to the ureologist and he priscribed a medicine for but couldnt get some still seaching for one,now it happen very severe to me and i took it to the clinic and put a drip on me so i was okay for a month after then it keeps haunting me each night now i dont know what to do am in pain……some one help meeeeee…………………..

  6. Professor Felix Konotey-Ahulu MD
    Professor Felix Konotey-Ahulu MD February 06, 14:45

    Take a look at my recent post in the British Medical Journal “Acute osteomyelitis in African children unmasks sickle cell disease with salmonellosis”. http://www.konotey-ahulu.com/publication_articles.asp lists what I have been writing on Sickle Cell Disease patient since 1965 till this week.

  7. Professor Felix Konotey-Ahulu
    Professor Felix Konotey-Ahulu February 06, 14:55

    My textbook of 643 pages describes any condition that Sickle Cell Disease patients suffer from, with the incidence in all the phenotypes SS (Sickle Cell Anemia, SC ie Sickle Cell Haemoglobin C Disease, then Sbeta-Thalassaemia, etc. My “The Sickle Cell Disease Patient” is available.

  8. Godsent
    Godsent June 26, 03:54

    I had priapism at age eleven and we waited 3days before operating on me. After the operation i got no erection till I turned 19 even at that erection isnt that hard but it has improved a little now. I can have meaningful sex now. Then at 20 I developed a problem that reoccurred every night. If I sleep I wake up with painful erection. I would have to run around press my penis and even do pushups at night to get it down. If I go back to sleep it comes back more severe than the previous episode so I stay awake all night chatting and watching movies but immediately the sun comes up and I get my penis to get flaccid I will sleep without any pains. I have siestas with no pains but at night it’s something else.

    My mum got to know about it and we met doctors who prescribed tramadol, Valium and other drugs all to no avail. I finally met a doctor who prescribed cyproterone. The pains stopped immediately but each time I take it I have poor erection, loss of sexual appetite. I just read online that the drug causes what I listed and I can’t afford to have erectile dysfunction. What do I do?
    You also said priapism when left for 24hrs will lead to permanent impotence. Mine stayed for 3days and at age 19 I got my girlfriend pregnant. At age 21 same happened. At age 23 I got another girl pregnant and then this year I had a girlfriend who lived in with me and in February she got pregnant for me. I’m asking now did all these girls lie or is there a possibility that my prolonged priapism didn’t make me impotent? Sorry for my indiscretion in protecting myself, would be note careful and I have no diseases because I’ve gone for tests.

  9. Godsent
    Godsent June 26, 04:09

    I forgot to add if i take the cyproterone for 3days the pains stop for 3weeks to a month and then gradually come back and i can have my erection without pains at first, higher sex drive but after a few days the pains at night resurface

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