For many men, reaching their 40s and 50s brings a new focus
on hormonal health. We talk openly about decreasing libido, fatigue, and the
challenges of managing erectile dysfunction (ED)—all common symptoms of
Andropause, or the natural decline in testosterone.
But there is a far less common, yet medically urgent, sexual
health concern that can sometimes surface during this chapter of life: Priapism.
Priapism is defined as a painful, prolonged erection that
persists for hours, unrelated to sexual stimulation. While it might sound like
a dream scenario for some, it is a urological medical emergency that requires
immediate attention to prevent permanent damage.
If you or a loved one is navigating andropause, here is what
you need to know about this serious condition, why it may occur during midlife,
and why time is crucial.
Defining the Crisis: What is Priapism?
The term "priapism" comes from Priapus, the Greek
god of fertility, but there is nothing divine about the condition. It occurs
when blood flow regulation in the penis fails, causing blood to become trapped
within the shafts (corpora cavernosa).
It is crucial to understand that there are two primary types
of priapism, and one is far more dangerous than the other:
1. Ischemic Priapism (Low-Flow)
This is the most common and the most dangerous form. It
happens when the blood is trapped, unable to drain. Because the blood is
static, it becomes starved of oxygen (ischemic), which causes severe, throbbing
pain.
⚠️ Ischemic priapism is a true
medical emergency. The lack of oxygen rapidly damages the corporal
tissue (spongy tissue of the penis). If not treated quickly, this can lead to
fibrosis (scar tissue) and potentially permanent, severe erectile dysfunction.
2. Non-Ischemic Priapism (High-Flow)
This type is usually painless and less urgent, often caused
by trauma (such as a straddle injury) that ruptures an artery, leading to
uncontrolled blood flow into the penile tissue. It still requires medical
intervention but does not present the same immediate risk of tissue death.
The Andropause Connection: Why Does This Happen Now?
Priapism can occur at any age, but men in midlife (the age
bracket most commonly associated with andropause) often face a unique overlap
of risk factors that increase their susceptibility.
1. Increased Use of ED Treatments
While declining testosterone itself is generally not a
direct cause of priapism, the treatments used to combat ED are the most common
culprits in the andropausal age group.
- Intracavernosal
Injections (ICI): This treatment involves injecting vasodilating
drugs (like Trimix or Bimix) directly into the penis. While highly
effective, if the dosage is too high or if the medication is not fully
metabolized, it can result in a prolonged erection.
- Oral
Medications (PDE5 Inhibitors): While less common than with
injections, overuse or recreational use of medications like Sildenafil
(Viagra) or Tadalafil (Cialis), especially when combined with other drugs
or alcohol, can sometimes trigger a low-flow event.
2. Underlying Health Conditions
As men age, they are more likely to develop systemic
diseases that can affect blood viscosity and flow regulation. Conditions that
increase the risk of priapism include:
- Diabetes: Affects
vascular and nerve health.
- Sickle
Cell Disease or Thalassemia: These blood disorders cause
abnormally shaped blood cells, which can easily clot and block the small
veins that drain the penis.
- High
Blood Pressure (Hypertension): The medications used to treat
hypertension can sometimes have side effects that affect erectile
function.
3. Medication Side Effects
Men in their 50s and 60s are often on complex medication
regimens. Certain psychiatric medications, antidepressants (especially
Trazodone), and blood thinners have all been linked as potential—though
rare—causes of priapism.
The Critical Rule: Time is Tissue
If you experience an erection that lasts longer than four
hours and is not related to sexual activity (especially if it is painful and
firm), you must seek emergency medical care immediately.
This is not a condition you can "sleep off" or
wait until the morning to address. Every hour that passes increases the risk of
permanent damage.
What Happens in the Emergency Room?
When you arrive at the ER with ischemic priapism, your
doctor (ideally a urologist) will aim to restore normal blood flow and
oxygenation as quickly as possible. Treatments include:
- Aspiration: The
doctor will use a fine needle to drain the trapped, deoxygenated blood
from the penis.
- Irrigation
and Injection: After draining the old blood, a saline solution is
often used to flush the tissue, and medication (usually phenylephrine) is
injected to contract the blood vessels and allow normal drainage.
- Surgical
Intervention: If aspiration and injection fail, a surgical shunt
may be necessary to bypass the blocked drainage system and restore
circulation.
Prevention and Proactive Health Management
While priapism is a scary ordeal, it is highly preventable,
especially when treatment for ED is involved.
1. Communicate Honestly with Your Urologist
If you are using injectable ED therapies (ICI), it is
paramount that you are trained on the correct dosage and technique. Always
follow the established guidelines for injection, and never increase the dose
without consulting your urologist.
2. Know Your Rescue Plan
If you use injection therapy, your doctor should provide you
with a reversal agent (often a pill or shot) and clear
instructions on when to use it and when to immediately head to the ER.
3. Manage Underlying Conditions
Keeping chronic conditions like diabetes and hypertension
well-controlled is essential for overall vascular health, helping to ensure
healthy blood flow in and out of the corpora cavernosa.
The Takeaway
Andropause comes with its share of health challenges, but
awareness is the best defense. If you struggle with ED and are exploring
aggressive treatments, discuss the risk of priapism openly with your urologist.
Remember the four-hour rule. If a prolonged, painful
erection occurs, put down the phone, forget the embarrassment, and get
emergency help immediately. Protecting your long-term sexual health is the
ultimate priority.
