Subjective
Date of visit
Reason for visit (evaluation and management of priapism)
Duration of erection (since onset)
Pain level (scale 0-10) and character of pain (aching, burning)
Prior episodes of priapism
Sexual activity preceding the erection (if any)
Past medical history:
Sickle cell disease (major risk factor)
Coagulopathies (blood clotting disorders)
Medication use (especially medications that can cause priapism, e.g., certain antidepressants)
Trauma to the penis
Objective
Vital signs (temperature, blood pressure, heart rate)
Physical exam:
General (assessing for signs of systemic illness)
Genital exam:
Appearance of the penis (tumescence, discoloration)
Corpus cavernosum involvement (both sides or one side)
Glans penis involvement (turgid or flaccid)
Neurological exam (brief exam to assess for sensory abnormalities)
Diagnostic Tests
Priapism score (classifies severity based on duration, pain, and tumescence)
Blood tests:
Complete blood count (CBC) – to assess for blood cell abnormalities (e.g., sickle cell disease)
Coagulation studies – to assess for clotting problems
Arterial blood gas (ABG) – may be done to assess for tissue hypoxia (oxygen deprivation) in prolonged priapism
Color Doppler ultrasonography of the penis:
To differentiate between ischemic priapism (low blood flow) and non-ischemic priapism (high blood flow)
To assess for corpus cavernosum thrombosis (blood clot)
Assessment
Priapism confirmed
Duration and severity of priapism (based on priapism score)
Type of priapism (ischemic or non-ischemic) – ischemic priapism is a medical emergency requiring urgent intervention
Potential underlying cause (sickle cell disease, medications, trauma)
Plan
Urgent intervention for ischemic priapism to prevent tissue damage:
Aspiration of blood from corpus cavernosum
Intracavernosal injection of medications (e.g., phenylephrine) to constrict blood vessels
Possible surgical intervention (shunt placement) in severe cases
Management of non-ischemic priapism:
Aspiration of blood from corpus cavernosum
Observation and pain management
Identifying and addressing the underlying cause (if possible)
Education
Explain priapism, its types, and potential causes.
Discuss the importance of seeking immediate medical attention for priapism, especially if lasting longer than 4 hours.
Review the treatment plan and potential risks and benefits.
Discuss preventive measures to avoid future episodes (if a cause is identified)
Follow-up
Schedule for follow-up appointments:
Monitor for resolution of priapism and any complications
Address any underlying cause that may have contributed to priapism
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of priapism.