Priapism

What is priapism?

Priapism is a long-lasting erection that occurs without sexual arousal or stimulation. It’s usually painful and it can last for more than four hours. It occurs when blood remains in your penis and can’t drain.

Priapism needs immediate treatment. Without treatment, it can cause permanent damage.

What are the types of priapism?

The types of priapism include:

• Low-flow (ischemic) priapism. Low-flow priapism occurs when blood remains in the erection chambers (corpora cavernosa) and can’t escape. It often occurs without a known cause in people without preexisting conditions, but it also affects people with sickle cell disease, blood cancer (leukemia) or malaria. It’s the most common type of priapism.
• Recurrent (stuttering) priapism. Stuttering priapism is a type of low-flow priapism. A long-lasting erection may repeatedly go away and come back. It may last longer and grow more painful each time it comes back.
• High-flow (nonischemic) priapism. High-flow priapism is rarer than low-flow priapism and is usually not painful. Causes may include an injury to your penis or the area between your scrotum and anus (perineum). The injury causes uncontrolled blood flow into the penile tissues, causing a long-lasting erection.

How common is priapism?

Priapism is relatively rare overall, but you may be more likely to have it if you have certain conditions. It occurs in 30% to 45% of people with sickle cell disease.

What are the symptoms of priapism?

The main symptom of priapism is a prolonged erection, usually lasting longer than four hours without sexual arousal or stimulation. Other symptoms depend on the type of priapism you have.

If you have low-flow priapism, your symptoms may also include:

• An erect shaft but a soft tip (glans).
• Pain that gets worse as time goes on.

If you have high-flow priapism, your symptoms may also include:

• An erection that isn’t completely stiff in your shaft.
• An erection that isn’t painful.

What is the main cause of priapism?

Up to 33% of all priapism cases don’t have a known cause.

Low-flow priapism causes may include an underlying health condition, including:

• Sickle cell disease.
• Blood cancer (leukemia).
• Malaria.
• Thalassemias.
• Black widow spider bites.
• Carbon monoxide (CO) poisoning.
• Penile cancer.
• An injury to your spinal cord or genital area.

Other priapism causes may include recreational drug use (marijuana, cocaine and amphetamines) and use or nonmedical use of certain medications, including:

• Erectile dysfunction medications (phosphodiesterase type 5 inhibitors and intracavernous injection therapy).
• Certain antidepression medications (trazodone).
• Certain antipsychotic (neuroleptic) medications (chlorpromazine).

Is priapism contagious?

No, priapism isn’t contagious. It isn’t a sexually transmitted infection (STI) or STI symptom.

Who does priapism affect?

Priapism can occur in anyone with a penis in all age groups, including (very rarely) newborns. However, it most commonly affects two different age groups:

• Children between the ages of 5 and 10.
• Adults between the ages of 20 and 50.

What are the complications of priapism?

Without treatment, priapism can permanently damage your penis. Your blood contains oxygen, which the cells in your body use to create energy. If you have priapism, the trapped blood eventually runs out of oxygen, which can harm the tissues in your penis. Untreated priapism can cause:

• Scarring of the tissues inside the penis.
• Erectile dysfunction (ED).

How is priapism diagnosed?

If you have an erection that lasts longer than a few hours, it’s important to get medical care immediately. A healthcare provider will review your medical history, note your symptoms and conduct a physical examination. During the physical exam, they may ask the following questions:

• How long have you had an erection?
• How long do your erections usually last?
• Has a healthcare provider diagnosed you with any other conditions?
• Have you recently injured your penis or groin area?
• Are you currently taking any medications?
• Have you used any medications in a way a doctor didn’t prescribe?
• Have you used any recreational drugs?

What tests will be done to diagnose priapism?

After the physical exam, the provider will measure the blood oxygen level in your penis. During this test, they’ll insert a small needle into your penis to withdraw a tiny amount of blood. They’ll send the blood sample to a lab for analysis. The lab results will tell the provider:

• What kind of priapism you have.
• How long you’ve had the priapism.
• How much damage the priapism has done to the tissues in your penis.

If an injury causes priapism, the provider may order a Doppler ultrasound. A Doppler ultrasound uses sound waves to show where and how fast blood flows through your blood vessels. It helps confirm that an injury is the cause of your priapism.

In some cases, a provider may order a drug test (toxicology screen). A drug test helps determine what substances and the approximate amount you have in your system.

How do you fix priapism?

The goal of all priapism treatment is to make your erection go away and preserve your ability to have erections in the future. If you think you have priapism, don’t attempt to treat it yourself. Get emergency help as soon as possible.

A healthcare provider may initially give you decongestants, such as phenylephrine (Sudafed PE®). They can help decrease your erection by reducing blood flow to your penis. Decongestants are most effective within four to six hours after first developing priapism.

Other treatment options include:

• Draining excess blood from your penis (aspiration). A provider will first numb your penis. They’ll then use a small needle and syringe to withdraw oxygen-poor blood from your penis to reduce pressure and swelling. They may have to repeat this process a few times until your erection goes away.
• Injecting medications into your corpus cavernosum (intracavernous injection). A provider will use a small needle to inject medication (alpha-agonists) into your penis. Alpha-agonists cause your arteries to narrow. This reduces blood flow to your penis and causes the swelling to decrease. Intracavernous injection treats low-flow priapism.
• Ice packs. Applying an ice pack to your penis and perineum may reduce swelling.
• Surgical ligation. If an injury causes an artery to rupture, a urologist can perform a procedure to surgically tie off (ligate) the injured artery and restore normal blood flow. Surgical ligation treats high-flow priapism.
• Surgical shunt. A urologist can create a channel (shunt) inside your penis to divert blood flow and allow circulation to return to normal. A surgical shunt treats low-flow priapism.

A painful erection can make you feel self-conscious or embarrassed, and you may think you can try some of these treatment options at home first. However, it’s important to see a provider as quickly as possible if you have priapism symptoms.

If an underlying condition causes priapism, you may receive other treatments.

Will masturbating make priapism go away?

No, masturbating or having sexual intercourse usually won’t make priapism go away even if you ejaculate.

How soon after treatment will I feel better?

If the treatment is effective, it should fix your priapism immediately. You may experience relief with the first treatment, or you may need more than one treatment if the priapism doesn’t go away at first. After the priapism is treated, your penis may be sore and feel swollen, but it shouldn’t be rigid.

It’s important to remember that your body is unique. Your recovery time may vary. Follow your provider’s instructions on managing pain or discomfort as you recover.

Can priapism be prevented?

The following tips may help prevent priapism:

• Treat any conditions that may cause priapism.
• Use medications only as prescribed by a healthcare provider.
• Wear an athletic cup to protect your penis if you play sports or participate in other rigorous activities.

How long does priapism last?

High-flow priapism may go away on its own without treatment within hours to weeks.

Low-flow priapism doesn’t go away without treatment.

What is the outlook for priapism?

As long as you get treatment quickly, the outlook for most people is good.

About half of people with low flow priapism can still achieve an erection if they can reverse priapism within 24 hours. If you have low-flow priapism for more than 36 hours, you’ll likely have scarring and permanent erectile dysfunction.

How do I take care of myself if I have priapism?

The following tips may help reduce your erection and relieve pain early on:

• Take nonsteroidal anti-inflammatory drugs (NSAIDs). Not everyone can take NSAIDs, so it’s a good idea to check with a healthcare provider.
• Drink water.
• Try to urinate (pee).
• Go for a walk.
• Do light or moderate physical activities, including jumping rope, running in place or squats.

When should I see a healthcare provider?

Talk to a healthcare provider if you get recurrent painful erections without sexual arousal or stimulation that go away on their own.

After treatment, schedule a follow-up appointment with your healthcare provider. Call your provider right away if priapism comes back after treatment.

Should I go to the ER for priapism?

Priapism is a medical emergency. If you have an erection without sexual arousal or stimulation that doesn’t go away within a few hours, go to the emergency room immediately. The longer you wait, the greater your risk of permanent damage to your penis.

What questions should I ask a healthcare provider?

• How do you know that I have priapism?
• Will I have permanent damage to my penis?
• What type of priapism do I have?
• What’s the cause of my priapism?
• Should I see a urologist?

Can I get priapism while I’m sleeping?

Yes, you can get priapism while you’re sleeping. Getting erections while you sleep is normal (nocturnal penile tumescence). However, priapism pain will wake you up. It usually won’t go away, and it’s difficult to go back to sleep.