Overview

What is priapism?

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

Priapism can occur in all age groups, including newborns. However, it usually affects men in two different age groups: between the ages of 5 and 10, and 20 and 50.

There are two types of priapism: low-flow and high-flow.

Low-flow priapism: This is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but it also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria.
High-flow priapism: This is rarer and is usually not painful. It is the result of a ruptured artery from an injury to the penis or the perineum (the area between the scrotum and anus), which prevents blood in the penis from circulating normally.

Symptoms and Causes

What causes priapism?

Sickle cell anemia: Some adult cases of priapism are the result of sickle-cell disease. Approximately 42% of all adults with sickle-cell will eventually develop priapism.
Medications: A common cause of priapism is the use and/or misuse of medications, including drugs such as Desyrel® (used to treat depression or as a sleeping aid) or Thorazine® (used to treat certain mental illnesses). For people who have erectile dysfunction, injection therapy medications to treat the condition may also cause priapism.

Other causes of priapism include:

Trauma to the spinal cord or to the genital area.
Black widow spider bites.
Carbon monoxide poisoning.
Drug use, such as marijuana and cocaine.

In rare cases, priapism may be related to cancers that can affect the penis and prevent the outflow of blood.

Diagnosis and Tests

How is priapism diagnosed?

If you have priapism, it is important to get medical care immediately. Tell your doctor:

How long you have had the erection.
How long your erection usually lasts.
If you have used any medication or drugs, legal or illegal. Be honest with your doctor—drug use is especially of interest, since both marijuana and cocaine have been linked to priapism.
Whether or not the priapism happened after trauma to that area of the body.

Your doctor will review your medical history and perform a physical examination to help determine the cause of priapism.

After the physical exam is complete, the doctor will take a blood gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, some blood is drawn, and then it is sent to a lab for analysis. This provides a clue to the type of priapism, how long the condition has been present, and how much damage has occurred.

Management and Treatment

How is priapism treated?

The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may decrease blood flow to the penis, may be very helpful. Other treatment options include:

Ice packs: Ice applied to the penis and perineum may reduce swelling.
Surgical ligation: Used in some cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing the priapism in order to restore normal blood flow.
Intracavernous injection: This treatment is used for low-flow priapism. Drugs known as alpha-agonists are injected into the penis. They cause the arteries to narrow, reducing blood flow to the penis and causing the swelling to decrease.
Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you think that you are experiencing priapism, you should not attempt to treat it yourself. Instead, get emergency help as soon as possible.

Outlook / Prognosis

What is the outlook for people with priapism?

As long as treatment is prompt, the outlook for most people is very good. However, the longer medical attention is delayed, the greater the risk of permanent erectile dysfunction.

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Priapism