What is Priapism? (Prolonged Erection of Penis)

Priapism is a prolonged (full or partial) erection of the penis that usually lasts more than 4 hours.

The erection is not caused by sexual stimulation and can be painful sometimes.

Priapism develops when blood in the penis gets trapped and cannot be drained.

Prompt treatment for priapism is needed to prevent tissue damage and permanent erectile dysfunction (ED) (the inability to maintain or get an erection).

Priapism is uncommon. It can also occur in all age groups, including newborns; however, it typically affects males in their 30s.

Types Of Priapism (Prolonged Erection of Penis)  

Low-flow priapism or ischemic priapism   

This is the result of blood being trapped in the erection chambers. It often occurs without a known cause in otherwise healthy men, but it also affects men with sickle-cell disease, leukemia (cancer of the blood), or malaria.

High-flow priapism or nonischemic priapism

This is rarer and is usually not painful. It results from 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 Of Priapism  

Priapism symptoms depend and vary on the type of priapism.

Signs and symptoms of Ischemic priapism  

  • Erection lasting > 4 hours or unrelated to sexual interest or stimulation 
  • Rigid penile shaft, but the tip of the penis (glans) is soft 
  • Progressively worsening penile pain 

Signs and symptoms of Nonischemic priapism  

  • Erection lasting > 4 hours or unrelated to sexual interest or stimulation 
  • Erect but not fully rigid penile shaft 
  • Usually not painful

What Causes Priapism?

Conditions that may cause priapism include:

  • Sickle cell anemia
  • Certain medications  
  • An injury to the spinal cord or genital area
  • Black widow spider bites and scorpion stings
  • Carbon monoxide poisoning
  • Using street drugs like marijuana and cocaine
  • Multiple myeloma
  • Leukemia
  • Hormone therapy
  • Alcohol abuse
  • Metabolism disorder
  • Neurogenic disorder
  • Cancers involving the penis

Diagnosis of Priapism  

Physical examination:  

Your doctor will ask questions about your medical history and do a thorough physical exam. Your doctor will also look for any signs of rectum and belly cancer.

Blood tests  

A complete blood picture and other parameters to look for sickle cell disease and other blood disorders 

Doppler ultrasound  

A color Doppler ultrasound, an imaging test, shows how blood flows in the penis.

Arteriogram  

An X-ray called an arteriogram detects a dye your doctor injects into an artery.

Penile blood gas measurement  

A test measuring the amounts of certain gases in the blood to confirm the type of priapism 

Toxicology test  

Blood or urine tests to screen for drugs that may lead to priapism.

Treatment of Priapism  

Ice packs   

Reduces the swelling in the high-flow priapism.

Removing the trapped blood  

After numbing the penis, a needle drains the trapped blood from the area to ease pressure and swelling.

Medicines  

For low-flow priapism, drugs called alpha-agonists are injected into the penis. These drugs can also be taken orally.

Blocking the artery  

Arterial embolization is performed to block the blood vessels causing the problem.

Tying off the artery  

Surgical ligation is performed to tie a ruptured artery that is causing priapism.

Surgical shunt  

A passageway is created in the penis to allow the blood to drain.

 Prevention of Priapism

  • Prompt treatment of the underlying condition 
  • Use of oral or injectable phenylephrine 
  • Hormone-blocking medications  
  • Use of oral medications used to manage erectile dysfunction.

Myth and Fact on Priapism  

Myth: Men with sickle cell anemia only get priapism 

Fact: Sickle cell anemia is a major contributing factor to priapism. However, many other conditions, such as an injury or cancer, etc. can also cause priapism 

Did You know?

  • Priapism occurs in males of all ages (newborns to adults).
  • An erection usually lasts for more than 4 hours without any sexual stimulation