What is Priapism?

Priapism is a condition of having a prolonged partial or full erection of the penis. Specifically, it happens when blood gets trapped in the penis and is unable to drain. The condition is painful and persistent, typically lasting 4 hours or more without any sexual stimulation. Priapism usually requires some form of treatment to prevent any long-term or permanent scarring or tissue damage (erectile dysfunction). There are two types of priapism: ischemic (low flow priapism) and non-ischemic (high flow priapism). Ischemic priapism is considered a medical emergency.

• Low flow priapism. This occurs when blood gets caught in the erection chamber.
• High flow priapism. This occurs when a broken artery prohibits appropriate blood circulation in the penis, which results in high flow. This is often caused by an injury.

Priapism is usually caused by medication, sickle cell disease, or injury. It is not a common condition, but it does impact males who suffer with sickle cell disease at a much higher rate. It typically impacts males in their 30’s or older but can affect younger males who have sickle cell disease. It is important to consult with your healthcare provider immediately if you have any symptoms of priapism to prevent any tissue damage that may result in erectile dysfunction.

Signs and Symptoms

Signs and symptoms of priapism vary depending on the type of priapism you have. However, the primary symptom of priapism is a prolonged erection. It is important to consult with your healthcare provider if you have an erection lasting 4 hours or more. Common symptoms include:

Ischemic (low flow) priapism

• An erection that lasts longer than 4 hours without sexual interest or stimulation
• The penile pain gets worse over time
• Rigid penile shaft, but the tip of the penis remains soft

Stuttering Priapism

• Also known as recurrent or intermittent priapism
• Recurrent episodes of prolonged erections, usually including ischemic priapism
• Occurs more often in males with sickle cell disease
• May begin in childhood

Non-ischemic (high flow) priapism

• A prolonged erection lasting 4 hours or more without sexual interest or stimulation
• The erection occurs without a fully rigid penile shaft
• It is usually not painful

Causes

Often, underlying causes for priapism may not be able to be determined. However, there are several conditions that may contribute to developing priapism. Causes include:

• Blood disorders. These include sickle cell disease, leukemia, and hematologic dyscrasias (thalassemia and multiple myeloma).
• Medications. Medications used to treat erectile dysfunction, certain antidepressants, certain anxiety medications, certain mood stabilizers, alpha-blockers, blood thinners, certain hormones, and certain ADHD medications can cause priapism.
• Injury. A common cause for non-ischemic priapism is trauma or injury to the penis, pelvis, or perineum.
• Alcohol and drug use. Marijuana, cocaine, other drug usages, and alcohol can be a cause for priapism.
• Other factors. Other potential causes of priapism include spider bites (black widow), scorpion bites, other toxic infections, metabolic disorders, neurogenic disorders, and cancers that involve the penis.

Diagnosis

It is important to seek emergency medical care when you have an erection lasting 4 hours or more. To determine what treatment to proceed with, a doctor must first determine what type of priapism it is (ischemic or non-ischemic). The treatment is different depending on the type. There are several diagnostic tools that can be used. Typically, to diagnose priapism, a thorough history and physical examination will be performed, and various diagnostic tools will be used. Diagnostic tools are used to determine which priapism type it is and possibly identify underlying causes. These tools include:

• Penile blood gas measurement. This test places a small needle into the penis to take a sample of blood. If the color of the blood is black, it is indicative of ischemic priapism. If the blood is bright red, it indicates a non-ischemic priapism. The sample is sent to a lab where it will measure levels of gases, which also helps to determine the type of priapism.
• Ultrasound. An ultrasound can be used to detect blood flow through the blood vessels in the penis. This type of test can differentiate between ischemic and non-ischemic priapism, and may also be able to determine the underlying cause.
• Blood tests. This can be used to measure red blood cells and platelets, which can indicate sickle cell disease, cancer, or other blood disorders.
• Toxicology test. These tests are used to rule out any drugs that may be causing the priapism

Treatment

Treatment for priapism is determined by the type of priapism you have (ischemic or non-ischemic). Doctors will work quickly to determine which type it is so that treatment can be administered immediately. There are several treatment options that are used. The best outcome in treating priapism is to treat it immediately. Treatments include:

Ischemic Priapism

The most common treatment for ischemic priapism involves using a needle and syringe to drain excess blood from the penis. This procedure stops the erection and helps prevent involuntary erections in the future. Another treatment option for priapism is administering medication that helps to shrink the blood vessels and reduce blood flow coming into the penis and expand the blood vessels that increase blood out of the penis. Additionally, if neither treatment options are effective, doctors may recommend surgery to help regulate blood flow in the penis. If the priapism is connected to sickle cell disease, there may be additional treatments required.

Non-Ischemic Priapism

High flow (non-ischemic) priapism may not require treatment, as it often clears up on its own. A doctor will assess whether your condition requires specific treatment. During a “wait and watch” approach, it may be recommended to use an ice pack on the perineum (area between the base of the penis and the anus) to help alleviate the erection. In some cases, surgery may be recommended to regulate blood flow in the penis or to repair damaged arteries or tissues caused by an injury.

Complications

If treated promptly, priapism generally has a positive outcome. However, if treatment is delayed, there is risk for complications, such as permanent tissue damage and erectile dysfunction. It is important to seek medical attention immediately if you have an erection lasting over four hours.