Priapism

Alternative Names

Pain – penis, Priapism

What is Priapism

Priapism is a constant and painful erection lasting more than 4 hours in duration. The priapism erection is not associated with sexual activity and is not relieved by orgasm. It occurs when blood flows into the penis but is not adequately drained. It happens when your penis fills with blood as it usually does when you have an erection, but your blood becomes trapped and can’t return to your body's normal circulation. Priapism can happen without any sexual stimulation and your erection doesn’t go even if you ejaculate.

Priapism can affect men and boys of any age, including young babies.

Signs and symptoms

Symptoms of priapism can be varying depending on the type of priapism.

Ischemic priapism. Low-flow priapism is the result of blood not being able to leave the penis. It's the most common type of priapism. Signs and symptoms include:

• Unwanted erection lasting more than four hours
• Rigid penile shaft, but usually soft tip of penis (glans)
• Erection not related to sexual stimulation or persistent after stimulation
• Usually painful or tender penis

Nonischemic priapism. High-flow priapism occurs when too much blood flows into the penis. Signs and symptoms include:

• Unwanted erection lasting at least four hours
• Erect but not rigid penile shaft
• Erection not related to sexual stimulation or persistent after stimulation
• Usually painless
• Stuttering priapism

Another type of ischemic priapism is stuttering or recurring, priapism occurs off and on. A stuttering erection is usually painful and generally lasts several hours.

Possible complications

Erectile dysfunction – is the main priapism complication. This happens when you have difficulty getting or keeping an erection. This can happen as a result of permanent damage to the muscle and erectile tissue in your penis, which becomes much scarred. This damage usually occurs within 24 hours of priapism starting, so it's important to seek medical treatment quickly. It’s thought that priapism may affect fertility, particularly if you have stuttering priapism.

What causes

Common causes of priapism include:

• Alcohol or drug abuse (especially cocaine)
• Certain medications, including some antidepressants and blood pressure medications
• Spinal cord problems
• Injury to the genitals
• Anesthesia
• Penile injection therapy (a treatment for erectile dysfunction)
• Blood diseases, including leukemia and sickle cell anemia

Prevention

Depending on the cause of the priapism, ways to prevent priapism may include:

• Treating the disease that may have caused priapism
• Changing medications if a prescription medication was the probable cause
• Avoiding triggers, such as alcohol or illegal drugs
• Self-injection of phenylephrine to stop prolonged erections
• Hormone treatment — only for adult men
• Prescription muscle relaxant, such as baclofen (Lioresal)

Treatment

If the erection lasts for only two to three hours, some decongestant medications, such as pseudoephedrine may do the trick.

At the first stage of the treatment, the cavernous tissue of the penis shaft gets punctured by a special needle under local anesthesia, the excess blood is drained and vasoconstrictive drugs are injected. Vasoconstrictve drugs constrict the blood vessels and thus, help reduce the blood flow to the penis. Since these drugs may end up in blood vessels servicing other parts of the body, they may cause a sudden drop in arterial pressure and, consequently cause fainting. Hence is it very important that the treatment is administered under medical supervision, preferably in a hospital, and the arterial blood pressure is constantly monitored.