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What is Priapism?

Priapism is a rare condition resulting in an uncontrolled erection lasting for an unusually long time. It can be painful. Sexual stimulation can be involved, but there are often other causes such as medical conditions, medications or recreational drugs. Immediate treatment is important to prevent tissue damage and erectile dysfunction (ED).

When an erection lasts for too long, blood becomes trapped in the penis. One function of blood is to carry oxygen to different organs in the body. When the blood is trapped in the penis, the erectile tissues no longer receive the oxygen they need to stay healthy and to function normally. A prolonged lack of oxygenated blood can irreversibly damage or destroy tissue in the penis. This can disfigure the penis. It may also cause problems like erectile dysfunction (when the penis cannot become erect).

If you have an erection that lasts for four (4) or more hours, go to the emergency room for treatment. If a long-lasting erection eventually goes away, still make time to see your doctor. Treatment can prevent this from happening again and from causing damage.

Types of Priapism

Priapism can happen in a wide age range of males. There are two types of priapism:

  • Acute Ischemic (veno-occlusive, low flow): when blood cannot enter or leave the penis. This erection can last for more than four (4) hours. The penis shaft may be very hard, while the tip is soft. It is known to cause pain and discomfort. This type may stop and start (stuttering priapism). This is a nonsexual, persistent erection.
  • Non-ischemic (arterial, high flow): when a large quantity of blood constantly flows through the penis. This is a less painful erection, but it can also last for more than four (4) hours. The penis shaft and tip are both rigid.

How Does the Penis Normally Work?

The main roles of the penis are to carry urine and sperm out of the body. There are three tubes inside the penis. One is called the urethra. It is hollow and carries urine from the bladder through the penis to the outside. The other two tubes are called the corpora cavernosa. These are soft, spongy tubes that fill with blood to make the penis stiff during an erection. The three tubes are wrapped together by a very tough fibrous sheath called the tunica albuginea.

How Do Erections Work?

When you are not sexually aroused, your penis is soft and limp. During sexual arousal, nerve messages release chemicals that increase blood flow into the penis. The blood flows into two erection chambers made of spongy tissue (the corpus cavernosum) in the penis. The “smooth muscle” in the erection chambers relaxes, which lets blood enter and stay in the chambers. The pressure of the blood in the chambers makes the penis firm, giving you an erection. After you have an orgasm, the blood flows out of the chambers and the erection goes away.

Causes

Priapism happens when blood flow to the penis doesn’t work correctly. Understanding the history of your priapism is of great value because it may help your doctor choose treatment. Some things that could cause priapism are:

  • Blood disorders, like sickle cell anemia and leukemia
  • Prescription drugs, like some erectile dysfunction drugs, mental health drugs and blood thinners
  • Alcohol and drug use
  • Injury to your genitals, pelvis or the area between the penis and the anus; or to the spinal cord
  • Tumors

Diagnosis

To learn why you are having priapism, and which type, talk to your health care provider. He or she will ask questions and examine your genitals, abdomen, groin and perineum. Your doctor will want to learn your symptoms, and if you’ve had an injury. Blood tests, blood gas measurements and a blood flow ultrasound may be used to help diagnose the cause.

Treatment

There are treatment options for priapism. Treatments depend on what type of priapism you have.

Non-ischemic priapism often goes away without treatment. Simple ice and pressure on the perineum may help end the erection. A watch and wait approach is used before surgery.

Ischemic priapism calls for emergency care. Blood must be drained from the penis. There are several ways to do this:

  1. Aspiration (when a surgical needle and syringe is used) to drain excess blood
  2. Medicine or a saline mix may be injected into penile veins to improve blood flow. The veins are flushed to relieve pain, remove oxygen-poor blood and stop the erection
  3. A surgeon may perform a “shunt” to vent blood from the penis

In addition, if you have sickle cell anemia, you will need treatment for that disease. If you have damage to the area from an injury, surgery to repair arteries or tissue could be helpful. If you have stuttering priapism, your doctor may prescribe medical treatments to prevent future events.

 

Publish September 2021

Related Resources

Priapism 101 with Dr. Brian Stork

In this episode of the Urology Care Podcast we discuss priapism with Dr. Brian Stork. Dr. Stork is a urologist with West Shore Urology in Muskegon and Grand Haven, Michigan.


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