Priapism: Causes, Symptoms & Treatments

May 15, 2024

4 mins

Priapism is a medical condition characterized by prolonged and often painful erections that occur without sexual stimulation. The condition gets its name from Priapus, the Greek god of fertility. Priapism can be distressing and, if left untreated, can lead to serious complications.

Understanding the causes, symptoms, and available treatments for priapism is crucial for timely intervention and management.

What is Priapism?

Priapism is a persistent, usually painful erection that occurs unrelated to sexual stimulation. While there isn’t a specific amount of time a normal erection typically lasts, most erections last  between a few minutes to an hour. 

Priapism can result in erections that last for hours or, in severe cases, even days. Priapism is not associated with sexual desire or arousal and does not resolve with ejaculation.

This condition is considered a medical emergency as it can lead to permanent damage to the penis if not treated promptly.

Types of Priapism

There are two main types of priapism:

Ischemic (low-flow) priapism: This is the most common type of priapism – accounting for approximately 95% of cases. Ischemic priapism occurs when blood becomes trapped in the penis, leading to oxygen deprivation and tissue damage. It’s typically painful and requires immediate medical attention.

Nonischemic (high-flow) priapism: This type of priapism is rare and occurs when there is an excessive inflow of arterial blood into the penis, often due to trauma. Unlike ischemic priapism, non-ischemic priapism is usually painless and resolves spontaneously without treatment.

Causes of Priapism

Ischemic Priapism

Ischemic priapism is often idiopathic, meaning the cause is unknown. However, several factors can contribute to the development of ischemic priapism, including:

Sickle cell disease: Individuals with sickle cell disease are at a higher risk of developing priapism due to the abnormal shape of their red blood cells, which can obstruct blood flow.

Leukemia: Priapism may be a complication of leukemia, a type of cancer that affects the blood and bone marrow.

Certain medications: Drugs such as antipsychotics, antidepressants, anticoagulants, and medications used to treat erectile dysfunction may increase the risk of priapism as a side effect.

Trauma to the genital area: Injury to the penis or perineum can disrupt blood flow, leading to priapism.

Blood disorders: Other blood disorders, such as thalassemia and leukemia, can increase the risk of priapism.

Non-ischemic Priapism

Non-ischemic priapism is usually caused by trauma to the penis or perineum, such as:

Pelvic injury: Trauma to the pelvic area, such as a fall or a sports injury, can damage the arteries supplying blood to the penis, resulting in non-ischemic priapism.

Penile surgery: Surgery on the penis or nearby structures can sometimes lead to non-ischemic priapism.

Penile injections: Injections used to treat erectile dysfunction can sometimes cause priapism as a side effect.

Symptoms of Priapism

The main symptom of priapism is a persistent erection that lasts for several hours and is unrelated to sexual stimulation. Other symptoms may include:

Penile pain: The erection is often accompanied by severe pain, which may worsen over time.

Difficulty urinating: Some men with priapism may experience difficulty urinating or blood in the urine.

Swelling and tenderness: The penis may appear swollen and tender to the touch.

Fever: In some cases, priapism may be accompanied by fever and other signs of infection.

Complications of Priapism

If left untreated, priapism can lead to several complications, including:

Erectile dysfunction

Prolonged episodes of priapism can cause permanent damage to the erectile tissue, leading to erectile dysfunction.

Penile deformity

In severe cases, priapism can cause scarring and fibrosis of the penile tissue, resulting in a permanent deformity known as Peyronie's disease.

Infection

Prolonged erections can increase the risk of infection in the penis and surrounding tissues.

Tissue necrosis

Severe, untreated priapism can lead to tissue necrosis (death of tissue) and gangrene, which may require surgical intervention.

How to Diagnose Priapism

To diagnose priapism, your doctor will perform a physical examination and may order additional tests, including:

Blood tests: Blood tests can help identify underlying medical conditions, such as sickle cell disease or leukemia, that may be causing priapism.

Penile ultrasound: An ultrasound of the penis can help determine the type of priapism and identify any underlying structural abnormalities.

Blood gas analysis: Analysis of blood samples taken from the penis can help determine the oxygen and carbon dioxide levels, which can help differentiate between ischemic and non-ischemic priapism.

Treatment Options for Priapism

Treatment for priapism depends on the type and severity of the condition. The main goals of treatment are to relieve pain, restore normal blood flow to the penis, and prevent complications.

Treatment for ischemic priapism may include:

• Aspiration and irrigation: A needle is used to drain blood from the penis, relieving pressure and reducing the erection.

• Medications: Medications such as phenylephrine may be injected directly into the penis to help constrict blood vessels and reduce blood flow.

• Surgery: In severe cases, surgery may be necessary to remove blood clots and restore normal blood flow to the penis.

Nonischemic priapism often resolves spontaneously without treatment. However, if the condition persists or causes significant pain, treatment options may include:

• Observation: In many cases, non-ischemic priapism will resolve on its own without the need for medical intervention.

• Medications: Medications to reduce blood flow to the penis, such as alpha-blockers, may be prescribed to help alleviate symptoms.

• Surgery: In rare cases, surgery may be necessary to repair damaged blood vessels and restore normal blood flow to the penis.

How to Prevent Priapism

While priapism cannot always be prevented, there are steps you can take to reduce your risk:

If you have a history of priapism, talk to your doctor about avoiding medications that may increase your risk, such as antidepressants, antipsychotics, and medications used to treat erectile dysfunction.

If you have a medical condition that increases your risk of priapism, such as sickle cell disease or leukemia, work with your doctor to manage your condition effectively.

Take precautions to avoid injury to the penis and perineum, such as wearing protective gear during sports activities.

Where Can You Learn More About Priapism and Other Sexual Discomfort

Priapism is a rare but serious medical condition that requires prompt treatment to prevent complications. If you experience a prolonged erection that lasts for more than four hours, seek medical attention immediately. 

With early intervention and appropriate treatment, the majority of cases of priapism can be successfully managed, reducing the risk of long-term complications such as erectile dysfunction and penile deformity. 

If you’re looking for solutions to treat erectile dysfunction, Rex MD offers medications like Viagra and Cialis, both of which rarely cause priapism. This being said, if you have experienced priapism or are prone to the condition, consult with your doctor about the risks of taking ED medications. 

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