A normal penis erection occurs because of physical or physiological stimulation. An increase in blood flow to the penis causes the erection. Once the stimulation ends, the blood flow decreases and the erection subsides. In some rare cases, an erection lasting for hours may occur without any stimulation. This is called as priapism.
What Is Priapism?
Priapism is a condition that causes persistent and sometimes painful erections, which may last for four hours or more without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. Priapism is a relatively rare condition that typically affects males in their 30s. It can occur in all age groups, including newborns. However, most cases are seen in males between the ages of 5 and 10, and 20 and 50.1
There are two types of priapism: low-flow and high-flow.2
- Low-flow (ischemic) priapism occurs when blood gets stuck in the erection chamber.
- A broken artery, sometimes due to an injury, that prevents proper circulation of blood in the penis causes high-flow (non-ischemic) priapism.
An erection that lasts more than four hours without sexual stimulation is a medical emergency.
The oxygen-deprived blood in your penis can damage tissue in the penis. If left untreated, it can damage or destroy penile tissue and cause permanent erectile dysfunction.
Symptoms Of Priapism
The symptoms of priapism differ depending on whether you experience low-flow or high-flow priapism. Symptoms of low-flow priapism include,
- Erections lasting for more than four hours
- Rigid penile shaft with a soft tip (glans)
- Pain in the penis
Low-flow priapism can become a recurrent condition. When symptoms begin, involuntary erections may only last for a few minutes. But, over time, these erections occur more often and last longer. Symptoms of high-flow priapism are the same as low-flow priapism. The main difference is the absence of pain in high-flow priapism.
Causes Of Priapism
Problem with blood flow to your penis is the main cause of priapism. The blood flow in and out of the penis is affected by various disorders and diseases like sickle cell anemia, leukemia, and multiple myeloma.
About 42 percent of adults who have sickle cell anemia experience priapism at some point in their lives. Certain prescription medications, alcohol abuse, marijuana, cocaine, and other illicit drugs may also cause priapism. Prescription medications that may affect blood flow to the penis include:
- Medications for erectile dysfunction
- Medications for anxiety disorders
- Alpha blockers
- Metabolism disorder
- Neurogenic disorder
- Blood thinners
- Hormone therapy
- Medications for attention deficit hyperactivity disorder
- Carbon monoxide poisoning
- Black widow spider bite
- Cancers involving the penis
Diagnosis Of Priapism
Although both types of priapism have similar symptoms, doctors must perform diagnostic tests to ascertain the exact type of priapism. Doctors may diagnose priapism based on symptoms and a physical examination of the genital area. Tests used to determine the type of priapism may include,
Blood Gas Measurement
This procedure involves inserting a needle into your penis and collecting a blood sample. If blood in your penis is deprived of oxygen, it indicates low-flow priapism. If the sample reveals bright red blood, it indicates high-flow priapism.
Since various diseases and blood disorders may cause priapism, blood samples are collected to check the level of red blood cells and platelets, which helps doctors diagnose blood disorders, cancers, and sickle cell anemia.
As priapism is also associated with drug abuse, doctors may collect a urine sample to look for drugs in your system.
Ultrasound can measure blood flow in the penis, which helps doctors to determine whether trauma or injury is the underlying cause of priapism.
Treatments For Priapism
Treatment options differ depending on whether you have low-flow or high-flow priapism.
- For low-flow priapism, doctors may insert a syringe into your penis to remove excess blood from your penis, which relieves pain and stops involuntary erections.
- Another treatment method involves injecting medication into your penis. The medication contracts the blood vessels that carry blood into your penis and expand the blood vessels that carry blood out of your penis.3
- If neither of these therapies works, doctors may perform a surgery to help blood flow through your penis.
- For high-flow priapism, immediate treatment may not be necessary. This type of priapism often goes away on its own. Doctors usually check the patient’s condition before prescribing a treatment. Cold therapy with ice packs can get rid of an involuntary erection. Doctors may also recommend surgery to stop blood flow to the penis, or to repair arteries damaged by an injury to the penis.
- When priapism is recurrent, doctors may suggest taking a decongestant such as phenylephrine (Neo-Synephrine) to reduce blood flow to the penis. Sometimes, hormone-blocking medications or medications for erectile dysfunction are also prescribed.
- If an underlining condition such as sickle cell anemia, a blood disorder, or cancers causes priapism, the underlying problem must be treated first to rectify and prevent future occurrences of priapism.
|↑1||Melman, A., and S. Serels. “Priapism.” International journal of impotence research 12, no. S4 (2000): S133.|
|↑2, ↑3||Cherian, J., A. R. Rao, A. Thwaini, F. Kapasi, I. S. Shergill, and R. Samman. “Medical and surgical management of priapism.” Postgraduate medical journal 82, no. 964 (2006): 89-94.|