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Priapism

Published by Bupa's health information team, July 2009.

This factsheet is for men who have priapism, or who would like information about it.

Priapism is a long-lasting, often painful erection, unrelated to sexual stimulation. It requires emergency medical treatment, otherwise permanent damage can be done to your penis.

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

• About priapism
• Symptoms of priapism
• Complications of priapism
• Causes of priapism
• Diagnosis of priapism
• Treatment for priapism
• Questions and answers
• Related topics
• Sources

About priapism

Priapism is when a man has a long-lasting, often painful, erection. It usually occurs without any sexual stimulation and in spite of ejaculation.

Priapism happens when the penis fills with blood (as it usually does during erection), but the blood becomes trapped and is unable to return to the body's normal circulation.

There are two types of priapism.

Low blood flow priapism

Low blood flow priapism is the most common and the most serious type of priapism. It's a medical emergency and you should seek treatment within four hours of it starting. It's usually caused by a blockage in the vein that runs from the penis. Over time tissue damage can occur in the penis causing permanent erectile problems.

High blood flow priapism

This is caused by an injury to the penis or the area between your anus and scrotum (perineum). A ruptured blood vessel causes too much blood to flow into the penis. This is a rare type of priapism and doesn't usually cause long-term damage.

Priapism can last for many hours. Usually a diagnosis is made if you have had an erection for four hours or more. Sometimes you may have re-occurring erections for shorter periods of time, from a few minutes to a couple of hours - this is known as stuttering priapism.

Symptoms of priapism

The main symptom of priapism is a prolonged erection. Your penis may be fully erect or it may be semi-erect.

With low blood flow priapism you will have pain in the shaft of your penis. Also the head of your penis (glans) will be soft.

With high blood flow priapism you usually don't have pain in the shaft of your penis, but it may feel uncomfortable. Your glans will be firm.

Complications of priapism

The main complication of priapism is erectile dysfunction. This is when you have difficulty getting or keeping an erection. This is as a result of permanent damage to the muscle and erectile tissue in the penis. This damage usually occurs within 24 hours of priapism starting so it's important to seek medical treatment quickly.

Causes of priapism

Known causes of priapism include:

• medicines such as some antidepressants, anticoagulants like heparin and warfarin, and drugs injected directly into the penis to treat impotence
• illicit drug use, including cocaine, marijuana, ecstasy and alcohol abuse
• blood disorders such as sickle cell disease, thalassaemia and leukaemia
• injury to your pelvic area, perineum or genitals
• pelvic tumour
• spinal cord injury
• infections, specifically some types of pneumonia, malaria and gonorrhoea
• carbon monoxide poisoning
• vigorous sexual activity
• black widow spider bites

For up to half of men with low blood flow priapism no cause for the condition is found.

Diagnosis of priapism

Priapism can cause permanent damage to your penis, so getting medical help quickly is important.

Although your GP will be able to diagnose priapism, it's best to go to the accident and emergency department of your local hospital as immediate treatment is needed. Any delays may result in complications. You may be referred to a urologist - a surgeon who specialises in identifying and treating conditions of the urinary system - for urgent treatment.

The doctor will examine you penis and draw some of the blood directly from the shaft of your penis (aspirate) using a needle and syringe. You will be given a local anaesthetic before the aspiration is carried out. This completely blocks feeling from the penis area and you will stay awake during the procedure.

The doctor will be able to diagnose which type of priapism you have based on the appearance of the blood aspirated from your penis. With low blood flow priapism the blood is usually thick and dark in colour. With high blood flow priapism the blood is usually bright red.

As priapism can be caused by an underlying health condition, your doctor may carry out further tests, such as blood or urine tests, to rule out other conditions.

Treatment for priapism

Usually, the sooner you seek medical attention, the easier and more successful treatment is.

Often during the first four hours of your erection placing ice packs on your penis and perineum may be all that is needed to make it go down. Make sure you wrap the ice in a towel or cloth first, never apply ice directly to your skin as it can give you an ice burn. Walking up stairs is another technique that may help your erection subside.

If you don't respond to these initial treatments, you will need treatment from a urologist. The type of treatment will be determined by the kind of priapism you have.

For low blood flow priapism, blood will be aspirated from your penis using a needle and syringe until your erection goes. This may be followed by an injection into your penis of medicines to reduce the priapism. You will be given a local anaesthetic before the aspiration is carried out. This completely blocks feeling from the penis area and you will stay awake during the procedure. Surgery may be used if this has not been effective.

High blood flow priapism doesn't cause any long-term damage to your penis, so often your doctor will wait for your erection to go by itself. If this doesn't work, surgery may be required.

Surgery may be used to repair the ruptured blood vessel in your penis. This is normally carried out under general anaesthetic. This means you will be asleep during the procedure.

Alternatively, a technique called embolisation will be used. Embolisation aims to block the ruptured blood vessel to stem the flow of blood into the penis. You will be given a local anaesthetic before the procedure is carried out. This completely blocks feeling from the penis area and you will stay awake during the procedure.

If an underlying condition is found to be the cause of your priapism, you will be given additional treatment for it.

Related topics

• Antidepressant
• Beta thalassaemia
• Impotence
• Leukaemia
• Local anaesthesia and sedation
• Sickle cell anaemia

Sources

• Priapism. eMedicine. http://emedicine.medscape.com, accessed 13 May 2009
• Muneer A, Minhas S, Arya M, et al. Stuttering priapism - a review of the therapeutic options. Inter J Clin Pract 2008; 62(8):1265-70.
• Priapism. GP Notebook. www.gpnotebook.co.uk, accessed 13 May 2009
• Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2007:280
• Pattman R, Snow M, Handy P, et al. Oxford handbook of genitourinary medicine, HIV and AIDS. Oxford: Oxford University Press, 2005:324

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009