What is Priapism? Symptoms, Causes, & Treatment

Priapism is a persistent, painful erection that lasts longer than four hours without sexual arousal or stimulation. This condition requires immediate medical attention because it can damage the penis and lead to permanent problems with erections if left untreated.

Think of it as your body's blood flow system getting stuck in the "on" position when it should naturally return to normal. While this might sound embarrassing to discuss, it's a legitimate medical emergency that doctors treat regularly and professionally.

What are the symptoms of priapism?

The main symptom is an erection that won't go away on its own, typically lasting four hours or longer. You'll notice the erection persists even without any sexual thoughts, stimulation, or arousal.

Here are the key signs that indicate you may be experiencing priapism:

• Erection lasting more than 4 hours
• Erection unrelated to sexual arousal or stimulation
• Rigid shaft of the penis with a soft tip (most common type)
• Progressive pain that often gets worse over time
• Difficulty urinating in some cases
• Tender or painful penis to touch

The pain often starts as mild discomfort but can become quite severe as time passes. This progression happens because blood becomes trapped and oxygen levels in the tissue decrease.

What are the types of priapism?

There are two main types of priapism, and understanding the difference helps doctors choose the right treatment approach. The type you have affects both the urgency of treatment and the specific medical approach needed.

Ischemic priapism (also called low-flow priapism) is the most common and serious type. Blood gets trapped in the penis and can't flow out properly, causing the tissue to lose oxygen. This type causes significant pain and requires emergency treatment to prevent permanent damage.

Non-ischemic priapism (also called high-flow priapism) happens when too much blood flows into the penis, usually due to an injury. This type is typically less painful and less urgent, though it still needs medical attention. The penis may feel firm but not completely rigid.

What causes priapism?

Priapism can develop from various underlying conditions and triggers that affect blood flow to the penis. Sometimes the exact cause remains unclear, but doctors can usually identify contributing factors during evaluation.

The most common causes include:

• Sickle cell disease (accounts for about 40% of cases)
• Medications for erectile dysfunction when used improperly
• Blood thinning medications like warfarin or heparin
• Antidepressants, particularly trazodone
• Blood pressure medications
• Recreational drugs, especially cocaine
• Alcohol abuse
• Trauma or injury to the penis or pelvis

Less common but possible causes include leukemia, other blood disorders, spinal cord injuries, and certain infections. In some cases, priapism occurs without any identifiable trigger, which doctors call idiopathic priapism.

When to see a doctor for priapism?

You should seek emergency medical care immediately if you have an erection lasting longer than four hours. This isn't a condition you can treat at home or wait out, as delayed treatment significantly increases the risk of permanent damage.

Head to the emergency room right away if you experience persistent erection with pain, even if it hasn't reached the four-hour mark yet. Early treatment gives you the best chance of preserving normal function and avoiding complications.

Don't let embarrassment delay your decision to seek help. Emergency room staff and urologists handle these situations regularly and will treat you with professionalism and discretion. Remember, this is a medical emergency, not a sexual health issue you need to feel awkward about.

What are the risk factors for priapism?

Certain conditions and circumstances make priapism more likely to occur. Understanding your risk factors can help you recognize the condition early and seek appropriate medical care when needed.

Here are the main risk factors to be aware of:

• Sickle cell disease or sickle cell trait
• Other blood disorders like leukemia or thalassemia
• Taking medications for erectile dysfunction
• Using recreational drugs, especially cocaine or marijuana
• Having a spinal cord injury
• Recent trauma to the genital area
• Taking certain prescription medications
• Having a history of priapism

Age also plays a role, with priapism occurring most commonly in two age groups: children ages 5-10 (often related to sickle cell disease) and men ages 20-50. If you have any of these risk factors, discuss prevention strategies with your doctor.

What are the possible complications of priapism?

The most serious complication of untreated priapism is permanent erectile dysfunction, which occurs when lack of oxygen damages the tissue in the penis. This damage can be irreversible if treatment is delayed beyond 24-48 hours.

Potential complications include:

• Permanent inability to achieve or maintain erections
• Scarring of penile tissue
• Deformity of the penis shape
• Chronic pain
• Psychological distress and anxiety
• Relationship difficulties
• Gangrene in extremely rare, severe cases

The good news is that prompt treatment significantly reduces these risks. Most men who receive treatment within the first 24 hours maintain normal erectile function afterward. This is why immediate medical attention is so crucial.

How is priapism diagnosed?

Doctors can usually diagnose priapism based on your symptoms and physical examination. The diagnosis is typically straightforward, but determining the underlying cause and type requires additional testing.

Your doctor will ask about your medical history, current medications, and recent drug use. They'll perform a physical exam to assess the firmness of the erection and check for signs of injury or infection.

Additional tests may include blood tests to check for sickle cell disease, infections, or blood clotting problems. In some cases, doctors use ultrasound to measure blood flow in the penis, which helps distinguish between the two types of priapism and guides treatment decisions.

What is the treatment for priapism?

Treatment depends on the type of priapism you have and how long the erection has lasted. The goal is to restore normal blood flow and prevent permanent damage to the penis.

For ischemic priapism, doctors typically start with needle aspiration, where they use a small needle to drain trapped blood from the penis. This procedure often provides immediate relief and can be done in the emergency room with local anesthesia.

If aspiration doesn't work, your doctor may inject medications directly into the penis to help constrict blood vessels and reduce blood flow. Common medications include phenylephrine or epinephrine, which are generally safe and effective.

In severe cases that don't respond to these treatments, surgery may be necessary. Surgical options include creating a temporary shunt (bypass) to redirect blood flow or, in rare cases, more complex procedures to restore normal circulation.

Non-ischemic priapism often resolves on its own over time, so doctors may recommend watchful waiting with regular monitoring. However, if it persists, treatment options include medication or procedures to reduce blood flow to the area.

How to manage symptoms at home during priapism?

While priapism requires professional medical treatment, there are a few things you can do while getting to the hospital that might provide temporary relief. However, these are not substitutes for emergency medical care.

You can try taking a warm shower or bath, which may help relax blood vessels and improve circulation. Some men find that light exercise, like walking or climbing stairs, helps redirect blood flow away from the genital area.

Apply ice packs to the inner thighs or perineum (area between the genitals and anus) for 10-15 minutes at a time. Never apply ice directly to the penis, as this can cause additional tissue damage.

Avoid any sexual activity or stimulation, as this will likely make the condition worse. Also avoid medications or treatments you might find online, as these can be dangerous and delay proper medical care.

How should you prepare for your doctor appointment?

For priapism, you'll likely go straight to the emergency room rather than scheduling a regular appointment. However, being prepared with information can help doctors treat you more effectively.

Write down or remember all medications you're currently taking, including prescription drugs, over-the-counter medications, and supplements. Include recreational drugs if applicable, as this information is crucial for diagnosis and treatment.

Prepare a brief medical history including any blood disorders, previous episodes of priapism, recent injuries to the genital area, and any chronic conditions you have. Also note when the erection started and any activities or events that preceded it.

Bring a list of your current doctors and their contact information, especially if you're being treated for sickle cell disease, blood disorders, or taking medications for erectile dysfunction. This helps the emergency team coordinate your care effectively.

Can priapism be prevented?

While you can't prevent all cases of priapism, you can take steps to reduce your risk, especially if you have known risk factors. Prevention strategies focus on managing underlying conditions and avoiding known triggers.

If you have sickle cell disease, work closely with your hematologist to manage your condition effectively. Stay well-hydrated, avoid extreme temperatures, and follow your prescribed treatment plan to reduce the risk of sickle cell crises that can trigger priapism.

Use erectile dysfunction medications exactly as prescribed by your doctor. Never exceed the recommended dose or combine different ED medications. If you're using injectable medications for ED, follow proper injection techniques and dosing guidelines carefully.

Avoid recreational drugs, particularly cocaine and excessive alcohol, which can increase your risk. If you're taking medications known to cause priapism as a side effect, discuss alternatives with your doctor if you experience any concerning symptoms.

What's the key takeaway about priapism?

Priapism is a medical emergency that requires immediate attention, but with prompt treatment, most men recover completely without long-term problems. The key is recognizing the symptoms early and seeking help without delay.

Remember that any erection lasting more than four hours needs emergency medical care, regardless of whether it's painful or not. Don't let embarrassment prevent you from getting the treatment you need – healthcare providers handle these situations professionally and discreetly.

If you have risk factors like sickle cell disease or take certain medications, discuss prevention strategies with your doctor. Being informed and prepared can help you respond quickly if priapism occurs and may help prevent it from happening in the first place.