Priapism

Content provided by the Faculty of the Harvard Medical School

Priapism

What Is It?

Priapism is an abnormally prolonged and often painful erection. Usually, this erection is not caused by sexual desire or stimulation, and is not relieved by orgasm. Priapism may start after prolonged sexual activity, although this by itself is not believed to cause priapism. Most men seek medical attention within hours to days, but a few people may have a partial erection that persists for weeks.

Priapism can affect males of any age. Most cases occur in boys aged 5 to 10 years or men aged 20 to 50 years. Common causes include:

• Alcohol or cocaine abuse

• Medications, including antidepressants, especially trazodone (Desyrel), tranquilizers, blood pressure medications and blood thinners

• Spinal cord problems

• Trauma to the genitals, groin or pelvis

• Sickle cell disease

• Anesthesia

• Penile injection therapy as part of a regimen to treat impotence

In up to one-third of cases, no specific cause can be found.

In a normal erection, the veins that drain blood from the penis narrow and cause blood to back up, which makes the penis stiffen and swell. After the veins relax and open, the penis will not be erect. In most cases of priapism, these veins do not relax after orgasm, which causes the penis to remain erect. Less commonly, priapism occurs when so much blood flows into the penis that it cannot drain, even through veins that function properly. This increased blood flow is usually caused by a damaged blood vessel.

Symptoms

Symptoms of priapism include:

• A painful erection that lasts longer than to four to six hours and is not relieved by orgasm

• A partial erection that lasts longer than several days, even if it is not painful

Diagnosis

Your doctor will ask about your medical history, and use of medications, drugs and alcohol. He or she will examine you, and will order blood tests. Additional tests may include:

• An ultrasound or angiogram (X-ray using dye injected into blood vessels) of the penis

• A blood sample from the penis

Expected Duration

Usually priapism does not improve without medical attention.

Prevention

In a few cases, priapism can occur more than once. If this happens, it is important to avoid medications, alcohol or drugs that may trigger these episodes. However, in most men, priapism occurs unexpectedly and cannot be prevented.

Treatment

Treatment for priapism depends on the cause. In most cases, a physician will start by numbing the penis, and will then use a needle to remove trapped blood from the swollen penis. Often, the doctor will inject a medication that helps to relax the narrowed veins. Usually, this treatment works promptly.

Men with semi-erect, painless erections, which are less common, are more likely to have a problem with too much blood flowing into the penis rather than narrowed veins. This condition often follows trauma to the penis or groin. After the diagnosis is confirmed by ultrasound or an angiogram, treatment involves slowing the blood flow. This can be done with surgery or with a catheter threaded through blood vessels in the groin.

When sickle cell disease causes priapism, treatment usually starts with fluids given intravenously (into a vein), oxygen and transfusion of non-sickle blood. If this treatment is not effective, aspiration therapy as described above or surgery may be required.

When To Call A Professional

You should call a physician if you develop an erection that lasts longer than four to six hours, particularly if this erection is painful and is not caused by sexual stimulation.

Prognosis

If priapism is treated early, the outcome is usually excellent. However, if medical attention is delayed, the problem can lead to permanent impotence.

Additional Info

American Foundation for Urologic Disease 1128 North Charles St. Baltimore, MD 21201 Phone: (410) 468-1800 Toll-Free: (800) 242-2383 Fax: (410) 468-1808 http://www.afud.org/

Last updated:	August 20, 2008