Priapism

Symptoms, Doctors, Treatments, Advances & More

Priapism is a prolonged, usually painful erection of the penis that lasts more than four hours. Priapism occurs when blood gets trapped in the penis and is unable to drain. There are two types of priapism: 1) Low-flow priapism, also known as ischemic priapism, in which blood is trapped in the erection chambers; and 2) High-flow priapism, also known as non-ischemic priapism, which is caused by an injury to the penis or the perineum that ruptures an artery, thus preventing normal blood flow.

Symptoms of priapism include a prolonged, and usually painful partial or full erection of the penis that last more than four hours. In some cases of priapism, a partial erection may last for weeks. Symptoms of priapism depends on the type: Low-flow (ischemic) priapism or high-flow (non-ischemic) priapism. Symptoms of low-flow (ischemic) priapism include an erection that lasts more than four hours unrelated to sexual stimulation, a rigid penile shaft, a soft penile tip (glans), and progressive penile pain. A subtype of low-flow-ischemic priapism, known as recurrent or stuttering priapism, may occur in males with sickle cell anemia and is characterized by repeated episodes of prolonged, painful erections. Symptoms of high-flow (non-ischemic) priapism may include an erection lasting more than four hours unrelated to sexual stimulation, and an erect, but not fully rigid, penile shaft. High-flow (non-ischemic) priapism is usually not as painful as low-flow (ischemic) priapism.

Priapism is considered to be a medical emergency and treatment should be sought immediately. Treatment for priapism should be administered in a timely manner to prevent scarring and permanent erectile dysfunction (ED). Treatment for priapism focuses on relieving the erection and preserving erectile function. Treatment for priapism depends on the type: Low-flow (ischemic) priapism or high-flow (non-ischemic) priapism. Treatment for low-flow (ischemic) priapism involves a combination of medications, draining blood from the penis, or surgery. Medications for low-flow (ischemic) priapism include phenylephrine injection directly into the penis to constrict the blood vessels and allow the blood to drain more normally. Other therapies for low-flow (ischemic) priapism may include drainage of blood from the penis by aspiration with a small needle and syringe, after which a saline flush may be used. These therapies may be repeated until the priapism is relieved. Surgery may be performed to treat low-flow (ischemic) priapism by rerouting blood flow with the use of a surgical shunt if more conservative therapies are not successful. Patients with high-flow (non-ischemic) priapism may not require treatment (watch-and-wait) as the condition may resolve on its own. High-flow (non-ischemic) priapism may also be treated with ice packs and pressure applied to the perineum to stop the erection. In some cases of high-flow (non-ischemic) priapism, surgery may be necessary to stop the blood flow to the penis temporarily with the use of an absorbable gel or to repair arteries or tissue damage.