Patient education: Priapism (The Basics)

What is priapism? — Priapism is an erection that lasts a long time even if you are not aroused. It might start when you are aroused, but then it does not go away. Priapism can be very painful and serious. It is not related to having sex or wanting to have sex.

There are 2 main types of priapism:

●Ischemic – This type of priapism happens when blood stays trapped in the penis. "Ischemic" means that the blood in the penis does not contain the normal amount of oxygen. It can be caused by many things, including certain medicines, blood diseases (such as sickle cell anemia), cocaine use, spider bites, and spinal cord injury.

Priapism that happens again and again, also called "stuttering" priapism, is a type of ischemic priapism. It can happen in adults or children with sickle cell anemia. It begins with brief erections that often start during sleep and continue when the person wakes up. As time goes on, this happens more often and the erection lasts longer.

Ischemic priapism that lasts more than 4 hours can cause long-term damage to the penis. It can lead to a condition called "erectile dysfunction," which is when you have problems getting or keeping an erection. The longer an erection lasts, the more likely it is to cause damage.

●Nonischemic – This type of priapism happens when blood keeps flowing into the penis, keeping it erect, but not always fully hard. "Nonischemic" means that the blood in the penis contains the normal amount of oxygen. It is often due to an injury of some kind and is usually not as painful as ischemic priapism. This type of priapism is less likely to cause lasting damage to the penis.

What are the symptoms of priapism? — The symptoms depend on the kind of priapism.

The symptoms of ischemic priapism are a very hard erection that is often painful. Nonischemic priapism is less painful and the erection is often not as hard.

Should I see a doctor or nurse? — Yes. See your doctor or nurse right away if you have any erection that lasts longer than 2 to 4 hours. This can be a serious medical emergency.

Will I need tests? — Maybe. Your doctor or nurse can tell if you have priapism by learning about your symptoms and doing an exam. But they might need to do tests to find out which kind of priapism you have. These tests include:

●Blood gas analysis – In this test, the doctor takes a sample of blood from your penis and checks the blood to see how much oxygen is in it.

●Doppler ultrasound – For this test, the doctor uses sound waves to look at how the blood is flowing in your penis.

How is priapism treated? — The treatment depends on the type of priapism you have.

If you have ischemic priapism and your erection has lasted longer than 4 hours, your doctor will probably use a needle to inject a medicine into your penis. This will make the erection go down. The doctor might need to repeat the injection until the erection is fully gone. If you have severe pain, your doctor can prescribe a strong pain medicine.

If these treatments do not work, your doctor might recommend surgery. There are different types of surgery. Your doctor will talk to you about which is best for you.

Nonischemic priapism often goes away on its own without treatment, even though it might last hours or days. If you have nonischemic priapism that does not go away, your doctor might do a procedure to treat it. But this is rarely needed.

Can priapism be prevented? — Priapism caused by sickle cell anemia can sometimes be prevented. If you have sickle cell anemia, your doctor will work with you to find the best treatment for your situation.

More on this topic

Patient education: Sex problems in males (The Basics)
Patient education: Sickle cell disease (The Basics)