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Priapism

A sustained and painful erection

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Updated October 04, 2013

Priapism refers to an erection, usually painful, that lasts for more than four hours and is not necessarily the result of sexual arousal. This condition develops when blood in the penis becomes trapped and is unable to drain. The condition is most common between the ages of 5 and 10 years, and between 20 and 50 years.

Priapism should be treated immediately to avoid the likely outcome of permanent erectile dysfunction. Priapism does not usually resolve itself, so medical attention is definitely required.

Causes of Priapism
Although up to one third of cases have no specific cause, other conditions causing priapism include:

  • Sickle cell anemia. Up to 42% of men with sickle cell will develop priapism.

  • Alcohol and cocaine abuse

  • Spinal cord trauma or other conditions

  • Trauma to the genital area

  • Medications such as Desyrel used to treat depression, Thorazine used to treat certain mental illnesses

  • Medications to prevent blood clotting and drugs used to treat blood pressure can all cause priapism

  • Anesthesia

  • In rare cases, some types of penile cancer can cause priapism

  • Penile injections designed to treat impotence can also cause priapism

Penis changes that cause priapism
In a normal erection, the veins narrow, causing the penis to become bigger and hard. In priapism, the veins do not relax after an orgasm, so the penis remains erect and usually becomes very painful.

Diagnosis of Priapism
The doctor will ask about your medical history and examine you. He may do some tests ― possibly an ultrasound or angiogram ― as well as blood tests.

Treatment of Priapism
Treatment is aimed at making the erection go down, then treating the underlying cause, if one can be ascertained. Treatment is usually in the form of injecting a decongestant medication, often following the draining of a small amount of blood from the penis to relieve pressure. A local anesthetic to numb the penis is usually given prior to this procedure.

Surgery is usually required to restore normal blood flow if the cause is a ruptured artery. A surgical shunt for low flow priapism may be required; this is inserted into the penis to divert the blood flow and restore normal blood flow and function.

People with sickle-cell disease usually receive intravenous fluids and a transfusion of blood. If that fails to have the desired effect, surgery may be required.

Some men experience semi-erect and painless erections that are usually a result of trauma, in which too much blood flowing into the penis ― rather than narrowed veins ― is the cause. This can be treated via surgery or with a catheter threaded through blood vessels in the groin.

Importance of medical intervention for Priapism
Always seek treatment as quickly as possible to avoid any future problems of permanent erectile dysfunction.

Article Sources Include:
Penis Pain. ADAM
J Cherian, A R Rao, A Thwaini, F Kapasi, I S Shergill, R Samman, (20060 Medical and surgical management of priapism. Postgraduate Medical Journal 2006;82:89-94; doi:10.1136/pgmj.2005.037291
 

 

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