Priapism: Treatment, causes, symptoms, and types

By Nicole Galan

Reviewed by Daniel Murrell, MD

Priapism is a prolonged and often painful erection of the penis. It causes blood in the penis to become trapped and unable to drain through the penile arteries.

It is often unrelated to or continues long beyond sexual activity. It can be a serious condition due to the risk of permanent tissue damage.

Here we explore the treatment options for priapism, as well as some of the more common causes. The symptoms and types of priapism will also be covered.

Fast facts on priapism:

• There are three main types; Ischemic, recurrent, and non-ischemic.
• Priapism can occur in males of all ages, from birth upwards.
• The main symptom is a prolonged erection unrelated to sexual activity or interest.
• Medications, including erectile dysfunction drugs, blood thinners, antidepressants, and some blood pressure drugs can cause priapism.

What are the types of priapism?

There are several different types of priapism:

• Ischemic: Also known as low-flow priapism, it occurs when blood is not able to leave the penis after an erection. Most cases of priapism are ischemic.
• Recurrent: This is a type of ischemic priapism also called recurrent or stuttering priapism. It is uncommon and usually seen in men with sickle cell anemia.
• Non-ischemic: Also known as high-flow priapism, this type is caused by poorly regulated blood flow in the penis.

Symptoms

The primary symptom of priapism is a prolonged erection. Other symptoms depend on the type of priapism that is occurring.

Symptoms of ischemic priapism include:

• penile pain that gets worse with time
• an erection where the tip of the penis remains soft

Non-ischemic priapism is usually painless and causes an erection that is not fully rigid.

What causes priapism?

There are several different causes of priapism. They include:

• Medications: Some medications can affect nerves in the body, including in the penis. Ordinarily, these nerves widen the arteries that supply the penis, allowing it to become engorged and erect.
• Drugs: Use of some recreational drugs is associated with priapism, including crystal meth, marijuana, cocaine, and ecstasy.
• Injury: Damage to the penile artery can occur with an injury to the penis or perineum and can prevent blood from circulating or draining. This is a common cause of non-ischemic priapism.
• Sickle cell anemia: Abnormally-shaped red blood cells can cause blockage of the penile artery and, thus, priapism. According to the Cleveland Clinic, "Approximately 42 percent of adults with sickle-cell anemia will eventually develop priapism."
• Cancers: In rare cases, priapism can occur with certain types of cancerous growths, especially if they impede on the penile artery or nerve supply and cause blockages.
• Blood disorders: Rarely, some blood conditions can cause priapism. Thalassemia, chronic leukemia and multiple myeloma, in particular, have been associated with priapism.

Causes vary, and all ages can be affected, but priapism most commonly affects males in early childhood, between ages 5-10, and in young adulthood, from ages 20-50.

Diagnosis

Diagnosing priapism usually starts with a detailed medical history and physical exam. The doctor will look at the genitals and groin to determine the pattern of rigidity and whether any trauma has occurred.

Sometimes, diagnostic testing is ordered to gain more information. The procedure for this is as follows:

• a small sample of blood is taken from the penis
• if the blood is black, it indicates ischemic priapism
• if the blood is bright red, it is probably non-ischemic priapism.

A doctor may also order:

• blood tests
• ultrasounds
• urine toxicology

As well as deciding the presence of priapism, these tests determine what may be causing the condition.

What are the complications of priapism?

It is important for someone who has had an erection, for 4 hours or more, to seek immediate emergency care. The blood trapped in the penis does not have oxygen, which means that the penile tissue is deprived of oxygen and can become damaged or even destroyed.

Without prompt treatment, permanent nerve damage and erectile dysfunction can occur.

Tissue damage can begin 4-6 hours after onset, so it is important to avoid delay in getting emergency help. Any damage to the sensitive penile tissue is permanent and cannot be reversed.

Treatment

Treatment of priapism depends on the type and the cause. A doctor will do an evaluation and decide whether it is ischemic or non-ischemic and the likely cause.

If the penis has been erect for fewer than 4 hours, decongestant medications to decrease blood flow to the penis can be effective at reducing the erection. If the erection has lasted for 4-6 hours, medication is usually effective.

After 6 hours, or if medication is unsuccessful, other measures are needed. These include:

• Ice packs: If applied to the penis or perineum, ice packs can reduce swelling and non-ischemic priapism.
• Aspiration: The penis is numbed with medicine, and a needle is inserted by a doctor, to drain the accumulated blood. This procedure usually results in quick relief of pain and swelling.
• Surgery: If ice packs and aspiration are unsuccessful, surgery may be needed to restore normal blood flow to the penis. Insertion of a shunt, or extra passageway, can help drain excess blood and restore circulation and can be used for ischemic priapism.

If an artery is ruptured or damaged during surgery, a surgeon can ligate, or tie, it to reduce blood flow. This is most effective in non-ischemic priapism.

Outlook

With quick treatment, the prognosis for someone with priapism is good.

However, if someone delays treatment, hoping it will go away on its own, permanent damage to the penis can occur.

SOURCE: MEDICAL NEWS TODAY