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Priapism (Painful Erections)

Priapism is the medical term for a potentially painful and dangerous medical condition whereby an erection lasts for four hours or longer without sexual or medical stimulation. It is considered a medical emergency, and if left untreated can lead to Erectile Dysfunction (ED) and penile disfiguration. This condition can occur in males of any age, even infants.

Types of Priapism

Low-flow (Ischemic) Priapism: Up to 90 percent of priapism cases are of this type, caused by blood becoming trapped in chambers of the penis so that blood does not leave the penis normally after the erection.  Low-flow priapism can be caused by sickle-cell disease, leukemia, or malaria – but may also occur in males who are otherwise healthy. Symptoms include:

  • Erection lasting more than four hours without stimulation
  • Intermittent erection for several hours without stimulation (stuttering priapism)
  • Rigid penile shaft, but soft glans (tip of penis)
  • Painful or tender penis

High-flow (Nonischemic) Priapism: A less common form of this disorder, high-flow priapism is caused by disruption of arterial blood flow from rupture, possibly as a result of injury to the penis or nearby areas. The disruption prevents blood from circulating normally within the penis. Symptoms include:

  • Erection lasting at least four hours without stimulation
  • Usually painless
  • Erect (but not rigid) penile shaft

Risk Factors

Sickle-cell disease, or anemia, is closely linked with the development of priapism. Some studies show that nearly half of men with sickle-cell disease will eventually develop this condition.

Certain medications are also linked with this condition – particularly Thorazine and Desyrel, used in the treatment of depression and other mental conditions. If you are being treated for ED, some of the medication used to treat your condition could cause priapism.

Other risk factors include:

  • Injury to the penis or groin
  • Back injury
  • Poisonous venom, such as spider bite
  • Illicit drug or alcohol abuse
  • Urological cancers

What should you do if you have Priapism?

If you have an erection lasting for several hours, regardless of whether it is painful, you should seek medical attention at an emergency or urgent care facility. The blood trapped in the penis becomes starved of oxygen, and can cause permanent disfigurement of your penis or Erectile Dysfunction. Do not attempt to treat this condition yourself.

You should be prepared to disclose to the examining physician the duration of your erection, as well as any drugs you have taken, either prescription or illicit. The following treatments will likely be employed to resolve the erection immediately:

  • Icing – ice packs applied to the penis and surrounding area to reduce swelling
  • Surgical litigation of the ruptured artery (in certain high-flow cases)
  • Drug therapy – either injected or oral alpa-agonist drugs may be used to narrow veins in the penis and reduce blood flow and swelling
  • Surgical Shunt – used to stimulate circulation (in certain low-flow cases)
  • Needle aspiration – after numbing, some blood may be drawn from the penis to reduce swelling and to allow fresh blood into the penis. 

Follow-Up

Regardless of whether you seek emergency care or your painful erection resolves on its own in less than four hours, if you suffer a priapism it is important that you follow-up with your physician within a few weeks to evaluate the causes of your condition, diagnose any damage done by the event, and work together to find ways of avoiding future episodes.