Possible Causes of Priapism

A Sustained and Painful Erection

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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. Priapism is seen more commonly in genetically-assigned males over the age of 30. However it should be noted it can happen at any age based on medical history and risk factors.

If you have an erection lasting more than four hours, seek emergent medical attention. Untreated priapism can cause penile pain, scarring, swelling, and permanent erectile dysfunction

Causes

The two main types of priapism are ischemic and nonischemic priapism. Ischemic priapism is also known as low-flow priapism. In this case, there is typically an erection lasting more than four hours, associated penile pain, and swelling. Nonischemic priapism (aka high-flow priapism) is less common and usually not related to sexual activity but more related to traumatic injuries.

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

  • Medications used to treat impotence like sildenafil and tadalafil
  • Penile injections (ie: trimix) used to treat impotence 
  • Sickle cell anemia: Up to 42% of men with sickle cell will develop priapism
  • Recreational drugs like alcohol and cocaine
  • Antidepressant medications like trazadone, bupropion, fluoxetine
  • Spinal cord injury
  • Trauma to the genital area
  • Anticoagulant medications like heparin and coumadin 
  • Anesthesia
  • Some types of penile cancer and cancer of the pelvis

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

The doctor will ask about your medical history and examine you. They may do some tests―possibly an ultrasound―as well as blood tests. Your doctor will ask specific questions to help assess if this is ischemic vs nonishemic priapism. From there, you may be requested to complete labwork that includes testing the oxygen level in your penile blood (ABG of the penile blood).

Treatment

Treatment is aimed at making the erection go down, then treating the underlying cause, if one can be ascertained. Treatment may vary depending on the type of priapism presented.

Ischemic Priapism

Treatment is aimed at getting the erection down in an effort to prevent permanent damage to the penis. 

Treatment may include a trial of oral medications. The next steps include placing a needle into the penile corporal bodies where the blood is congested. Through this needle the doctor can irrigate the penis to help relieve the pressure and decrease the priapism. The doctor may at the same time inject medications to help bring down the erection. 

If these treatments aren't successful, a urologist might need to perform surgery to reduce the priapism. The surgeon can reroute blood flow by creating an internal “shunt” to get fresh blood back into the penis. 

Patients with sickle-cell disease may receive intravenous fluids and/or transfusion of blood as primary treatment. If that fails to have the desired effect, surgery may be required.

Nonischemic Priapism

This type of priapism may resolve on its own. There is little risk fo damage to the penis. Ice and pressure packs may help. If surgery is needed, minimally invasive procedures may be done to reduce blood flow or repair injured blood vessels.

Always seek treatment as quickly as possible to avoid any future problems of permanent erectile dysfunction.

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