Priapism: The Pain of a Prolonged Erection
What is Priapism?
Priapism is an erection that lasts far longer than normal—often for four hours or more. It may start as a regular erection when you’re sexually aroused. Or, it can pop up without any stimulation. The erection can last for several hours, and can be very painful. If priapism isn’t treated, it can cause erectile dysfunction and scarring. Priapism is most common in men ages 5 to 10 and 20 to 50, according to Cleveland Clinic.
A Normal Erection
An erection is usually caused by sexual stimulation. When a man gets aroused, blood vessels widen to let more blood flow into the penis. As the penis fills with blood, it becomes hard and erect. After the man has an orgasm or the stimulation ends, the blood flows back out of the penis. The penis then softens and becomes flaccid.
There are two kinds of priapism. Low-flow (ischemic) priapism is when blood becomes trapped inside the penis and can’t flow back out. This can be very painful, and constitutes a medical emergency. The erection can last for four hours or more, or it may come and go over time. High-flow (nonischemic) priapism occurs when too much blood flows into the penis. It is usually not painful.
Causes of Priapism
Diseases that affect blood flow, such as sickle cell anemia and leukemia, can cause priapism. Additionally, some drugs have priapism as a potential side effect. These include erectile dysfunction drugs like tadalafil (Cialis) and sildenafil (Viagra), antidepressants, and blood thinners. Excess alcohol use, as well as illegal drugs like marijuana and cocaine, can also have this effect. Injuries that damage arteries can cause priapism as well.
If your erection goes away on its own within four hours, make an appointment to see your doctor. This is especially important if you experience priapism more than once. If your erection lasts longer than four hours, go to the emergency room. When blood is trapped in the penis, it loses oxygen. That oxygen-poor blood can damage tissues in the penis. Over time, it can leave you with erection problems or permanent scars.
What to Tell Your Doctor
When you see your doctor, he or she will take a medical history. The doctor also will ask you several questions, including: For how long have you had the erection? What were you doing when it started? Were you taking any drugs or drinking alcohol? Did you have an injury? The doctor will also ask about your medical history, and will examine the area.
One test a doctor can use to help find the cause of priapism is a blood gas measurement. In this test, a small needle is used to draw blood from the penis. The doctor then checks the blood to see if it is low in oxygen. This can help the doctor determine the type of priapism you have. Other blood tests can look for diseases that cause priapism, such as sickle cell anemia. Additionally, an ultrasound can measure blood flow in the penis.
Treating Ischemic Priapism
When blood isn’t leaving the penis, one treatment is to drain it. This is done with a needle and syringe using a technique called aspiration. Draining the blood helps relieve the pain and get rid of the erection. Medicine may also be injected into the penis to narrow the blood vessels and push the blood back out. If these treatments don’t work, you may need surgery to fix blood flow problems.
Treating Nonischemic Priapism
Priapism that’s caused by excessive blood flow into the penis usually gets better on its own. Sometimes putting ice on the perineum—the area between the penis and anus—will relieve the erection. If you continue to experience priapism, surgery may become necessary. During the procedure, the doctor will insert material that temporarily blocks blood flow into the penis or will fix damaged blood vessels.
- Guideline on the Management of Priapism. (2003). American Urological Association. Retrieved September 16, 2013, from http://www.auanet.org/education/guidelines/priapism.cfm
- Priapism. (2011, July). Cleveland Clinic. Retrieved September 16, 2013, from http://my.clevelandclinic.org/disorders/priapism/hic_priapism.aspx
- Priapism: Prolonged Erection. (2013, June 15). Mayo Clinic. Retrieved September 16, 2013, from http://www.mayoclinic.com/health/priapism/DS00873