Priapism is condition that causes persistent and sometimes painful erections. This is when an erection lasts for four hours or more without sexual stimulation. Priapism is uncommon, but when it occurs, it typically affects males in their 30s.
Low-flow, or ischemic priapism occurs when blood becomes stuck in the erection chamber. A broken artery that prevents proper circulation of blood in the penis causes high-flow, or nonischemic priapism. This could be due to an injury.
An erection that lasts longer than four hours is a medical emergency. The oxygen-deprived blood in your penis can damage tissue in the penis. Untreated priapism can result in damage or destruction of penile tissue and permanent erectile dysfunction.
The symptoms of this condition vary depending on whether you experience low-flow or high-flow priapism. If you have low-flow priapism, you may experience:
- erections lasting for more than four hours
- rigid penile shaft with a soft tip
- penis pain
Low-flow or ischemic priapism can become a recurrent condition. When symptoms begin, involuntary erections may only last for a few minutes or a short length of time. As time moves on, these erections occur more and last longer.
If you have high-flow priapism, you’ll have some of the same symptoms as low-flow priapism. The main difference is that pain doesn’t occur with high-flow priapism.
Any erection lasting more than four hours without sexual stimulation is considered a medical emergency.
A normal penis erection is one that occurs because of physical or physiological stimulation. An increase in blood flow to the penis causes the erection. Once the stimulation ends, there’s a decrease in blood flow and the erection goes away.
With priapism, there's a problem with blood flow to your penis. Different conditions affect how blood flows in and out of the penis. These disorders and diseases include:
- sickle cell anemia
- multiple myeloma
About 42 percent of adults who have sickle cell anemia experience priapism at some point in their lives.
Priapism can also occur if you take certain prescription medications or abuse alcohol, marijuana, and other illicit drugs. Prescription medications that may affect blood flow to the penis include:
- medications for erectile dysfunction
- alpha blockers
- medications for anxiety disorders
- blood thinners
- hormone therapy
- medications for attention deficit hyperactivity disorder
- carbon monoxide poisoning
- black widow spider bite
- metabolism disorder
- neurogenic disorder
- cancers involving the penis
Even though both types of priapism have similar symptoms, your doctor has to run diagnostic tests to determine whether you have low-flow or high-flow priapism. The treatment options differ depending on the exact type of the condition.
Sometimes, doctors can diagnose priapism based on symptoms and a physical examination of the genital area. Tests used to determine the type of priapism may include:
Blood gas measurement
This procedure involves inserting a needle into your penis and collecting a blood sample. If the sample reveals that blood in your penis is deprived of oxygen, you have low-flow priapism. But if the sample reveals bright red blood, you have high-flow priapism.
Since priapism can be caused by other diseases and blood disorders, your doctor may also collect a blood sample to check your level of red blood cells and platelets. This can help your doctor diagnose blood disorders, cancers, and sickle cell anemia.
Priapism is also associated with drug abuse, so your doctor may collect a urine sample to look for drugs in your system.
Doctors use an ultrasound to measure blood flow in the penis. This test also helps your doctor determine whether trauma or injury is the underlying cause of priapism.
Treatment depends on whether you have low-flow or high-flow priapism.
If you have low-flow priapism, your doctor may use a needle and syringe to remove excess blood from your penis. This can relieve pain and stop involuntary erections.
Another treatment method involves injecting medication into your penis. The medication will shrink the blood vessels carrying blood into your penis, and expand the blood vessels carrying blood out of your penis. Increased blood flow can reduce an erection.
If neither of these therapies work, your doctor may recommend surgery to help blood flow through your penis.
If you have high-flow priapism, immediate treatment may not be necessary. This type of priapism often goes away on its own. Your doctor may check your condition before prescribing a treatment. Cold therapy with ice packs can get rid of an involuntary erection. Sometimes, doctors suggest surgery to stop blood flow to the penis, or to repair arteries damaged by an injury to the penis.
When priapism is recurrent, you can also talk to your doctor about taking a decongestant such as phenylephrine (Neo-Synephrine) to reduce blood flow to the penis. They may also use hormone-blocking medications or medications for erectile dysfunction. If an underlining condition causes priapism, such as sickle cell anemia, a blood disorder, or cancers, seek treatment for the underlying problem to correct and prevent future occurrences of priapism.
The outlook for priapism is good if you receive prompt treatment. For the best possible outcome, it's important that you seek help for prolonged erections. Especially if the problem is persistent, not caused by an injury, and doesn't respond to ice therapy. If left untreated, you increase the risk of permanent erectile dysfunction.