Your Guide to Priapism

Medically Reviewed By Roger Bielinski, MD
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Priapism is a condition that involves prolonged erections without stimulation. These erections are potentially painful and, if left untreated, can cause lasting effects. This article will define the types of priapism that a person may have. It will also discuss the symptoms, causes, diagnosis, and treatment of the condition.

What are the types of priapism?

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Priapism is generally a rare condition that involves uncontrollable and prolonged, or long lasting, erections. These erections can occur even in the absence of sexual activity or stimulation.

Experts have varying opinions over what the definition of a prolonged erection is. Typically any erection that lasts for more than 4 hours is considered priapism.

The three types of priapism are:

  • ischemic
  • non-ischemic
  • recurrent

Ischemic priapism

Also called veno-occulsive priapism, this is the most common type of priapism. It happens when the venous outflow of the penis is reduced. Venous outflow refers to blood moving out of the penis and into the body through the veins.

When the venous outflow within the penis is low, the blood cannot leave the penis to reduce an erection. This can then cause a prolonged and rigid erection.

Even though any erection lasting more than 4 hours is considered priapism, cell changes and tissue damage typically do not begin to occur until more than 6 hours after the condition starts. That is why early treatment and reduction of the erection is crucial.

If treated early, the priapism typically does not result in any permanent damage. If priapism lasts more than 24 hours, however, permanent damage is possible. In fact, 90% of people with priapism that lasts more than 24 hours cannot have typical sexual intercourse afterward, according to 2004 research.

Non-ischemic priapism

Non-ischemic priapism is not as common as ischemic priapism. It occurs most commonly as the result of an injury or trauma to the penis or perineum. This trauma can either be blunt or penetrating.

The priapism typically develops within 72 hours of the trauma. For some, however, it can take several weeks to develop.

Non-ischemic priapism does not generally require emergency care. It has typically resolved on its own in around 62% of cases, even without treatment.

Recurrent priapism

Recurrent priapism, also known as stuttering priapism, is a fairly common subtype of ischemic priapism. It is often seen in people with sickle cell disease. In a case report from 2020, researchers suggested that cannabis use might have played a role.

Recurrent priapism occurs in approximately 40% of people with sickle cell disease.

Recurrent priapism typically occurs at night. It begins with periods of erection that are relatively short. These periods then gradually grow longer.

The erections due to recurrent priapism are sometimes painful but are generally self-limiting. This means they reduce on their own after a period of time.

Repeated episodes of priapism can cause permanent damage and lead to erectile dysfunction.

Learn more about erectile dysfunction.

What are the symptoms of priapism?

The main symptom of priapism is a prolonged erection. Other symptoms depend on the type of priapism.

Ischemic priapism has symptoms that may include pain in the penis that gradually worsens. In addition, the erection involves the tip of the penis remaining soft, rather than rigid.

Non-ischemic priapism does not typically involve pain. It does, however, involve a prolonged erection that may not get fully rigid.

What causes priapism?

The most common cause of priapism is sickle cell disease, according to the National Health Service (NHS).

Other causes of priapism include:

  • certain medications, such as blood thinning medication
  • certain antidepressants
  • illegal substances, such as cocaine or cannabis
  • certain blood pressure medications
  • blood disorders, such as leukemia or thalassemia
  • certain treatments for erectile dysfunction
  • trauma or injury
  • certain malignancies, in rare cases

Learn more about sickle cell disease.

How do doctors diagnose priapism?

In order to diagnose priapism, rule out other conditions, and discover what type of priapism you are experiencing, your doctor will ask you about your symptoms and history.

Diagnosis of priapism

In order to diagnose priapism, your doctor may ask you about:

  • the duration of the erection
  • the rigidity of the erection
  • the presence or absence of pain
  • any recent trauma
  • any history of recreational drug use
  • medical history, including medications you are taking
  • family history of certain blood disorders

Specific concerning factors they are looking for include:

Your doctor will also typically perform a physical exam. During this time, they will examine your genitals to check how rigid your erection is and for any tenderness. They will also check for signs of infection, inflammation, or changes related to gangrene.

They may examine your head and neck, abdomen, and rectum to check for signs of conditions that could cause your priapism.

It is possible that your doctor will recommend further testing to confirm their diagnosis. This testing may include:

  • complete blood count
  • urine analysis
  • hemoglobin electrophoresis

What are the treatments for priapism?

Treatment for priapism depends on the type. Ischemic priapism is considered a medical emergency and requires immediate treatment.

Treatments for ischemic priapism may include:

  • Aspiration: This is when a doctor uses a surgical needle and syringe to drain the excess blood from the penis.
  • Saline irrigation or intracavernosal drug therapy: This involves saline or medication being injected into the penile veins to improve blood flow. It flushes the veins to help relieve pain and remove any oxygen-poor blood, stopping the erection.
  • Surgery: If other treatments are not effective, your doctor may recommend surgical intervention. This typically involves a procedure using a thin tube, called a shunt, to give the blood a way to flow out of the penis.

If you have sickle cell disease, treatment for this condition is also imperative to treating your priapism as well.

Non-ischemic priapism typically resolves on its own within a few hours. You can try a few things to reduce your erection in the meantime.

According to the NHS, you may:

  • Try to urinate.
  • Take a warm shower or bath.
  • Drink lots of water.
  • Go for a slow, gentle walk.
  • Try exercises, like squats or running in place.
  • Take over-the-counter pain medication if needed.

You should avoid certain other activities that may worsen the condition. These include:

  • Do not apply ice or cold water to your penis.
  • Do not have sex or masturbate.
  • Do not drink alcohol.
  • Do not smoke.

Contact your doctor and seek medical care for any erection lasting longer than 4 hours or that is extremely painful.

What are the complications of priapism?

If priapism is treated quickly, it rarely involves any long-term complications. Priapism that remains untreated for more than 24 hours or is recurrent can lead to lasting complications.

One of the main complications that can result from priapism is long-term erectile dysfunction, according to 2022 research. This typically results from tissue damage within the penis. The longer priapism lasts, the greater the damage may become.

A highly uncommon complication of priapism is glans necrosis. This is the necrosis, or death, of certain tissues of the penis. Both surgical and nonsurgical treatment options exist for this rare complication.

Summary

Priapism is a condition that involves prolonged and sometimes painful erections. These erections occur without stimulation. Any erection lasting more than 4 hours is typically considered to be priapism.

The types of priapism include ischemic, non-ischemic, and recurrent. Treatment depends on the type of priapism and what causes it. Non-ischemic priapism is typically self-limiting and resolves on its own within a few hours.

Any erection that lasts more than 4 hours or that is extremely painful requires medical care. Contact your doctor right away.

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Medical Reviewer: Roger Bielinski, MD
Last Review Date: 2022 Sep 1
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  3. Montgomery, S., et al. (2020). Recurrent priapism in the setting of cannabis use. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819303/
  4. Priapism (Painful erections). (2020). https://www.nhs.uk/conditions/priapism-painful-erections/
  5. Silberman, M., et al. (2022). Priapism. https://www.ncbi.nlm.nih.gov/books/NBK459178/
  6. What is priapism? (2021). https://www.urologyhealth.org/urology-a-z/p/priapism