Priapism: Causes, Treatments, and When to Get Help
Key takeaways:
Priapism is an erection lasting over 4 hours.
It can be caused by certain medical conditions, medications, drug use, or trauma to the penis.
Priapism is an emergency that needs prompt medical care.
Priapism is a prolonged erection that won’t go away on its own. It’s technically defined as an erection that lasts more than 4 hours. This is a medical emergency, because it can lead to permanent damage to the penis if left untreated. Often, the penis will start to become very painful as well.
An erection occurs when blood flows into the penis. If too much blood flows into the penis, or if the blood doesn’t eventually flow out of the penis, the erection may continue longer than it should. Read on to find out more about what causes priapism and when you should seek medical care.
What causes priapism?
The cause of priapism depends on the type. In theory, there are two types of priapism: termed “ischemic” and “nonischemic.” In practice, it’s not always easy to tell the difference, even for healthcare professionals.
Ischemic priapism occurs when the blood can’t drain out of the penis. It’s the more serious of the two types. The penis can be damaged, because the blood inside it doesn’t have enough oxygen to keep the surrounding tissue healthy. Some of the causes of ischemic priapism are:
Blood conditions like sickle cell disease or leukemia. In these conditions, the abnormal shape and size of the blood cells can interfere with its ability to flow out of the penis
Medications, such as erectile dysfunction medications, blood pressure medications, blood-thinning medications, and antidepressants
Alcohol and drugs, such as cocaine or marijuana
In nonischemic priapism, there is too much blood flowing into the penis (as opposed to problems with blood flowing out). This is less serious, because the blood in the penis has plenty of oxygen. Usually, this is a result of significant trauma to the penis — like a bicycle accident, for example.
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When should I seek medical care?
Priapism is always an emergency. While the associated pain often brings people to the ER for emergency care, timely treatment also prevents any long-term damage to the penis.
If you have an erection that is painful, or lasting more than 4 hours, seek medical care right away. Most people will need to go to an emergency department. A lot of people might be embarrassed and delay getting treatment for priapism, but know that healthcare providers understand the importance of early treatment, so don’t hesitate.
How is priapism treated?
The first step in treatment is to remove the trapped blood from the penis. A healthcare provider will numb the penis and use a small needle to remove trapped blood. This helps the erection go away. Next, your provider may inject a medication if the penis remains partially erect. This medication is called phenylephrine, which helps open blood vessels and allow for blood to flow out of the penis.
This procedure might sound scary, but your healthcare provider will numb the penis first, and the whole procedure is actually pretty fast. Since priapism is usually painful, this procedure often provides quick pain relief as well.
In rare cases, priapism won’t improve with this treatment, and surgery might be necessary. During this procedure, a urologist will place a tube — called a shunt — in the penis that will let the blood flow out to make the erection stop.
Will priapism go away on its own?
Nonischemic priapism, the less serious kind, is more likely to resolve on its own than ischemic priapism. But it can be tricky to tell the difference, so it’s best not to wait to find out, especially given the risks.
What happens if I don’t get priapism treated?
Priapism can cause complications, as the blood in the penis doesn’t have enough oxygen to keep the tissues alive and functioning. If an erection goes on for too long, certain tissue inside the penis can get damaged. This can lead to scarring that results in painful erections, or, in the worst case, permanent inability to have an erection. This is why getting emergency medical care is important.
The bottom line
Priapism is a condition in which an erection lasts more than 4 hours. There are many different causes of priapism, including erectile dysfunction medications and sickle cell disease. Priapism can lead to permanent damage to the penis, so it’s important to get help fast. There are quick and effective treatments available, and emergency medicine and urology providers are well trained to provide them.
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References
Montague, D. K., et al. (2003). American Urological Association guideline on the management of priapism. Journal of Urology.
National Health Service. (2020). Priapism (painful erections).
