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Priapism

Priapism

Priapism is a long-lasting painful erection. If it’s not treated straight away, it can cause permanent damage to your penis. Priapism may get better on its own within 2 hours, but if you are still in pain and find it is not getting any better, you must visit a doctor as soon as possible.
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What is priapism?

Priapism is an often painful, persistent erection that can last for more than 4 hours and  is not related to sexual arousal or stimulation. The condition most commonly affects people who have sickle cell disease.Scientists believe that roughly 42% of men with sickle cell disease will get priapism at some point in their lifetime.

Less common causes of priapism include:
  • blood-thinning medicines, such as warfarin
  • some treatments for erection problems
  • recreational drugs, such as cocaine and cannabis
  • some medicines used for high blood pressure
  • some antidepressants
  • other blood disorders, such as leukaemia and thalassaemia

How common is priapism?

While priapism is an uncommon condition, it occurs more often in certain groups. This includes people who have sickle cell disease. It can also be a rare side effect for people who use erectile dysfunction medication or take too much erectile dysfunction medication.

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What causes priapism?

Priapism can be caused by:
  • Nerve damage
  • Medication side effects
  • Recreational drug use
  • Injury to the genitals
  • Health conditions like leukaemia or sickle cell disease

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How is priapism treated?

There are several ways that priapism can be treated. The most common way to treat it is with a procedure called aspiration decompression. This involves the excess blood being drained from your penis with a small syringe and needle (aspiration).

Other treatments for priapism include injections or tablets being inserted directly into your penis. Surgery can also be performed to drain blood through a tiny cut. This is normally done while you are asleep under general anaesthetic.

The type of treatment you have for priapism will depend on whether you have low-flow or high-flow priapism. If you have low-flow priapism, your doctor may use a syringe and needle to remove excess blood from your penis. This can help in relieving pain and stopping unwanted erections.

If you have high-flow priapism, you may not need immediate treatment. This is because this kind of priapism tends to go away on its own. Your doctor will check your condition before prescribing a treatment if needed.

Can priapism be cured?

The type of priapism you have will depend on whether it goes away completely. If you have high-flow priapism, it often goes away on its own. In general, the outlook for priapism is good if you get treatment straight away from your doctor or pharmacist.

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What are the symptoms of priapism?

The main symptom of priapism is a long-lasting (more than 4 hours) painful erection. 

Types of priapism

There are 3 types of priapism. These are ischaemic (low-flow priapism), non-ischaemic (high-flow priapism) and recurrent (priapism keeps coming back).

Ischemic priapism happens because of blood being trapped in the erection chambers. It usually happens without a known cause in men who are otherwise fit and healthy. However, it can affect men with sickle cell disease and leukaemia.

Nonischemic priapism is rarer and is not normally painful. This happens because of a ruptured artery from an injury to the perineum (the area between the anus and scrotum) or the penis. This stops blood in the penis from circulating normally. It can also happen due to nerve damage. 

Recurrent priapism is when the condition occurs regularly or repeatedly. 

Is priapism dangerous?

Yes. While some forms of priapism can go away on their own, if you delay treatment, there is a risk of permanent damage and scarring to your penis.
It’s also important to see a doctor if you suffer with priapism to check for any underlying, serious causes for this that might need urgent treatment.

What complications can priapism cause?

Ischemic priapism in particular can cause serious complications. When oxygen cannot get to the blood trapped in the penis, this can begin to destroy or damage issues in the penis. If you do not get priapism treated, this can lead to erectile dysfunction.

How does priapism affect sex?

Priapism is a prolonged erection that is not associated with sexual stimulation and cannot be relieved by ejaculation.

What if I don’t get my priapism treated?

If you do not get your priapism treated, this can lead to permanent erectile dysfunction and scarring.

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How is priapism diagnosed?

Ischemic priapism is diagnosed by your doctor performing examinations and looking at your medical history. This is to determine if there are any underlying medical causes, as well as the duration of the condition. When having a medical examination, your doctor will assess the severity of pain, and examine your penis and genitals. They will also check your abdomen and rectum for signs of unusual growths or abnormalities that may indicate the presence of cancer and check for any issues with your nervous system. You may also have a blood test that will be analysed to rule out sickle cell disease and other blood conditions linked to priapism.

Nonischemic priapism is diagnosed in a similar way, with your doctor performing examinations and looking at your medical records to check if there are any underlying medical causes, as well as the duration of the condition. Your doctor will measure the blood flow of your penis. A small needle may be placed in your penis to draw some blood. This will be sent off to a lab for analysis. This test is to check what kind of priapism you have. Your doctor may also recommend some scans of your penis, pelvis and abdomen.

If you think you have priapism, you must get medical care immediately. Let your doctor know how long you have had the erection, how long your erections normally last, as well as if you have been taking any drugs, legally or illegally.

How do I know if I have priapism?

If you have a prolonged erection that does not go away after 4 hours, this is a sign you may have priapism. Should you notice pain that does not get better over time, do not delay in seeing your doctor for treatment and analysis.

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How to prevent priapism

There are certain things you can do if you suspect you have priapism which can reduce your erection.

These include:
  • trying to go for a pee
  • having a warm shower or bath
  • drinking lots of water
  • going for a gentle walk
  • trying exercises, like running on the spot or squats
  • taking painkillers like paracetamol if you need to
There are certain things you should not do if you have priapism too.
These include:
applying ice packs or cold water to your penis (this can make things worse)
  • having sex or masturbating (they will not make your erection go away)
  • drinking alcohol
  • smoking
If a medicine has caused a painful erection, do not take anymore until you have been checked over.

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Sources

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