Priapism

What is priapism?

Priapism is a condition in which your penis remains erect (rigid) for a long time without sexual stimulation. This happens when there are problems with the flow of blood in and around your penis. Arteries (blood vessels) bring blood with oxygen into your penis, and veins return blood without oxygen to your body. With priapism, too much blood may go into your penis, or blood may not be able to flow out. Having too much blood in your penis causes it to become engorged (very full) and rigid. Engorgement lasting for a long time may put pressure on the tissues in your penis, causing pain and damage. Priapism may last for minutes, hours, or days. Treatment can help your penis to become soft again. Receiving treatment right away may also prevent permanent damage to your penis, such as erectile dysfunction (trouble having an erection).

What are the common types of priapism?

The following are the most common types of priapism:

  • Low-flow: Low-flow priapism is also called ischemic priapism. With low-flow priapism, the veins in your penis become blocked and blood cannot flow out of your penis. When this happens, your penis becomes engorged, and there is increased pressure in your penis. The pressure does not allow blood with oxygen to enter your penis. This means your penis may not get enough oxygen, and you may have permanent damage to your penis. Low-flow priapism is an emergency and must be treated immediately.

  • High-flow: High-flow priapism is also called nonischemic priapism. With high-flow priapism, too much blood flows into your penis. The blood then drains very slowly out of your penis. Too much blood may be going into your penis because of an injury to the arteries near or in your penis.

  • Stuttering: Stuttering priapism occurs when you have painful erections that happen over and over. The erections from stuttering priapism usually are not as painful as those from low-flow priapism. They can last for a few minutes to a few hours.

What are the causes of priapism?

The cause of priapism is usually not known, but the following may increase your risk of getting priapism:

  • Medical conditions and treatments: Certain diseases of the blood, such as sickle cell disease or leukemia (cancer of the blood) can increase your risk of having priapism. Having a tumor (lump) or cancer of the penis may increase your risk. Your risk may also be greater if you have problems with your spinal cord, such as an injury or disc pressure. If you get hemodialysis treatments or nutrition through a tube, such as an IV, your risk may be higher.

  • Medicines: Some medicines make you more likely to get priapism. These include blood thinners, medicines for high blood pressure, hormone medicines, and medicines used to treat mental health conditions. If you are using medicine to treat erectile dysfunction, you may also get priapism.

  • Street drugs or alcohol: Certain street drugs, such as cocaine and marijuana, increase your risk of getting priapism. Drinking a lot of alcohol may also increase your risk of getting priapism.

  • Trauma: An accident, such as a bike saddle injury, can damage blood vessels that bring blood to your penis. This may cause too much blood to flow into your penis. If you had an injury during sex, you may get priapism.

What are the signs and symptoms of priapism?

You may have one or more of the following:

  • An erection that is not related to sexual stimulation that lasts for four hours or longer.

  • Your penis stays erect even after you ejaculate (release semen) or take cold showers.

  • You may have pain in your penis.

How is priapism diagnosed?

Your caregiver will ask you about your erection, when it began, and if it has happened before. He may ask you about any medical problems you have, such as sickle cell disease. He may also ask you about any medicines you are taking. Your caregiver may do a physical exam of your penis, abdomen (stomach), perineum (area before your anus), and rectum. He may check for swelling, tenderness, trauma, or disease. You may also need any of the following tests:

  • Urine tests: Samples of your urine may be taken to test for medicines that you have taken. These can include medicines prescribed by your caregiver, or street drugs.

  • Blood tests: Caregivers may do blood tests to learn more about your condition and the type of priapism you have. Caregivers may need to take blood from your arm or your penis. They may need more than one sample to see if your condition is getting better.

  • Ultrasound: Sound waves are used to show pictures of your penis on a TV-like screen. This test shows how blood is flowing in your penis and where blood vessels may be blocked.

  • Angiography: This test shows pictures of the blood vessels in your penis. Caregivers may put a dye in your vein to see your blood vessels more clearly in the pictures.

How is priapism treated?

The goal of treatment is to reduce pain and get your penis to become soft in order to prevent tissue damage. Caregivers may give you medicine to reduce pain and swelling. Your treatment plan will depend on the type of priapism you have. If you have a medical condition that is causing priapism, such as sickle cell disease, caregivers will also treat that condition. Your treatment may include any of the following:

  • Low-flow priapism:

    • Aspiration: Caregivers may use needles to remove blood from your penis. They may irrigate (wash out) your penis with fluids to help clear out the blood. Caregivers may also put a medicine into the fluid that helps the blood flow out of your penis so it can get soft again. Caregivers may put a pressure bandage on your penis after this procedure to help your penis stay soft.

    • Surgery: Caregivers may need to create a shunt (passage) for blood flow within your penis. The shunt helps to take blood away from your penis. Even after treatment, you may have permanent damage to the tissue in your penis, which can cause erectile dysfunction.

  • High-flow priapism:

    • Observation: With high-flow priapism, the penis may become soft on its own without any treatment. Caregivers may watch you closely for a period of time to see if your priapism gets better without treatment. They may also do any of the following:

      • Ice: Caregivers may put ice or cold packs on your penis for short periods of time. This can help slow down the blood flow to your penis.

      • Walking: Walking may help the blood drain out of your penis and circulate better in your body.

    • Embolization: Embolization is a procedure in which the blood flow within a blood vessel in your penis is blocked off. Caregivers do this by placing a small plug in the blood vessel. This may help to keep the blood flow normal.

    • Surgery: Caregivers may do a procedure called surgical ligation to tie off a part of a blood vessel in your penis.

  • Stuttering priapism:

    • Medicines: Hormone therapy may be used to prevent priapism. If you cannot use hormone therapy, your caregiver may teach you how to give yourself an injection of medicine. This medicine can be used to treat priapism when it happens.

What are the risks of having and treating priapism?

  • You may have a reaction from medicines that are used to help blood flow out of your penis. Reactions may include headaches, high blood pressure, sweating, swelling, or skin rash. Your heartbeat may become irregular, slow, or fast. Hormone therapy may cause diarrhea (loose, watery bowel movements), hot flashes, swollen breasts, and a decrease in sex drive. Caregivers may be unable to remove the blood in your penis. Even after treatment, your priapism may come back. The aspiration procedure may cause you to get a hematoma (pooling of blood under the skin in your penis), or an infection. The shunt procedure may cause certain problems such as a urethral fistula (abnormal opening in your urethra). The shunt procedure may also cause inflammation of the tissue in your penis.

  • You may need more than one treatment to soften your penis. Even with treatment, you may have an erection that lasts longer than four hours. This may cause permanent damage to the tissue in your penis. You may lose your desire for sex. If you do not get treatment right away, you may have greater tissue damage, which can lead to erectile dysfunction. Speak to your caregiver if you have any questions or concerns about your condition, medicines, or care.

How can I prevent priapism?

While it may not be possible to prevent priapism, you may be able to reduce your risk. If you are taking medicine for erectile dysfunction, follow your caregiver's directions on how to take it. Taking this type of medicine incorrectly may cause priapism. If you have stuttering priapism, caregivers may want you to take hormone pills to help prevent priapism. Ask your caregiver for more information about how to decrease your risk of getting priapism again.

For support and more information:

You may feel embarrassed about your priapism. It is normal to feel anxious (worried) if you have priapism. Some men who have priapism feel guilt, anger, and depression (sadness). Ask your caregiver about ways to cope with this condition and the feelings you have.

When should I call my caregiver?

Call your caregiver if:

  • You have an erection that happens without sexual stimulation, is not painful, and does not go away.

  • You have any questions about your condition, medicines, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You have an erection that happens without sexual stimulation, is painful, and continues for several hours.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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