Treatments & Diagnosis
Priapism
Emergency diagnosis and treatment for priapism, a prolonged erection requiring urgent care to prevent lasting tissue damage.
Treatments & Diagnosis for Priapism
Priapism is a prolonged erection that isn't caused by sexual arousal and doesn't go away on its own. It's uncommon, but it's considered a urological emergency, if the erection has lasted more than four hours, that's a signal to seek care right away, not to wait and see.
If you or someone you know has had an erection lasting over 4 hours, please go to the emergency room or contact us immediately. Prompt treatment significantly reduces the risk of lasting damage.
The condition takes its name from Priapus, a minor Roman fertility deity traditionally depicted with an oversized erect penis.
Types of Priapism
- Ischemic Priapism: The most common form, caused by blood becoming trapped in the penis with nowhere to drain. It's typically very painful, with a rigid shaft but a soft tip, and can persist for more than four hours if untreated.
- Nonischemic Priapism: Caused by excess blood flowing into the penis, usually after an injury. It tends to be less painful and the shaft is firm but not fully rigid, though it can still last several hours.
Priapism can occur at any age, but it appears most often in three groups: young boys between about 5 and 10, young adults around age 20, and men over 50, frequently linked to different underlying causes in each group.
Common causes include:
- Blood disorders such as sickle cell anemia and leukemia
- Certain medications, including erectile dysfunction drugs like sildenafil (Viagra) and tadalafil, antidepressants such as fluoxetine, and blood thinners like warfarin
- Recreational drug or alcohol use
- Injury to the genitals, pelvis, or spinal cord
- Tumors affecting blood flow in the area
Why Prompt Treatment Matters
When blood stays trapped in the penis, the tissue is starved of oxygen. The longer this continues, the greater the risk of permanent tissue damage, and in some cases, lasting erectile dysfunction. This is why priapism lasting more than four hours is treated as an emergency rather than something to manage at home.
Treatment Options
Ischemic priapism accounts for the large majority of cases and requires emergency care. Treatment focuses on draining the trapped blood and may involve:
- Aspiration: A needle and syringe are used to draw blood out of the penis and relieve pressure.
- Intracavernosal Medication: Medication is injected directly into the penis to constrict blood vessels and help the erection subside.
- Shunt Surgery: If other treatments don't work, a surgeon may create a shunt to reroute blood flow. If priapism has persisted beyond about 36 hours, penile implant surgery may be recommended instead, since tissue damage at that point often makes a shunt less effective.
Nonischemic priapism is less urgent and often resolves without treatment. Conservative measures, such as applying ice or pressure to the perineum, are usually tried first, and surgery is generally reserved for cases that don't resolve on their own.