Priapism (PRY-e-piz-um) is a condition that causes a persistent and painful erection of the penis. It can occur without sexual desire or excitation.
Priapism, also called persistent erection, is a painful erection of the penis that does not go away in the usual time period and lasts longer than four hours. There may not be sexual desire or excitation associated with priapism. Priapism is considered a medical emergency and is a condition which requires immediate evaluation and treatment.
Priapism is most common in boys 5 to 10 years of age and men 20 to 50 years of age. It is estimated that a combination of drugs used to treat erectile dysfunction * and other medical conditions may be responsible for as much as 80 percent of priaprism cases. As many as 90 percent of adult males with sickle cell disease * are affected by priapism and most children who experience priapism have sickle cell disease.
Spaces or sinuses surrounding the penis, called erectile tissue, fill with blood, causing the penis to become larger and erect. Muscles then tighten around the veins (the vessels that allow blood to flow away) of the groin, preventing the blood from flowing out of the penis. Priapism is the result of the failure of blood to flow out of the penis. As the blood backs up, oxygenated blood is prevented from flowing into the penis, which can lead to erectile dysfunction and possible death of tissue of the penis.
The most common cause of priapism in boys is blood disorders such as sickle cell disease. Priapism can also be a side effect of drugs used to treat erectile dysfunction in men.
Other less common causes of priapism include bladder cancer, prostate cancer * , an injury to the penis or surrounding tissue, an injury to the spinal cord, and drugs other than those used to treat erectile dysfunction (for example, antidepressant medications * , antihypertensives * , anticoagulants * , corticosteroids * , antipsychotic drugs * , cocaine * , and amphetamines * ).
Priapism can be a complication of sickle cell disease. There may be an increased risk for priapism in people who have sickle cell disease. Men who take drugs to treat erectile dysfunction may experience priapism as priapism is a side effect of these drugs.
The most common sign of priapism is the painful penile erection that does not go away. Depending on the cause, the individual may not experience pain associated with priapism.
A physical examination is done to determine if there are any signs of injury to the penis or groin area. A neurologic examination may be done if spinal cord injury is suspected.
Laboratory studies of blood and urine specimens may be done to determine if there are any blood disorders or a urinary tract infection present.
Priapism is a medical emergency. If not treated promptly, lack of oxygen to the tissues of the penis may cause tissues to die. Immediate treatment includes applying ice to the area and having the person climb stairs. Applying ice narrows or constricts the arteries, which will slow the flow of additional blood to the penis, and having the person climb stairs attempts to promote the flow of blood out of the penis. Pain medication is given to relieve the pain associated with priapism.
A physician, called a urologist, who has specialized knowledge and experience in the treatment of disorders of the male reproductive organs, may be consulted. Treatment decisions are based on the cause of the priapism. For example, an individual experiencing priapism as a result of sickle cell disease may receive treatments aimed at treating the disease.
Two special procedures may be done. The penis is made numb by a local anesthetic and the doctor injects a drug into the penis to narrow or constrict the blood vessels that supply blood to the penis, slowing the blood flow and causing the swelling to decrease. Another procedure involves numbing the penis and then inserting a needle into the penis to withdraw or aspirate medications which may have been injected into the penis to stimulate erection and blood out of the penis to reduce the swelling and pressure. If these procedures don't work, a bypass or shunt is inserted into the penis to divert excess blood flow and enable normal blood circulation to return.
While an initial episode of priapism may not be prevented, once an episode occurs, and the cause identified, the cause may be corrected. For example, if the person is taking a particular medication that has an undesired side effect of priapism, the drug may be discontinued or changed to another drug that does not have the side effect of priapism.
See also Erectile Dysfunction • Fever • Hypertension • Prostate Problems: Overview • Sexual Disorders • Sickle Cell Anemia • Spinal Cord Injury • Substance Abuse
Dawson, Chris, and Janine Nethercliffe. ABC of Urology. Hoboken, NJ: Wiley, 2012.
Parsons, John Kellogg. Handbook of Urology. Hoboken, NJ: Wiley, 2013.
MedlinePlus. “Penis Disorders.” U.S. National Library of Medicine, National Institutes of Health. https://www.nlm.nih.gov/medlineplus/penisdisorders.html (accessed April 9, 2016).
Merck Manual: Consumer Version. “Erection, Persistent (Priapism).” http://www.merckmanuals.com/home/kidney-and-urinary-tractdisorders/symptoms-of-kidney-and-urinary-tract-disorders/erection-persistent (accessed April 9, 2016).
NHS Choices. “Priapism.” National Health Services. (accessed April 9, 2016).
American Urological Association. 1000 Corporate Blvd., Linthicum, MD 21090. Toll-free: 866-746-4282. Website: http://www.auanet.org (accessed April 9, 2016).
National Organization for Rare Disorders. 55 Kenosia Ave., PO Box 1968, Danbury, CT 06813. Telephone: 203-744-0100. Website: http://www.rarediseases.org (accessed April 9, 2016).
* erectile dysfunction is the inability of a man to attain or maintain an erection sufficient for satisfying sexual activity.
* sickle cell disease is a hereditary condition in which the red blood cells, which are usually round, take on an abnormal crescent shape and have a decreased ability to carry oxygen throughout the body. Also called sickle cell anemia.
* prostate cancer (PRAH-state) occurs in the small walnutshaped gland that produces seminal fluid and transports sperm in men.
* antidepressant medications are used for the treatment and prevention of depression.
* antihypertensives are medications used for the treatment of high blood pressure or hypertension.
* anticoagulants (ant-i-KO-agu-lant) are medications that interfere with blood clotting or coagulation.
* corticosteroids (kor-tih-ko-STIRoyds) are chemical substances made by the adrenal glands that have several functions in the body, including maintaining blood pressure during stress and controlling inflammation. They can also be given to people as a medication to treat certain illnesses.
* antipsychotic drugs (an-tiesigh-KO-tik) are medications that counteract or reduce the symptomsof a severe mental disorder such as schizophrenia.
* cocaine (co-KAYN) is a drug that produces a temporary feeling of alertness, energy, and euphoria.
* amphetamines (am-FET-ameenz) are drugs that produce a temporary feeling of alertness, energy, and euphoria.