What is priapism?
Dr. Aysha Butt is the Medical Director of FROM MARS, and is a GP Partner at Woodcote NHS Medical Practice.
Priapism is the medical name for a long-lasting erection. That might sound like a good problem, but trust us, it’s not. Priapism is often painful, and it can damage your penis. That damage can even give you erectile dysfunction (ED). So definitely not one of those good problems.
If priapism happens to you, you need to seek urgent medical treatment to stop or limit any tissue damage happening. You should make sure you know the symptoms of priapism, what causes it, and what to do about it.
The main symptoms of priapism are:
- An erection that lasts for more than 4 hours
- An erection that isn’t associated with sex
- Progressively worse pain in your penis
Priapism can also be divided into two types depending on your erection:
- Ischaemic priapism, also called low-flow priapism, is when you’re erect, and your penis is fully rigid. Around 95% of cases of priapism are ischaemic priapism.
- Nonischaemic priapism, also called high-flow priapism, is when you’re erect, but not fully rigid. It’s usually less painful too.
There’s also a type of priapism called stuttering priapism or intermittent priapism. It’s usually a form of ischaemic priapism. With stuttering priapism, you get repeated episodes of priapism. At first you may get unwanted, painful erections that last for shorter periods, perhaps only a few minutes. These episodes may increase in frequency and duration though until you have full-on priapism.
So, what causes priapism? You get an erection when your penis fills with blood. When you get aroused, signals from your brain and nerves trigger a cascade of events. This causes the flow of blood to your penis to increase, and the arteries and spongy tissues to relax and fill with blood. At the same time, valves close on the blood vessels that carry blood out of your penis. This traps blood in your penis, making it swell and harden.
You get priapism when too much blood stays in your penis. It can happen for a range of reasons. Here we’ll divide them up by ischaemic and nonischaemic priapism.
Causes of ischaemic priapism
With ischaemic (low-flow) priapism, the valves that trap blood in your penis don’t open up when they’re supposed to. Usually, when the sex or masturbation has finished, the values open up, the excess blood flows out of your penis, and your erection subsides. If this doesn’t happen, your erection doesn’t subside, even though the stimulation has stopped.
Ischaemic (low-flow) priapism can be caused by medical conditions, prescription medications, recreational drugs, and even venom. Here are some of the most common culprits:
Medical conditions that could cause priapism
- Blood disorders, like leukaemia, multiple myeloma, and sickle cell anaemia (around 42% of men with sickle cell anaemia experience priapism)
- Neurological disorders, particularly ones caused by spinal cord injuries
- Metabolic disorders, like amyloidosis and gout
Prescription drugs that can cause priapism
- Antidepressants, including fluoxetine, bupropion, and sertraline
- ADHD medications, like methylphenidate and atomoxetine
- Anti-anxiety and anti-psychosis medications, like clozapine, chlorpromazine, hydroxyzine, olanzapine, lithium, and thioridazine
- Alpha blockers, including prazosin, terazosin, and doxazosin
- Anticoagulants, like heparin and warfarin
- Hormone therapies, like testosterone and gonadotropin-releasing hormones
- Erectile dysfunction medications based on phosphodiesterase type 5 inhibitors, like sildenafil and tadalafil
- Illegal drugs, like cocaine and marijuana
- Venom, poisons, or other toxic infections, including spider bites and scorpion stings
Causes of nonischaemic priapism
Nonischaemic (high-flow) priapism can happen when your blood flow isn’t regulated properly. This means that blood isn’t trapped in the penis, but more may flow into it than flows out. It’s caused most often when an injury around your penis, testicles, perineum, or anus damages an artery and stops blood flowing normally.
Can priapism cause ED?
Yes, unfortunately, priapism can cause erectile dysfunction.
The cells in your body need oxygen to function. Blood is the way your body delivers oxygen to your cells. If blood stays in your penis for too long, all the oxygen it contains can be used up. Your cells then start to become oxygen deprived, leading to cell death, tissue damage, and even scaring inside your penis. This damage and scaring can harm your ability to get and stay hard (erectile dysfunction).
This is most likely to happen with ischaemic (low-flow) priapism.
Should you avoid ED medications?
The key thing you need to know is that you don’t need to avoid these medications, unless you have a condition that makes priapism more likely. If you do have a condition that makes it more likely, talk to your doctor about taking PDE5 inhibitor ED medications.
Can you die from priapism?
Most people recover fully from priapism if it’s treated quickly enough. Priapism can cause lasting tissue damage to your penis though, and it could potentially cause a blood clot that could lead to gangrene of the penis. In extremely rare cases, the clot could travel to another area of your body and cause damage, but death is very, very unlikely.
How to treat priapism?
The goal here is to make your erection subside before any lasting damage occurs. Most people recover well from priapism if it’s treated quickly.
How do you treat priapism at home?
Priapism can sometimes get better on it’s own within a couple of hours. There are a number of things you can try at home to ease the pain and reduce your erection:
- Try urinating
- Have a warm bath or shower
- Drink lots of water
- Try gentle exercises such as walking or running on the spot
- Take painkillers like paracetamol to help relieve pain
If your priapism lasts for more than two hours, you should seek urgent medical attention.
Medical priapism treatments
Once you’re in front of a doctor, they have a number of options to treat you:
- Removing blood from your penis – a doctor may numb your penis, then remove blood with a syringe.
- Medications – a doctor may give you an alpha-agonist medication as a pill or an injection into your penis. This causes the blood vessels that carry blood into your penis to narrow, and the ones carrying blood out of your penis to expand.
- A surgical shunt – a surgeon may cut an opening into your penis to help blood drain. This can be effective, but it can lead to ED too.
- Blocking or tying off an artery – if you have nonischaemic priapism caused by a damaged artery, a surgeon can block the artery or tie it off.
Priapism can be very serious. If you think you have it, make sure you seek medical attention.