Priapism

Published by Bupa’s Health Information Team, October 2011.

This factsheet is for men who have priapism, or who would like information about it.

Priapism is a long-lasting, often painful, erection that isn’t related to sexual stimulation. It can need emergency medical treatment to prevent permanent damage to the penis.

About priapism

Priapism happens when your penis fills with blood (as it usually does when you have an erection), but your blood becomes trapped and can’t return to your body's normal circulation. Priapism can happen without any sexual stimulation and your erection doesn’t go even if you ejaculate.

Priapism can last for many hours, or you can have reoccurring erections for shorter periods of time, from a few minutes to a couple of hours. This is known as stuttering priapism.

Priapism can affect men and boys of any age, including young babies.

Types of priapism

There are two main types of priapism.

Low blood flow (ischaemic) priapism

Low blood flow priapism is the most common and the most serious type of priapism. It's a medical emergency, so it’s important to seek treatment within four hours of it starting (or two hours for boys). It's usually caused by a blockage in the deep vein in your penis. Over time, it can damage the tissue in your penis and cause permanent erectile problems.

High blood flow (non-ischaemic) priapism

This is caused by an injury to your penis or the area between your anus and scrotum, called the perineum. A ruptured blood vessel can cause too much blood to flow into your penis. This is a rare type of priapism and doesn't usually cause long-term damage if treated properly.

Symptoms of priapism

The main symptom of priapism is a prolonged erection. Your penis may be fully erect or it may be semi-erect.

If you have low blood flow priapism, the shaft of your penis will be painful. The head of your penis (glans) will be soft.

If you have high blood flow priapism, you’re unlikely to have any pain in the shaft of your penis, but it may feel uncomfortable.

Complications of priapism

The main complication of priapism is erectile dysfunction. This is when you have difficulty getting or keeping an erection. This can happen as a result of permanent damage to the muscle and erectile tissue in your penis, which becomes very scarred. This damage usually occurs within 24 hours of priapism starting, so it's important to seek medical treatment quickly. It’s thought that priapism may affect fertility, particularly if you have stuttering priapism.

Causes of priapism

Priapism is caused by problems with the blood vessels and nerves in your penis and when blood becomes trapped in the erectile tissue of your penis. Causes of this include: 

• medicines, such as some antidepressants, anticoagulants like heparin and warfarin, and drugs that are injected directly into your penis to treat erectile dysfunction
  
• alcohol abuse or illegal drug use, including cocaine, marijuana and ecstasy
• blood disorders, such as sickle cell disease, thalassaemia and leukaemia
• an injury to your pelvic area, perineum or genitals
• a tumour in your pelvis
• a spinal cord injury
• infections, such as some types of pneumonia, malaria and gonorrhoea

Other possible causes of priapism include a bite from a black widow spider, vigorous sexual activity or carbon monoxide poisoning.

For some men with priapism, no cause is found.

Diagnosis of priapism

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Usually your GP will make a diagnosis of priapism if you have had an erection for four hours or more. This will then need to be treated as a medical emergency.

Your doctor may refer you to a urologist – a doctor who specialises in identifying and treating conditions that affect the urinary system – for urgent treatment, or straight to your local accident and emergency department.

You will need to have some blood tests, which will help your doctor diagnose which type of priapism you have. Your doctor may need to use a needle and syringe to draw (aspirate) some of the blood directly from the shaft of your penis. If you have low blood flow priapism, the blood in your penis will usually be thick and dark in colour. If you have high blood flow priapism, your blood will usually be bright red. You will be given a local anaesthetic, which will completely block feeling from your penis and you will stay awake during the procedure.

If you had an injury that could have caused the priapism, you may have an ultrasound scan, which uses sound waves to produce an image of the inside of your body. This may help to detect any problems with the blood vessels in your penis.

As priapism can be caused by an underlying health condition, your doctor may carry out further tests, such as blood or urine tests, to rule out other conditions.

Treatment of priapism

Usually for low blood flow priapism, the sooner you seek medical attention, the easier and more successful treatment is.

High blood flow priapism doesn't cause any long-term damage to your penis, so often your GP will wait for your erection to go by itself. If this doesn't work, you may need surgery.

Self-help

During the first four hours of your erection, place an ice pack or ice wrapped in a towel on your penis and perineum – this may be all you need to make the erection go down. Don’t apply ice directly to your skin as it can damage your skin.

Walking up stairs or jogging are other techniques that may help your erection subside. Having a warm bath may also help.

If you don't respond to these initial treatments, you will need medical treatment. The type of treatment will depend on the kind of priapism you have.

Hospital treatments

For low blood flow priapism, your doctor may use a needle and syringe to aspirate blood from your penis until your erection goes. You will be given a local anaesthetic. Your doctor may also ‘irrigate’ (wash out) your penis with sterile water to remove any blood clots or other blockages from your blood vessels.

If this doesn’t work, you may need to have an injection of a type of medicine called a sympathomimetic, for example phenylephrine, into your penis to reduce the priapism. These medicines work by squeezing the blood vessels in your penis, which helps to push blood out of your penis while preventing any more being pumped in. You will have a local anaesthetic for this procedure. If the medicine isn’t effective, you may need to have surgery.

Surgery

There are different types of surgery to treat priapism. The operation you have will depend on the type of priapism you have and what is causing it – ask your surgeon what the best operation is for you. Types of surgery are listed below.

• Embolisation. This is a technique that aims to block the ruptured blood vessel to stop the flow of blood into your penis. Your doctor will insert a specially designed coil, glue or sphere into your penis. This is for high blood flow priapism.
• Surgical ligation. This involves tying off the ruptured artery, which can help to restore normal blood flow in your penis. It’s used for high blood flow priapism.
• Surgical shunt surgery. This involves implanting a small device called a shunt into your penis. The shunt reroutes the blood supply out of your penis. This is for low blood flow priapism.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.