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Priapism is the medical term for a potentially dangerous and painful condition in which an erection lasts for four hours or longer without sexual or medical stimulation. It is considered a medical emergency, and if left untreated can lead to erectile dysfunction (ED) and penile disfiguration. This condition can occur in males of any age – even infants.

Forms of Priapism

Low-flow (Ischemic) Priapism: This type of priapism is by far the most common, accounting for up to 90 percent of all priapism cases. It is caused by blood becoming trapped in chambers of the penis so that it does not leave the penis normally after the erection.

Low-flow priapism can be caused by sickle-cell disease, leukemia, or malaria, but may also occur in males who are otherwise healthy. Symptoms include:

  • An erection lasting more than four hours without stimulation
  • An intermittent erection for several hours without stimulation (stuttering priapism)
  • Rigid penile shaft, but soft glans (tip of penis)
  • Painful or tender penis

High-flow (Nonischemic) Priapism: A less common form of this disorder, high-flow priapism is caused by disruption of arterial blood flow from rupture, possibly as a result of injury to the penis or nearby areas. The disruption prevents blood from circulating normally within the penis. Symptoms include:

  • An erection lasting at least four hours without stimulation
  • Erect (but not rigid) penile shaft
  • Usually without pain

Risk Factors for Priapism

Sickle-cell disease, or anemia, is closely linked with the development of priapism. Some studies show that nearly 50% of men with sickle-cell disease will eventually develop this condition.

Certain medications are also linked with priapism, particularly Thorazine® (chlorpromazine) and Desyrel® (trazadone), used in the treatment of depression and other mental conditions. If you are being treated for ED, some of the medications used to treat your condition could cause priapism.

Other risk factors include:

  • Injury to the penis, groin, or back
  • Venom, such as with a spider bite
  • Illicit drug or alcohol abuse
  • Urological cancers

If you have an erection lasting for several hours, regardless of whether it is painful, you should seek medical attention at an emergency or urgent care facility. The blood trapped in the penis becomes starved of oxygen and can cause erectile dysfunction or permanent disfigurement of your penis. Do not attempt to treat this condition yourself.

You should disclose the duration of your erection, as well as any drugs you have taken, either prescription or illegal. The following treatments will likely be used to resolve the erection immediately:

  • Ice packs applied to the penis and surrounding area to reduce swelling
  • Surgery to address the ruptured artery (in certain high-flow cases)
  • Drug therapy: alpha-agonist drugs may be used to narrow veins in the penis and reduce blood flow and swelling
  • Surgical shunt: used to stimulate circulation (in certain low-flow cases)
  • Needle aspiration: after numbing, blood may be drawn from the penis to reduce swelling and to allow blood flow into the penis

Following Up

Regardless of whether you seek emergency care or your painful erection resolves on its own in less than four hours, if you suffer a priapism it is important that you follow up with your physician within a few weeks to evaluate the cause of your condition, diagnose any damage done by the event, and work together to find ways of avoiding future episodes.

Miami urologist Dr. Marvin Bondhus diagnoses and treats men with priapism in our South Miami office. For a consultation, call (305) 661-9692 or request an appointment online.