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Monday, August 18, 2025

Priapism (painful erections)


Priapism is a prolonged and often painful erection of the penis that lasts for more than 4 hours and occurs without sexual stimulation. It is a medical emergency because delayed treatment can lead to permanent tissue damage and erectile dysfunction.

Causes

  • Blood disorders:
    – Sickle cell disease
    – Leukemia
    – Thalassemia

  • Medications:
    – Erectile dysfunction drugs (sildenafil, tadalafil, vardenafil)
    – Antidepressants (trazodone, SSRIs)
    – Antipsychotics
    – Blood thinners

  • Trauma or injury to the genital or pelvic region

  • Spinal cord injury or neurological disorders

  • Alcohol and drug use, especially cocaine and cannabis

  • Unknown causes (idiopathic cases are common)

Types

  1. Ischemic (low-flow) priapism – most common and most dangerous; blood becomes trapped in the penis, causing pain and risk of tissue damage.

  2. Non-ischemic (high-flow) priapism – usually caused by injury to the penis or perineum, leading to uncontrolled blood flow; less painful and not as urgent.

  3. Stuttering (recurrent) priapism – repeated episodes, often seen in patients with sickle cell disease.

Symptoms

  • Erection lasting longer than 4 hours

  • Rigid penile shaft with soft glans (ischemic type)

  • Significant penile pain (especially in ischemic priapism)

  • Swelling and tenderness

  • Anxiety and distress

Diagnosis

  • Physical examination – to distinguish ischemic vs non-ischemic

  • Blood gas analysis of aspirated blood from the penis

  • Blood tests – check for sickle cell disease, leukemia

  • Ultrasound – to assess penile blood flow

Treatment

Emergency treatment is essential for ischemic priapism to prevent long-term damage.

  • Immediate medical care (go to hospital)

  • Aspiration – withdrawal of blood from the penis with a needle

  • Injection of vasoconstrictive agents (e.g., phenylephrine) into the penis to reduce blood flow

  • Surgical shunts if aspiration and medication fail

  • Oxygen and IV fluids in patients with sickle cell disease

  • Blood transfusions for sickle cell-related priapism

  • Non-ischemic priapism often resolves without urgent treatment, but embolization or surgical repair may be needed for persistent cases

Home Management (Not a substitute for emergency care)

  • Do NOT wait – seek urgent hospital care if erection lasts >4 hours

  • Cold compresses or gentle exercise may help in mild, early stages, but are not reliable

Complications

  • Permanent erectile dysfunction

  • Penile fibrosis (scarring of tissue)

  • Recurrence (especially in blood disorders)

Medications (used under medical supervision)

  • Phenylephrine (injection into the penis) – first-line treatment for ischemic priapism

  • Hydroxyurea – in sickle cell patients to reduce recurrent episodes

  • Hormonal therapy (e.g., gonadotropin-releasing hormone agonists, anti-androgens) in recurrent cases

When to Seek Immediate Help

  • Any erection lasting more than 4 hours

  • Severe penile pain

  • Recurrent episodes, especially with sickle cell disease




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