Health Tips

Priapism is a condition wherein a man experiences penile erection without sexual stimulation for an extended time. The erection may last a few hours or even days. In addition to being embarrassing and inconvenient, priapism is often painful and it can result in extensive tissue damage to the penis, as well as long-term impotence if not treated promptly.

Fortunately, it is uncommon compared to other forms of sexual dysfunction, and many men can return to normal sex lives after receiving proper treatment.

In general, priapism results from a disturbance to the mechanisms that control penile detumescence (the process by which the penis becomes flaccid). Blood enters the penis, but it cannot drain properly because it becomes trapped in the corpora cavernosa, a large chamber in the penis. The penis glans (head) and area around the urethra, however, remain flaccid.

Types of priapism fall under two broad categories:

Arterial, or high flow: This is the rarer and less painful form of priapism. It is usually caused by injury to the penis or perineum (the area between the scrotum and the anus), resulting in a ruptured artery that prevents proper blood circulation in the penis. This may happen, for example, if you fall down very hard onto the frame of your bicycle. There may be a lapse of time between the injury and onset of priapism.

Veno-occlusive, or low flow: The much more common form of priapism is characterized by painful and persistent erections due to blocked veins in the penis. Low flow priapism is usually associated with two main causes: diseases affecting the blood, such as leukemia, sickle cell, malaria and arteriolosclerosis; and side effects from intracavernous injections used to treat erectile dysfunction (ED).

When related to the latter, the medications papaverine and phentolamine are often the culprits. There are also a number of other possible causes, including tumors, spinal chord injury, carbon monoxide poisoning and black widow spider bites. Alcohol and recreational drug use (cocaine, marijuana and ecstasy), as well as using some anabolic steroids, may increase the risk of developing priapism.

The methods used to treat priapism depend on its causes and severity. The first thing anyone experiencing the condition should do is apply ice packs to the penis and perineum to reduce swelling. Also, walking up a flight of stairs is sometimes effective as it may divert blood flow. If these don’t work though, it’s time to go to the hospital.

There, doctors may either use an intracavernous injection to narrow the veins and cause swelling to subside, or especially in severe cases, puncture cavernous bodies to drain the trapped blood. In the case of high flow priapism, surgical ligation may be required to close off the ruptured artery.

Delayed treatment of severe priapism could result in irreversible impotence. However, this is probably the exception rather than the rule. Impotence due to priapism can be treated in several ways, including intracavernous injection of medicines such as phenylephrine and terbutaline, and penile prosthesis implantation for more serious cases. But again, many men have a good chance of recovering from priapism and leading normal sex lives again.