Priapism is a prolonged, often painful, erection that lasts for four hours or more and is not related to sexual stimulation. It occurs when the blood that flows to the penis to create an erection cannot flow back out of the penis, causing it to remain fully or semi-erect for an extended period of time.

There are two types of priapism:

1. Low-flow (ischemic) priapism: This is the more common type of priapism, and it is caused by blood that is unable to leave the penis. Low-flow priapism can occur in men with sickle-cell disease, leukemia, or malaria. However, it can also affect otherwise healthy individuals. Because low-flow priapism can lead to permanent penile scarring that could impact a person’s erectile function, it is important to seek immediate treatment for this condition.
2. High-flow (non-ischemic) priapism: The rarer form of priapism, high-flow priapism, is generally less painful and is caused by injury or trauma to the penis or perineum (the area between the scrotum and the anus). Such an injury might rupture an artery, which in turn, impairs the process of blood flow to and from the penis.

What are the symptoms?

The main symptom of priapism is a persistent erection that lasts for four hours or more without sexual interest or stimulation. However, a person may also notice penile pain, a rigid shaft and a soft tip of the penis, and/or a partially rigid erection.

Who does priapism affect?

Priapism can affect men of all ages, but it is more common in people between the ages of 5-10 years old and 20-50 years old. Certain blood-related conditions can contribute to low-flow priapism such as sickle cell disease, leukemia, and malaria, so men with these conditions may be at higher risk of experiencing priapism.

What causes priapism?

Priapism does not have a singular underlying cause, but various conditions and situations may contribute to its development including:

• Blood disorders
• Some prescription medications
• Alcohol and drug use (marijuana and cocaine)
• Injury to the penis or perineum
• Toxic infections including a toxic spider bite or scorpion sting
• Spinal cord injuries

Can priapism be caused by medication for erectile dysfunction?

Phosphodiesterase type 5 inhibitors (PDE5is) are medications for the treatment of erectile dysfunction (ED). Some well-known PDE5is are Sildenafil (Viagra), Vardenafil (Levitra), Tadalafil (Cialis), and Avanafil (Stendra).

Priapism is a possible adverse side effect of taking PDE5is. It is important for a man to discuss the risks and benefits of any ED medication with his health care provider before taking it and to use the medication strictly as directed.

When should I seek medical attention?

You should seek emergency care if you have an erection that lasts for more than four hours. If you often have painful, long-lasting erections that end up going away on their own, you should speak with your primary care physician or another trusted health care provider.

How is priapism treated?

Treatment for priapism depends on its cause and severity. Some treatment options include:

• Ice packs to reduce swelling
• Removing blood from the penis by needle
• Medication for low-flow priapism (usually delivered via injection)
• Surgically blocking or tying off the artery that is causing high-flow priapism
• Inserting a surgical shunt (passageway) into the penis to allow the blood to flow out (generally used for low-flow priapism)

Resources:

• Cleveland Clinic. (2019, October 14). https://my.clevelandclinic.org/health/diseases/10042-priapism.

• Mayo Clinic. (2021, August 31). https://www.mayoclinic.org/diseases-conditions/priapism/symptoms-causes/syc-20352005.

• Rezaee, M.E., & Gross, M.S. (2020). Are We Overstating the Risk of Priapism With Oral Phosphodiesterase Type 5 Inhibitors? The Journal of Sexual Medicine, 17(8), 1579-1582. DOI: https://doi.org/10.1016/j.jsxm.2020.05.019.
  
  
• WebMD. (2021, September 9). Erectile Dysfunction and Priapism. Medically reviewed by Nazia Q. Bandukwala, DO. https://www.webmd.com/erectile-dysfunction/erectile-dysfunction-priapism.