What causes priapism and how is it treated?

Priapism is a full, rigid erection that lasts for more than 4 hours. It is not necessarily caused by sexual stimulation and it is usually painful.

While priapism isn’t very common, it’s important for men to seek treatment immediately to avoid tissue damage. Left untreated, priapism will lead to erectile dysfunction (ED).

To understand priapism, it helps to review how erections occur.

In normal circumstances, erections are induced by signals from the nervous system – either as a result of sexual stimulation or thoughts or as a reflex during sleep. The signals cause arteries in the penis expand to allow more blood to flow in, causing the erection. Veins constrict to hold the blood in the penis and keep the erection rigid. After the man ejaculates (or if stimulation stops), the extra blood in the penis flows back into the body.

With priapism, there is a problem with this blood flow. Sometimes, too much blood flows into the penis as the erection forms. Or, the blood becomes trapped in the penis, unable to flow back out into the body as expected.

Priapism can have a number of causes, including the following:

• Blood disorders, such as sickle cell anemia and leukemia

• Substance abuse, including alcohol, marijuana, and cocaine

• Injury to the genitals, pelvis, or perineum (the area between the base of the penis and the anus)

• Spinal cord injury

• Carbon monoxide poisoning

• Venom from scorpions or black widow spiders

• Blood clots

Priapism can also be a side effect of certain prescription medications, including

  • Antidepressants

    • Erectile dysfunction (ED) drugs (oral and injected)

    • Mental illness medications

    • Blood thinners

    • Alpha blockers (sometimes used to treat high blood pressure or an enlarged prostate)

Treatment usually depends on the type of priapism.

Ischemic priapism, in which blood is trapped in the penis and can’t drain out, is an emergency and should be treated as quickly as possible to avoid damage to the penis.

Some common treatments are:

  • Aspiration. A small needle and syringe are used to drain the excess blood from the penis. Sometimes, a saline solution is flushed through the penis as well.

  • Medication. A drug may be injected into the penis. This drug narrows the blood vessels that let blood in. This makes it easier for the trapped blood to drain out.

  • Surgery. A shunt may be implanted so that blood flow can be redirected.

Men with sickle-cell anemia, a common cause of priapism, may be given treatment specifically for that condition.

Nonischemic priapism, when too much blood flows into the penis, may resolve on its own. Some doctors advise putting ice on the perineum. At times, surgery is done to prevent excess blood flow to the penis or to treat damage caused by an injury.

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