10042 Priapism

Overview

Priapism is a persistent, often painful erection of the penis that lasts for hours and is not related to sexual desire or stimulation. It happens when blood becomes trapped in the penis instead of flowing away normally. It is a medical emergency that requires prompt attention.

Priapism is uncommon, but it is serious. It mainly affects men of certain ages and those with specific underlying conditions.

It can occur at any age, including children and older men. It is most common in men with sickle cell disease, and in men taking certain medications or using recreational drugs.

Symptoms

Common symptoms

• Erection lasting more than 4 hours
• Pain or tenderness in the penis
• Erection that is not linked to sexual arousal

Symptoms in children

• Unexplained persistent erection
• Signs of pain or discomfort in the groin area

Symptoms in older adults

• Persistent erection often related to medications or blood disorders
• Discomfort in the penis or pelvis

Causes

Main causes

• Blood cell disorders such as sickle cell disease
• Injury or trauma to the genital area
• Certain medications, including some antidepressants and erectile dysfunction drugs
• Recreational drugs like cocaine or cannabis
• Blood cancers such as leukaemia

Risk factors

• Sickle cell disease
• A family history of blood disorders
• Use of injected erectile dysfunction treatments
• Heavy alcohol or drug use

When to see a doctor

See a doctor urgently if:

• Any erection lasting more than 4 hours
• Erection with increasing pain or tenderness

Book a routine appointment if:

• Frequent, short-lived erections that occur without sexual arousal
• Concern about any medication you are taking and its possible side effects

Diagnosis

A doctor will ask about your medical history, any medications or drugs you may have taken, and how long the erection has lasted. They will also examine your penis and groin.

Tests that may be done

• Blood test to check for sickle cell disease or other blood disorders
• Blood gas test on a sample taken from the penis to measure oxygen level
• Ultrasound to check blood flow in the penis

What to expect at your appointment

The doctor will explain what they are doing and why. You may need a small injection or a needle to drain blood from the penis. These tests help the doctor identify the type of priapism and decide on treatment.

Treatment

Priapism is treated in a hospital emergency department. The goal is to release trapped blood, relieve pain, and protect erectile function. Treatment depends on the type and how long the erection has lasted.

Self-care at home

• Do not wait or try home remedies – go to the emergency room
• Do not drink alcohol or take recreational drugs
• If you have a health condition like sickle cell disease, tell the doctor immediately

Medical treatments

Doctors may first try drawing blood out of the penis using a fine needle and syringe. They may also use a small injection of a medicine to help narrow the blood vessels and reduce blood flow. If these do not work, a surgical procedure may be needed to create a channel for blood to drain. You will not be sent home until the erection is resolved.

When is surgery considered?

If other treatments fail, surgery is performed to create a shunt that allows trapped blood to escape. Surgery is more likely if the erection has lasted a long time.

Living with this condition

After treatment, you may need to avoid sexual activity for a few days or weeks. Follow your doctor's advice about rest, healing, and follow-up appointments. Some men may have lasting changes to erectile function, so support and follow-up are important.

Lifestyle tips

• If you have sickle cell disease, stay well-hydrated and avoid extreme cold
• Avoid recreational drugs and heavy alcohol use
• Tell your doctor about any new medications that could affect blood flow

Diet and exercise

A healthy diet and regular exercise can improve blood flow and overall health. Drink plenty of water, especially if you exercise or live in a warm climate.

Mental health and emotional wellbeing

Priapism can be frightening and may cause embarrassment or anxiety. It is normal to feel upset or worried. Talk to your doctor if you have ongoing emotional distress after treatment.

Prevention

Not all types of priapism can be prevented, but you can reduce the risk by managing underlying conditions like sickle cell disease and avoiding drugs that trigger priapism.

Vaccines

There is no specific vaccine that prevents priapism.

Screening programmes

There is no routine screening for priapism, but people at high risk should have regular check-ups for blood disorders.

Complications

If left untreated

• Permanent erectile dysfunction
• Scarring or tissue damage in the penis
• Chronic pain and difficulty with sexual function

Long-term outlook

With prompt treatment, most men can recover without long-term problems. The key is not to delay. Even if some men experience lasting changes, treatments and support exist to help you maintain quality of life.

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