What is Priapism?

In Greek mythology, the god of fertility was named Priapus. He was always depicted as having a permanent exaggerated erection. In a nod to classical mythology, doctors named the condition of continual erection Priapism after the Greek god.

This condition is actually misnamed since priapism has nothing to do with sex and is incredibly painful. Blood flow to the penis helps a man get and maintain an erection. When the penis goes flaccid, blood has left the organ. In priapism, the blood remains in the penis and does not flow back out. There are many causes for priapism, including black widow spider bites, cocaine, marijuana, drug abuse of prescription medications such as Thorazine, sickle cell anemia, carbon monoxide poisoning and injury to the spine.

What are the Symptoms of Priapism?

There are three types of priapism which have slightly different symptoms.

Ischemic or low-flow priapism causes a painful, rigid erection lasting more than four hours. If the penis does not go flaccid within four hours, call an ambulance.

Non-ischemic or high-flow priapism is considered not as painful or rigid as low-flow priapism. Even a painless erection lasting more than four hours still warrants a trip to the hospital.

Stuttering priapism is a series of prolonged erections but the penis does go flaccid in between erections. The erections usually occur spontaneously and not due to sexual arousal. This also can be quite painful as well as quite embarrassing.

Priapism Causes

Priapism occurs when the blood, blood vessels, smooth muscles, or nerves responsible for the normal flow of blood out of the penis after stimulation has ended, to not occur. There are many different conditions that can lead to priapism.

Blood disorders can cause priapism. These include sickle cell anemia, leukemia, and other hematologic dyscrasias such as thalassemia and multiple myeloma. In fact, almost half of all men with sickle cell anemia will experience priapism at some point in their lives

Prescription medication can also cause the condition. Medications that can potentially cause the condition include medications injected directly into the penis to treat erectile dysfunction including alprostadil and papaverine. Certain antidepressants such as fluoxetine and bupropion have also caused it in some patients. Some alpha blockers, anti anxiety and anti psychotic drugs, blood thinners, hormones, and ADHD medication have also caused priapism in some cases.

Alcohol and drug use can increase the chance of priapism as well.

Injury to the penis, pelvis, or the area between the base of the penis and the anus might be a factor leading to the condition too.

Rare causes of priapism include, some spider bites or scorpion stings, metabolic disorders like gout, neurogenic disorders such as a spinal cord injury, and cancers involving the penis.

How is Priapism Treated?

If left untreated, priapism can cause permanent damage to the penis.

Place ice bags or a cold compress on the erection to help reduce pain and swelling while waiting for doctors to treat the patient. Do not place the ice directly onto the skin as this will cause cold burns.

Patients are given blood tests, drug tests physical exam of the genitals and abdomen help doctors determine what type of priapism the man suffers from and its probable cause. A medication like phenylephrine is injected into the penis to help the blood move out of the penis.

More drastic steps include doctors giving the patient an anesthetic and withdrawing blood from the penis with a needle and surgery.

Priapism Prevention

Prevention of priapism generally comes down to treating the underlying condition that caused the condition in the first place. In the case of drug and alcohol consumption, simply abstaining from the substances will suffice. In the case of cancer or injury, treatment at a medical facility can help treat the underlying condition and therefore the priapism. With priapism caused by medication, the medication can generally be changed to a different one that won’t cause the same symptoms.

Priapism can also be prevented directly using hormone blocking medications. This treatment can only be used on adult men, however, as it can effect development in children.