Priapism is a condition where one has an erection which will not go away.
The shaft is hard but the glans is not. It is very painful.
Priapism is named after Priapus, a Greek fertility god, and on looking at
a statue or painting of this god it is easy to see where the condition got its
name. Priapus, as a god of virility, has an everlasting and highly noticeable
erection. It is interesting to note that the enormous size of Priapus's penis
meant he was banished to be a scarecrow in the fields.
Priapism is not brought about by sexual thoughts or sexual activity (or
lack of it). It can occur at any age from infancy and seems to happen between the ages of five
and ten years or between twenty and fifty years. The specific mechanisms that
bring on attacks of acute priapism are unknown. Acute attacks often start during sleep, occasionally following sexual activity, but frequently no identifiable event is noted. An unusually full bladder is commonly associated with the onset of nocturnal attacks. Some episodes appear to be
triggered or exacerbated by dehydration.
Priapism can be separated into three main types:
RECURRENT ACUTE PRIAPISM
This is the most common form of priapism. With recurrent acute priapism the patient gets short attacks that subside
spontaneously. He usually copes with this problem and may not seek medical
Most men suffering recurrent acute priapism will continue to get attacks throughout their lives and will maintain some degree of
potency. Others will eventually become impotent. A small group will develop an acute attack that will not
subside without active and aggressive treatment in a timely fashion.
ACUTE PROLONGED PRIAPISM
The painful erection that does not subside after several hours is an emergency and should be treated aggressively. If untreated, the attack will last for several
weeks, resulting in total impotence. Even with aggressive treatment, preservation of potency may be
Rarely, a man may suffer chronic priapism either after a successfully
treated attack of acute prolonged priapism or out of the blue. In chronic
priapism the penis is semi-erect and there is no pain. The penis will slowly
grow but the man will have trouble achieving a full erection. This may
affect either the entire shaft or any part of it.
Most of the rest of the article deals with acute prolonged priapism.
THE MAIN CAUSES OF PRIAPISM ARE:
When blood is unable to escape the penis it tends to stagnate due to the
limited space available for circulation. As this stagnation happens the blood
becomes more acidic and looses oxygen. This causes the red blood cells to
become stiff, which makes their being squeezed out through the blood vessels
even more difficult.
There are two types of acute priapism - low-flow or ischemic priapism, which means that little or no blood flow is getting to the penis,
and high-flow priapism, which is the result of trauma to the penis. In the case
of high-flow priapism, there is actually a large amount of blood flow to the penis.
The most important factor when dealing with priapism is speed of treatment.
If treatment begins within between four and six hours from the onset of the
erection, the penis has a 50% chance of recovering fully and having normal
erectile function thereafter. However, if treatment is left for much longer
than this irreparable damage can be done to the penis, and in extreme cases no
erectile function can be returned.
Diagnosis and Treatment of Priapism.
Preliminary Questions and Medical History
- the length (time) of the erection is determined and compared with the
normal length of erection for that man.
- all medications which the man is taking are documented
- the man is asked whether any trauma has occurred
- the penis is examined to make certain it is showing the symptoms of
priapism - a hard shaft and a soft glans
- the rectum and abdomen are examined for signs of cancers which may be
inhibiting the blood flow
Determination of the Type of Priapism
- a blood sample is aspirated from the penis and examined to
determine a blood-gas measurement. This measurement helps determine whether
the priapism is low- or high-flow, and to determine how long the erection
has lasted and (in cases of trauma) how much damage has been done
- Decongestant medications.
These medications include drugs such as pseudoephedrine and terbutaline, which may act to decrease blood flow to the penis and
can be very successful in early cases.
Once the blood-gas measurement has been performed and the priapism is determined to be
ischemic, the old blood can be evacuated by aspirating through a small needle placed directly in the
corporal body. The skin is cleaned and a local anesthetic
is used on the penis. 50 to 150 ccs of blood is withdrawn. This usually
allows enough release of pressure to allow the erection to subside.
In most cases this treatment is enough to ensure a full recovery, but in
some cases the erection will recur. If this happens certain vaso-active type drugs including
epinephrine may be used, causing the blood vessels to constrict and prevent priapism from recurring.
If this is unsuccessful, a shunting procedure is performed. This is a minor
surgical procedure that can be done in the emergency room. It allows the blood to drain from the corporal body into the
glans and surrounding tissues.
- the patient is given a course of antibiotics (to ward off the very common
infections to which patients whose blood has been aspirated are susceptible)
and sent home.
Complications can and do occur during and after the treatment for priapism. These complications include:
The prevention of recurrent episodes can be difficult. If you have suffered
priapism and have an idea of what triggered the attack, that activity should