What is Priapism?
Priapism is a medical condition characterized by a prolonged and often painful erection of the penis that lasts for hours beyond, or is unrelated to, sexual stimulation. There are two main types of priapism:
Ischemic (Low-Flow) Priapism: This is the more common and serious type, where blood gets trapped in the erectile chambers of the penis and cannot flow out. It requires prompt medical treatment to prevent tissue damage and permanent erectile dysfunction.
Non-Ischemic (High-Flow) Priapism: This type is less common and usually less painful. It occurs when there is unregulated blood flow into the penis, often due to an injury to the perineum or penis.
Mechanism of Priapism Development
Ischemic (Low-Flow) Priapism: Blood becomes trapped in the penis, unable to drain, leading to prolonged erection and potential tissue damage due to lack of oxygen.
Non-Ischemic (High-Flow) Priapism: A rupture in an artery causes continuous blood flow into the penis, leading to an erection that is less rigid and less painful compared to ischemic priapism.
Signs & Symptoms of Priapism
The symptoms of priapism can vary depending on the type:
Key Symptoms
- Persistent erection lasting more than four hours.
- Erection is usually painful.
- Rigid penile shaft with a soft tip (glans).
- Can occur without sexual arousal.
Ischemic (Low-Flow) Priapism
- Persistent erection that may last for several hours or more.
- Typically less painful or not painful.
- Erection is usually not fully rigid.
- Often results from trauma or injury.
Non-Ischemic (High-Flow) Priapism
Cause of Priapism
Priapism can be caused by a variety of factors, ranging from medical conditions and medications to trauma and lifestyle choices. Here are the primary causes of both ischemic (low-flow) and non-ischemic (high-flow) priapism:
Causes of Ischemic (Low-Flow) Priapism
- Sickle Cell Anemia: This genetic disorder is a common cause of priapism, especially in children and young adults. The abnormal red blood cells can block blood flow in the penis.
- Leukemia: Increased white blood cell counts can obstruct blood vessels.
- Erectile Dysfunction Medications: Drugs like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can cause priapism.
- Antidepressants: Particularly trazodone.
- Antipsychotics: Such as risperidone and olanzapine.
- Blood Thinners: Like heparin can contribute to priapism in some cases.
- Alcohol, Illicit Drugs, Spinal Cord Injury, Multiple Sclerosis, Diabetes, Gout, Infections are some other reasons
Causes of Non-Ischemic (High-Flow) Priapism
- Perineal or Penile Injury: Direct trauma to the penis or perineum (the area between the anus and the genitals) can damage an artery, leading to unregulated blood flow into the penis.
- Congenital Abnormalities: Some individuals may have congenital vascular abnormalities that predispose them to priapism.
Priapism is an urgent urology condition
Priapism is a prolonged erection that may occur without sexual stimulation. A painful erection lasting more than four hours can be an emergency, especially ischemic priapism, and needs urgent urology evaluation to reduce the risk of tissue damage and erectile dysfunction.
Do not wait at home
A painful erection lasting more than four hours should be treated as urgent and assessed by a urologist or emergency team.
Low-flow vs high-flow
Ischemic priapism is usually painful and rigid. High-flow priapism is often less painful and may follow trauma.
Cause and medicine review
Evaluation includes medicines, ED injections/tablets, blood disorders, trauma, substance use, and previous episodes.
Tests for priapism
Priapism is an emergency, so tests are done quickly, often at the same time as treatment begins.
- Examination and history: the doctor asks how long the erection has lasted and about medicines, injections, injury and blood disorders.
- Penile blood gas test: a small blood sample is taken from the penis to tell the dangerous low-flow type from the high-flow type.
- Penile Doppler ultrasound: shows blood flow in the penis and can find a damaged artery in high-flow priapism.
- Blood count and sickle cell test: check for blood disorders that can cause priapism.
- Urine drug screen: may be done if medicines or other substances are suspected.
How priapism is treated
- Come to the hospital straight away if an erection lasts more than four hours, as early treatment helps protect erection function.
- The penis is numbed, and trapped blood is drawn out with a needle, sometimes with gentle washing with saline.
- A medicine may be injected into the penis to help the blood vessels tighten and the erection to go down, with careful monitoring.
- If this does not work, a small surgical procedure called a shunt may be needed to let the blood drain out.
- High-flow priapism is less urgent and may settle with observation; if it does not, the leaking artery may be blocked through a catheter procedure.
- Afterwards, the doctor looks for the cause, such as a medicine or blood disorder, to help prevent it from happening again.
Recovery after priapism treatment
- First 24-48 hoursYou are watched closely to make sure the erection does not come back. Some pain, swelling and bruising of the penis is common.
- First 1-2 weeksSwelling and bruising usually settle. Avoid sexual activity until the doctor says it is safe.
- Weeks to monthsErection function is reviewed at follow-up. Some men need treatment for erection problems later, and the doctor will guide you.
- OngoingAvoid the trigger if one was found, and follow the doctor's advice on medicines. Seek urgent care if priapism happens again.
Recovery depends on how long the erection lasted before treatment, so the doctor will give you a follow-up plan for your case.
Cost of priapism treatment in Lucknow
In priapism, getting treatment quickly matters far more than cost, so please do not delay coming to hospital. The final cost depends on whether simple drainage and medicine injection are enough or a surgical shunt is needed, which tests are done, and how long you need to be watched in hospital.
Precision Urology Hospital accepts almost all health insurance and cashless schemes, and the team will explain charges clearly as treatment is planned. For non-urgent follow-up questions, you can send your reports on WhatsApp for a free first opinion.
Send reports for a free opinionWhy see Dr. Aditya P.S. Sengar for priapism
- Private consultation, discussed one to one
- Andrology care from a DNB-trained urologist
- Medical treatment first; surgery only when it is needed
Watch: Dr. Aditya P.S. Sengar explains
Priapism: frequently asked questions
Is priapism an emergency?
A painful erection lasting longer than four hours is a medical emergency and needs urgent evaluation to reduce the risk of permanent erectile dysfunction.
What are the types of priapism?
Priapism may be ischemic low-flow or non-ischemic high-flow. Ischemic priapism is more urgent because trapped blood can damage penile tissue.
Can ED medicines cause priapism?
Some erectile dysfunction medicines or injections can contribute to priapism in selected cases, so medicine history is important during evaluation.
Can priapism come back?
Recurrent priapism can happen, especially with certain blood disorders or medicine triggers. A urologist can help identify risk factors and prevention steps.
Book a consultation for priapism
OPD Mon to Sat, 12:00 PM to 6:00 PM at Precision Urology Hospital. Book on WhatsApp and the team will confirm your time.
Send your report on WhatsApp for a free opinionPrecision Urology Hospital, 652B/37 Pratap Nagar, Tedhi Pulia Ring Road, Lucknow 226022. Get directions
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