If your penis becomes erect for no apparent reason, remains erect for more than 4 hours without subsiding, and there is no sexual arousal, this symptom may be a sign of priapism, a medical emergency that requires prompt treatment. If left untreated for too long, it can lead to permanent erectile dysfunction.
Although not a common condition, priapism can occur in men of all ages, especially between the ages of 5–10 and 20–50, and is more likely to be found in men over 40. If you have experienced an abnormally prolonged erection, do not overlook this article, as we will help you understand the types of priapism and the correct treatment approaches.
How many types of priapism are there and how can it occur?
There are 3 types of priapism:
1. Ischemic priapism (Low flow priapism) is the most common type, accounting for approximately 95% of all priapism cases. It occurs when the veins in the upper tissue of the penis remain dilated and cannot contract normally, causing blood to be trapped in the penile vessels continuously and preventing normal blood flow back to the heart. This results in priapism, and if it lasts more than 24 hours, there is a higher chance of tissue death and permanent fibrosis of the penis, leading to erectile dysfunction in up to 90% of cases. Patients with this type experience severe penile pain and must be urgently taken to the hospital.
2. Non-ischemic priapism (High flow priapism) is less common, found in about 5% of cases. It results from arterial injury in the penile tissue, such as an arterial aneurysm rupture or leak, or trauma to the penis or perineum, like a bicycle accident or surgery. This type does not cause tissue ischemia or fibrosis and does not require urgent treatment. The erection is firm but not rigid or painful.
3. Recurrent ischemic priapism (RIP or Recurrent priapism) is rare but often seen in individuals with a genetic history of sickle cell disease. It is caused by abnormal red blood cell clumping that blocks the veins in the penile tissue, leading to ischemic priapism episodes that are less severe but can still cause fibrosis and erectile dysfunction in about 29-48% of cases.
Risk factors and causes of priapism
Generally, non-ischemic priapism is caused by penile trauma. The causes of ischemic and recurrent priapism are not fully understood, but risk factors are known.
Risk factors for priapism
- Blood disorders and hematologic cancers, which can cause red blood cell breakdown leading to blood clots blocking penile veins. Commonly seen in sickle cell disease, but also in thalassemia, G6PD deficiency, leukemia, and multiple myeloma.
- Side effects of certain medications that affect blood vessel contraction and dilation in penile tissue, such as antihypertensives, antidepressants, vasopressors, hormones, anticoagulants, anesthetics including local anesthesia, spinal anesthesia, or general anesthesia.
- Various narcotics, including stimulants, as well as alcohol and cocaine.
- Animal venom such as scorpion venom and spider venom.
- Certain diseases such as rabies, malaria, and gout.
- Neurological diseases such as spinal cord injuries, back pain from herniated discs, lumbar spinal stenosis, and stroke.
- Psychiatric disorders such as anxiety, obsessive-compulsive disorder, stress, and panic disorder.
- Cancers such as hematologic cancers, male genital cancers including penile cancer, prostate cancer, lung cancer, colorectal cancer, urinary tract cancers like kidney, urethral, and bladder cancers, and brain tumors.
- In a small number of cases, the cause remains unknown.
Treatment approaches for priapism
1. Ischemic type
- Applying cold compresses to the penis
- Draining trapped blood from the penile tissue
- Injecting certain medications into the penile tissue at the site of erection to promote blood flow, such as Phenylephrine, Ephedrine, Epinephrine, Norepinephrine, or Methylene blue. The choice of medication depends on the doctor’s discretion.
- Surgical intervention if other treatments fail, such as creating a shunt to drain blood from the penis (Cavernoglanular shunt). If this is unsuccessful, penile prosthesis implantation may be necessary.
- Treating underlying conditions such as hypertension
- There are occasional reports of low-dose radiation therapy to the penis in cases where other treatments fail or surgery is not possible or refused.
2. Non-ischemic type treatment involves cold compresses and addressing the cause, such as trauma to the penis. This condition often improves on its own. Radiation therapy combined with embolization may be used if there is a vascular leak.
3. Recurrent type treatment is similar to ischemic priapism treatment combined with managing the underlying disease, such as sickle cell disease.
Summary
Priapism is a condition that should not be ignored. If the penis remains erect for more than 4–6 hours without softening, especially without sexual stimulation, it can cause tissue damage, fibrosis, permanent erectile dysfunction, or even require penile prosthesis surgery in severe cases.
If you experience priapism or suspect you may be at risk, you should see a urologist as soon as possible. Early treatment increases the chance of recovery. Do not let embarrassment harm your long-term sexual health.
