Priapism

Priapism is a prolonged or persistent erection that lasts for more than 4 hours and is often very painful. This erection will not subside after ejaculation and may not be related to sexual stimulation at all. During the erection, the shaft of the penis will be rigid, but the glans (head of the penis) may be soft.

Priapism is potentially dangerous and should be treated as a medical emergency. If you have a painful erection that lasts for more than 4 hours, seek immediate medical attention. Left untreated for more than 24 hours, Priapism can permanently damage the penis and cause erectile dysfunction.

The main symptoms of Priapism are:

• a prolonged erection (lasting 4 hours or more)
• a rigid shaft but soft head of the penis
• (usually) a painful or tender penis

Priapism is caused when the blood that flows into the penis during an erection cannot flow back out of the penis or becomes blocked. Priapism comes in three main types:

• low blood flow (ischaemic priapism), which is the most common and serious type of priapism, usually caused by a restricted blood flow or lack of blood flow to the penis
• high blood flow (non-ischaemic priapism), which is rarer, usually caused by trauma or injury to the genital area
• recurrent or intermittent (stuttering priapism), which can be either due to low or high blood flow, and is when you have recurrent, painful erections lasting around 2–3 hours at a time

Priapism can be caused by drugs or disorders that affect the central nervous system or blood flow to the penis. They can occur as an effect of:

• sickle cell anaemia (a blood disorder)
• certain antipsychotic or anticoagulant drugs

Priapism is extremely rare but more common in high-risk groups such as men with sickle cell anaemia, or men taking medical treatment for erectile dysfunction (like Viagra).

Up to 35% of men with sickle cell anaemia will experience an episode of priapism in their lifetime.

Fewer than 1 in 1,000 men will experience priapism as a side effect of their treatment for erectile dysfunction.

If you ever experience an erection that is painful and/or lasts for more than 4 hours, seek emergency medical attention.

Treatment for priapism usually comes in the form of ‘aspiration’, when the trapped blood in your penis is drained using a needle and syringe. If aspiration is unsuccessful, your doctor will try injecting medication into the penis to force the blood vessels to expand and flow back out of the penis. Surgery will only be recommended if and when all other forms of treatment fail. The type of surgery will depend upon the type of priapism you have.

The treatment for priapism will depend upon the root cause.

If your priapism is non-ischaemic (due to a suspected injury or trauma to your genitals), you will usually be sent for a scan of the surrounding area to check the blood vessels of your penis, and for any long-lasting damage.

If your priapism is ischaemic, it could be the result of an underlying blood problem, such as sickle cell anaemia (lack of red blood cells), or an uncommonly high white blood cell count. You will be given a blood test to determine whether the priapism is a result of a blood problem.

Priapism is a (very rare) potential side effect of taking medication for erectile dysfunction, such as Viagra. Cases of priapism in men taking Viagra are virtually unknown, except in cases where Viagra is taken alongside another form of medication for impotence, such as injections of prostaglandin.

When used correctly, Viagra is safe to use and rarely has serious or long-lasting side effects. If your erection lasts for any longer than four hours while using Viagra, seek immediate medical attention.