Priapism is a painful, persistent erection unaccompanied by sexual desire or excitement.
Priapism probably results from abnormalities of the blood vessels and nerves that cause blood to become trapped in the erectile tissue (corpora cavernosa) of the penis. In most cases, priapism is caused by drugs taken to cause erection. Drugs may be those taken by mouth (for example, sildenafil, tadalafil, or vardenafil) or injected into the penis (for example, alprostadil). Other causes of priapism include blood clots, leukemia, sickle cell disease (particularly in children), a tumor in the pelvis, an injury to the penis or surrounding areas, dysfunction of the spinal cord, and use of other drugs, such as certain antidepressants, drugs used to treat other psychologic disorders, cocaine, and marijuana. Sometimes, however, no cause can be found.
Several symptoms help differentiate priapism from normal erections. Priapism lasts longer, usually several hours. Sexual excitement does not accompany priapism, and the erection is usually painful. Also, in priapism, the glans penis (the cone-shaped end of the penis) may be soft.
Applying ice, climbing stairs, or both may help. These measures can be taken immediately and done easily. Any drug that appears to cause the priapism is stopped immediately. Injection into the penis of a drug that decreases erection (for example, phenylephrine) can relieve priapism, particularly priapism caused by injection of a drug into the penis. Spinal anesthesia may relieve priapism caused by a spinal cord injury. When a blood clot is the probable cause, surgery to remove the clot or restore normal circulation in the penis is necessary. Usually, when other treatments are ineffective or the erection has lasted more than 4 hours, priapism can be treated by draining excess blood from the penis with a needle and syringe and using fluid to wash out any blood clots or other blockages from the blood vessels. One or more of many possible drugs may also be used, depending on the cause. Prolonged priapism usually impairs erectile function permanently.
Last full review/revision October 2008 by Paul D. Lui, MD