Priapism

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The main symptom of priapism is a painful erection which lasts longer than four hours

Priapism is a medical condition, which is usually painful, where the penis remains erect for an extended period of time and does not return to its flaccid state. The erection remains without any psychological or physical sexual stimulation. Priapism occurs when blood, which fills the spongy tissue in the penis, is trapped and is unable to drain out of the penis. The penis remains erect even after ejaculation has occurred. Priapism requires urgent medical attention as most cases do not improve spontaneously. If priapism is not treated and not resolved it may result in permanent damage to the tissues of the penis as well as erectile dysfunction.

The word priapism is derived from the name of the Greek God, Priapus, who is often depicted as having a large, erect penis.

Priapism can occur in males of any age but mostly affects young boys between the ages of 5-10 years as well as adult men between the ages of 20-50 years. Priapism is rare in the general male population but its incidence is high in certain high risk groups like males with sickle cell disease and those using medication for erectile dysfunction. Overall, the international incidence of priapism is 1.5 cases per 100 000 persons. The incidence increases for men above the age of 40 years.

Symptoms of Priapism

The main symptom of priapism is a painful erection which lasts longer than four hours. The erection is not relieved by orgasm. Priapism can also be a non-painful, partial erection which lasts several days or longer. Partial erection priapism is less common than the persistent complete priapism.
There are 2 categories of priapism: low flow priapism and high flow priapism.

  • Low flow priapism
  • Low flow priapism is more common and is as a result of the blood in the penis being unable to drain because of blockage of venous flow. Blood cancer and blood abnormalities can cause the blockage of these veins. In low-flow priapism the blood quickly becomes oxygen depleted and results in tissue ischemia and cell death. Low flow priapism is more painful than high flow priapism.

  • High flow priapism
  • In High flow priapism blood flow in the penis is prevented from circulating normally. High flow priapism is often as a result of injury to the penis or perineum. Oxygen is still present in the blood which is in the penis so minimal ischemic damage occurs. This is why high flow priapism is not so painful.