What is Priapism?
Priapism is a persistent penile erection that lasts more than 4 hours and is unrelated to sexual stimulation.
Meaning
If you have an erection that won’t go away after ~4 hours, it’s called priapism. The common, ischemic (low flow) type happens when blood gets trapped in your penis, it’s usually painful, the shaft feels rigid while the tip may be softer, and it’s an emergency because the tissue isn’t getting enough oxygen.
Meaning of Priapism in Urdu
پرائاپزم ایک طبی حالت ہے جس میں عضوِ تناسل بغیر کسی جنسی تحریک کے چار گھنٹے یا اس سے زیادہ وقت تک مسلسل تناؤ میں رہتا ہے۔
سادہ الفاظ میں: اگر آپ کا عضو خود بخود لمبے وقت تک سخت رہے اور ڈھیلا نہ ہو، تو اسے پرائاپزم کہا جاتا ہے۔ اکثر اس میں درد ہوتا ہے، عضو زیادہ سخت جبکہ نوک نسبتاً نرم محسوس ہو سکتی ہے۔ یہ ہنگامی مسئلہ ہے کیونکہ خون اندر پھنسنے سے آہستہ آہستہ آکسیجن کم ہو جاتی ہے اور عضو کو نقصان پہنچ سکتا ہے، جس سے بعد میں کمزوری کا خطرہ بڑھ جاتا ہے۔ ایک قسم میں خون اندر پھنس جاتا ہے اور درد زیادہ ہوتا ہے، دوسری قسم عموماً کسی چوٹ کے بعد ہوتی ہے جس میں درد کم ہو سکتا ہے، مگر دونوں صورتوں میں فوری طبی جانچ ضروری ہے۔ اگر چار گھنٹے گزر جائیں تو فوراً قریبی علاج گاہ سے رجوع کری
What are the Types of Priapism ?
The main types of priapism are ischemic (low-flow), nonischemic (high-flow), and stuttering (recurrent ischemic).
Types of Priapism
Ischemic (low flow) priapism:
This is the common, emergency type. Blood can’t drain from your penis, so it becomes very rigid and usually painful. Cavernous blood-gas testing shows low oxygen (PO₂ < 30 mmHg), high carbon dioxide (PCO₂ > 60 mmHg), and acidic pH (< 7.25) findings that confirm poor oxygen delivery. If your erection lasts ≥4 hours, you need urgent care to prevent tissue damage and later erectile dysfunction.
Nonischemic (high flow) priapism:
This usually follows a perineal or groin injury that causes unregulated arterial inflow. The penis is often less rigid and less painful. Blood drawn from the corpora is typically bright red/oxygenated, and a Doppler ultrasound shows arterial flow features that help doctors distinguish it from the emergency low-flow type. You should still get evaluated, but it’s not usually as urgent as ischemic priapism.
Stuttering (recurrent ischemic) priapism:
These are repeated, self-limited episodes often under 3–4 hours each that tend to occur in conditions like sickle cell disease. Even though episodes stop on their own, they can progress to a full ischemic event; a urologist can help you with prevention strategies.
What are the Causes of Priapism?
The main causes of priapism are blood disorders (especially sickle cell disease and leukemia), medications (ED injections like alprostadil/papaverine, some antidepressants such as trazodone, antipsychotics, alpha-blockers, and rarely oral PDE-5 inhibitors), pelvic/perineal trauma (often causing high-flow priapism), recreational drugs (cocaine, amphetamines, alcohol), neurologic/spinal cord injury, pelvic cancers or infections, and idiopathic cases where no cause is found.
Causes of Priapism
Blood disorders:
Abnormal or “sticky” red blood cells can block penile blood outflow and trigger ischemic (painful) priapism. In sickle cell disease, about 30–45% of adult men experience recurrent (“stuttering”) episodes; even brief spells can progress, so you should discuss prevention with a specialist.
Medications ED injections:
Intracavernosal therapy is a well-recognized adult cause; too much drug or sensitivity can trap blood and lead to ischemic priapism. Recent reviews note rising cases among men using injection therapy for ED, so if you use these, you should be taught dose limits and what to do if an erection lasts ≥4 hours.
Medications Psychiatric and Other Drugs:
Trazodone and several antipsychotics (via alpha-adrenergic blockade) can impair detumescence, alpha-blockers, anticoagulants, and some antihypertensives have also been implicated. Oral PDE-5 inhibitors (sildenafil, tadalafil, etc.) rarely cause priapism but are listed among potential contributors. If you start any of these and notice prolonged erections, seek care.
Pelvic or Perineal Trauma:
A blow to the groin can create an arterial fistula and cause nonischemic (high-flow) priapism that’s typically less painful but still needs evaluation. If you have a persistent semi-rigid erection after an injury, get checked.
Recreational drugs:
These substances can disturb vascular control and precipitate prolonged erections, disclose any use to clinicians so they can treat you appropriately.
Neurologic/spinal causes:
Spinal cord compression or injury can disrupt the nerve signals that end an erection, leading to episodes that require medical assessment.
Pelvic cancers and infections:
Conditions like advanced prostate cancer or prostatitis/urethritis can irritate local tissues or vessels and contribute to priapism.
Idiopathic (no identifiable cause):
Even with testing, about one-third of cases have no clear trigger so if you develop priapism, it’s still vital to be seen promptly.
Which Drug Interaction Can Causes Priapism?
Medications can affect how blood enters and leaves the penis and how your nerves end an erection. Key drug-related causes include:
Erectile-dysfunction therapies:
Oral PDE-5 pills like sildenafil, which includes Viagra 100mg tablet.
tadalafil which includes Cialis 5mg Tablet and Cialis 20mg tablet, vardenafil (rare when used correctly), and intracavernosal injections (alprostadil, papaverine, phentolamine) the injections carry the highest medication-related risk, especially with high doses or combinations.
Trazodone (antidepressant):
Well, documented to cause prolonged, often painful erections likely via alpha-1 blockade so any erection nearing 4 hours needs urgent care.
Antipsychotics, alpha-1 blockers, and blood thinners: Antipsychotics (e.g., risperidone, quetiapine) and alpha-1 blockers (for BPH/BP) can hinder detumescence; blood thinners are a rare contributor risk may rise after starting or changing a dose.
ADHD medicines:
Methylphenidate and atomoxetine have a rare but reported risk, inform your clinician if you notice longer-than-usual erections.
Recreational substances:
Cocaine (strongest link), with occasional reports involving amphetamines, cannabis/MDMA, or heavy alcohol use.
What are the Treatment Options of Priapism?
Treatment options for priapism include immediate first-aid measures (ice packs, light exercise), aspiration of blood, intracavernosal injection of sympathomimetic drugs (phenylephrine), surgical shunts, and treating the underlying cause (like blood disorders or medications).
Treatment Options of Priapism
First-aid and supportive measures
If you reach the hospital early, doctors may advise applying ice packs to the perineum or doing light physical activity (like climbing stairs) to increase adrenaline, which sometimes helps detumescence. These steps are safe initial measures but not a substitute for urgent care.
Aspiration of blood
For ischemic priapism, the standard first treatment is aspiration. A doctor inserts a small needle into the corpora cavernosa and removes trapped blood. This not only relieves pressure but also helps oxygen flow return to the tissue.
Intracavernosal sympathomimetic injections:
If aspiration alone doesn’t work, doctors inject a drug such as phenylephrine directly into the penis. Phenylephrine stimulates alpha-adrenergic receptors, causing the smooth muscle to contract and blood to drain. It is considered the most effective drug treatment and may be repeated every few minutes under monitoring.
Surgical shunts
If aspiration and medications fail, the next step is surgical shunting. Surgeons create a passage between the corpora cavernosa and another vein or structure, allowing blood to exit. This is usually reserved for cases lasting more than 6–12 hours where less invasive steps have not worked.
Treatment of nonischemic (high flow) priapism
This type often resolves without aggressive treatment. Your doctor may monitor you closely, but if it persists, selective arterial embolization (blocking the injured artery with tiny coils/gel foam) is performed to reduce abnormal blood flow.
Treating Underlying Causes
If your priapism is linked to sickle cell disease, leukemia, medications, or drugs, you’ll also need treatment for that root cause such as hydration, oxygen therapy, or changing medications otherwise episodes may recur.