Priapism

If you have an erection lasting more than four hours, you need emergency care.

The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to happen as soon as possible.

Medical history and exam

To determine what type of priapism you have, your doctor will ask questions and examine your genitals, abdomen, groin and perineum. Your doctor might be able to determine what type of priapism you have based on whether you're experiencing pain and the rigidity of the penis. This exam might also reveal the presence of a tumor or signs of trauma.

Diagnostic tests

Diagnostic tests might be needed to determine what type of priapism you have. Additional tests might identify the cause of priapism. In an emergency room setting, your treatment will likely begin before all test results are received.

Diagnostic tests can include:

• Penile blood gas measurement. In this test, a tiny needle is inserted into your penis to remove a sample of blood. If the blood is black — deprived of oxygen — the condition is most likely ischemic priapism. If it's bright red, the priapism is more likely nonischemic. A lab test measuring the amounts of certain gases in the blood can confirm the type of priapism.
• Blood tests. Blood drawn from your arm can be tested to measure the number of red blood cells and platelets present. Results might show evidence of diseases, such as sickle cell disease, other blood disorders or certain cancers.
• Ultrasound. You might have Doppler ultrasonography — a noninvasive test that can be used to estimate blood flow through blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. This test can be used to measure blood flow within your penis that would suggest ischemic or nonischemic priapism. The exam might also reveal an injury or abnormality that might be an underlying cause.
• Toxicology test. Your doctor might order a blood or urine test to screen for drugs that might be the cause of priapism.

Ischemic priapism

Ischemic priapism — the result of blood not being able to exit the penis — is an emergency situation that requires immediate treatment. After pain relief, this treatment usually begins with a combination of draining blood from the penis and using medications.

• Aspiration decompression. Excess blood is drained from your penis using a small needle and syringe (aspiration). As part of this procedure, the penis might also be flushed with a saline solution. This treatment often relieves pain, removes oxygen-poor blood and might stop the erection. This treatment might be repeated until the erection ends.
• Medications. A medication, such as phenylephrine, might be injected into your penis. This drug constricts blood vessels that carry blood into the penis. This action allows blood vessels that carry blood out of the penis to open up, increasing blood flow out of the penis. This treatment might be repeated several times if needed. You will be monitored for side effects, such as a headache, dizziness and high blood pressure, particularly if you have high blood pressure or heart disease.
• Surgery or other procedures. If other treatments aren't successful, a surgeon might perform other procedures to drain blood from the penis or surgery to reroute blood flow so that blood can again move through your penis.

If you have sickle cell disease, you might receive additional treatments that are used to treat disease-related episodes.

Nonischemic Priapism

Nonischemic priapism often goes away with no treatment. Because there isn't a risk of damage to the penis, your doctor might suggest a watch-and-wait approach. Putting ice packs and pressure on the perineum — the region between the base of the penis and the anus — might help end the erection.

Surgery might be necessary in some cases to insert material, such as an absorbable gel, that temporarily blocks blood flow to your penis. Your body eventually absorbs the material. You might also need surgery to repair arteries or tissue damage resulting from an injury.

If you have an erection lasting more than four hours, you need emergency care. If you experience recurrent, persistent, partial erections that resolve on their own, see your doctor. Treatment might be needed to prevent further episodes. The doctor might suggest that you make a follow-up appointment with a specialist in the urinary tract and male reproductive system, such as a urologist or andrologist.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do

• Make a list of any symptoms you're experiencing, including any that might seem unrelated.
• Make a list of all medications, vitamins, herbs and supplements that you're taking. Tell your doctor if you use any illegal drugs.
• Prepare a list of questions to discuss with the doctor.

Questions for the doctor might include:

• What is likely causing the problem?
• What kind of tests might be needed?
• What can be done to prevent this problem in the future?
• If medication is necessary, is there a generic alternative?
• Are there activities, such as exercise or sex, that should be avoided? If so, for how long?
• Does priapism increase the risk of developing erectile dysfunction?
• Do you have brochures, or can you suggest websites that explain more about priapism?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them might allow time later to cover other points you want to address. Your doctor might ask:

• When did your symptoms first start?
• How long did the erection or erections last?
• Was the erection painful?
• Have you had an injury to your genitals or groin?
• Did the erection occur after using a particular substance, such as alcohol, marijuana, cocaine or other drugs?

Your doctor might order lab tests to determine if a health condition is causing priapism.

What you can do in the meantime

Don't stop taking any prescription medications without consulting your doctor.