Priapos was worshipped by the ancient Greeks as the god of sexuality and fertility, today he gives his name to a sexual disorder. Priapism is a usually painful permanent erection that lasts longer than two hours, even though pleasure, ejaculation and orgasm are absent. A wide variety of diseases can be the cause of the never-ending erection. If professional treatment is not initiated within a few hours (up to a maximum of six hours), there is a risk of serious damage (erectile dysfunction, etc.). Priapism is a urological emergency situation and should therefore be treated as quickly as possible.
How does a permanent erection occur?
A normal erection results from the relaxation of the muscles within the penis with a simultaneous increase in the blood supply from the arteries. This causes the erectile tissue of the male member (the corpora cavernosa) to swell, which prevents the outflow into the veins and thus the return flow of blood from the penis. After ejaculation, the arteries are constricted again, which reduces the pressure on the veins and thus the erection (detumescence).
Priapism occurs in around 60 percent of all cases without a recognizable cause (so-called idiopathic priapism). In the remaining 40 percent – these forms are referred to as secondary priapism – the permanent erection is often caused by one of the following diseases/situations:
- Blood diseases, in particular sickle cell anemia, plasmocytoma, thalassemia (Mediterranean anemia) polycythemia and leukemia
- Injuries (penis or spinal cord), surgery-related or after accidents
- Damaged nervous system, especially spinal cord injuries, more rarely multiple sclerosis (MS) or diabetes mellitus
- Various tumors
- Alcohol and drug abuse
- Medications for the treatment of impotence (especially those that are administered as an injection into the penis in so-called erectile tissue auto-injection therapy (SKAT)):
- Other medications, especially in case of overdose:
| Psychotropic drugs (Trazodone and Chlorpromazine) |
| Blood pressure medication (Prazosin and Nifedipine) |
| Immunosuppressants |
| cortisone |
What symptoms occur?
Painful permanent erection (longer than two hours) without involvement of the glans in the absence of sexual stimulation. So-called high-flow priapism can also be painless. There is often an upward curvature of the penis. After hours, the foreskin, the glans and later the entire penis turn blue.
How is priapism treated?
The diagnosis is made on the basis of the patient’s description. Ultrasound examinations (duplex sonography) and the analysis of a blood sample from the erectile tissue provide information about the cause of priapism.
Treatment consists of immediate pain treatment and other measures. The doctor first tries to reduce the swelling of the penis with medication. The active ingredient terbutaline in tablet form is particularly successful for high-flow priapism after SKAT therapy and for spontaneous, frequently occurring priapism. If there is no improvement after about 30 minutes, blood is aspirated from the erectile tissue using a syringe. If an erection occurs again, vasoconstrictor drugs (etilefrin, epinephrine) or methylene blue are injected directly into the erectile tissue. The last option is a surgical procedure in which either the arterial blood supply to the penis is reduced (selective embolization of the penile arteries) or the venous outflow is improved (shunt operation).