Priapism

WHAT IS PRIAPISM?  

Priapism is an erection that lasts too long.  The definition is an erection that lasts more than four hours, but there is reason for concern much earlier than 4 hours already.

WHAT CAUSES PRIAPISM?

There are many causes for priapism, but taking medication like the anti-depressant trazodone or oral treatment for erectile dysfunction (PDE5 inhibitors) and especially injectable treatment for erectile dysfunction (ED) can increase your risk of developing priapism.

For medical treatment of erectile dysfunction, visit this link.

For non-medical treatment of ED, visit this link.

HOW DOES PRIAPISM WORK? 

When you have a hard erection, fresh blood is not flowing into your penis and that can lead to a lack of oxygen in the penis, if it lasts too long. This lack of oxygen can lead to erectile dysfunction and is an emergency. It needs medical treatment to prevent long term consequences.

Priapism might happen without sexual stimulation (especially if you have taken an injection for ED) and you might stay hard even after ejaculating more than once.

A prolonged erection that is hard enough for penetration is dangerous.  If there is just a fullness, but you cannot penetrate with it, it is probably okay.  If you have any doubt, rather treat it like priapism!

WHAT TO DO IF YOUR ERECTION LASTS TOO LONG (PRIAPISM)

Erections lasting longer than one hour:

If your erection lasts longer than one hour, start to apply pressure at the base of your penis and on your perineum (between the scrotum and the anus) and apply ice to this area.  Ejaculating might also help.

Erections lasting longer than two hours:

You can take TWO SUDAFED SINUS PAIN tablets.  It contains Psuedoephedrine, which might help.  These tablets are available over the counter in pharmacies, but are kept behind the pharmacy desk, so just ask you pharmacist for it.  In South Africa, it comes in packs of ten.  You might also have been given some by the doctor who prescribed the medication with the increased risk for developing Priapism (Trazodone, PDE5 inhibitors or injectable ED treatment).  If you are taking any of these medicines and you have chronic medical conditions, especially heart disease, check with your medical doctor if it is okay for you to take tablets containing pseudoephedrine.

Erections lasting longer than three hours:

If you have taken the SUDAFED tablets and it did not work, start heading to your nearest hospital emergency room.  You need to get treated within 4 hours.  Do not wait for 4 hours and then risk sitting in long ques before you will get treated.

 

HOW IS PRIAPISM TREATED?

If you have had an erection for 4 hours i.e Priapism, the doctor on call or the urologist will withdraw some blood from your penis and inject saline (a medical salt water solution) into your penis.  If this is not effective, medication like a weak solution of adrenalin might be injected.  In very rare cases, surgery might be necessary.

 

HOW TO PREVENT PRIAPISM 

The easiest way the prevent priapism is to not take drugs that increase your risk for priapism (ED treatment and Trazodone, etc), but that is not always practical.  It is very important to always stick to the exact dosage your doctor prescribed.  Never use two ED drugs together. Never use somebody else’s ED drugs – you do not know if the dose is right for you.  Check in with your doctor at least annually to make sure you are still using the right dosage.

 

WHAT TO DO IF YOU HAVE HAD PRIAPISM 

If you have developed priapism, or even just an erection that lasted more than one hour, inform your doctor immediately.  Your dose needs to be adjusted or the treatment needs to be stopped to reduce your risk of developing priapism again.

 

HOW COMMON IS PRIAPISM?

In ten years, I am only aware of 3 MSH patients who have developed priapism and all of them were taking very strong injectable treatment for ED.  All three were treated immediately and did not develop any complications.  I have however seen many other patients who were prescribed high dosages of injectable ED treatment by other clinics and not educated about the risk of and the treatment of priapism.  These patients have developed severe, difficult to treat ED due to the poor management of their priapism.  It is very embarrassing to go to the emergency room and explain your situation, but it is not a train smash.  If you however leave it untreated, you can have severe lifelong ED. Don’t be afraid to use the medication prescribed to you, just know how to handle the complication!

Written by Dr Elna Rudolph

Clinical Head of MSH

www.drelnarudolph.com