Priapism Questions

As a woman, I’m not too well-versed on this topic. I’ve done Internet research, but it’s been surprisingly vague in some regards. I know, for instance, how priapism occurs. I’ve also read that it’s more likely to occur if men are on certain drugs, RX or street, or if there’s been some injury to the penis. Does it occur in men who are otherwise normal and healthy and drug-free? In other words, is this something that could happen just out of the blue? How common IS priapism in men who don’t use drugs or have health or injury issues? Do guys lie awake at night worrying about this?

I’m afraid I can only answer your last question, which is a resounding no. Perhaps I should, but since I don’t take any drugs or medications that have this as a likely side effect, it never really seemed worth worrying about.

In medicine, as in much of life, it’s best never to answer never. Weird shit happens everyday. But it’s *very *unlikely for priapism to occur without trauma or drugs being involved, especially in adult men. It’s a little more likely in small boys with an undiagnosed vascular issue (so really not perfectly healthy, just undiagnosed), but even that is pretty rare.

If you’re not staying up nights worrying about your chances of developing diabetes, he shouldn’t be staying up worrying about priapism. Diabetes is far more likely to happen to any individual than priapism is.

It doesn’t happen to men who are healthy and drug-free.

Disease states most likely to cause priapism include sickle cell anemia and leukemia. In these diseases, excessive or abnormal blood cells block penile outflow, resulting in severe prolonged turgidity.

Local injury can also cause priapism, for reasons similar to above.

Cerebral or spinal cord lesions may also cause priapism, by sending nerve signals which say: Stay Erect!

Otherwise, a variety of drugs can result in priapism, including ED meds like Viagra, cialis and others (such as papaverine, which is injected into the penis to cause an erection.) Also certain psychiatric meds like trazodone, thorazine, and others.

If one is prone to free-floating anxiety, the fear of never-ending erections is certainly grist for that particular mill.

I suspect, despite the danger, there are men who lie awake at night wishing for this.

Priapism is generally divided into two categories. Ischemic priapism results when blood can’t exit the penis. This is a more serious event; “ischemia” means “lack of blood” but in this case really means “lack of proper blood supply resulting in tissue damage or death.” Although an under-educated man might think a really good erection would be a great thing, the enthusiasm for the condition wanes when he learns it might also be the last woody he ever gets, and in a worse-case scenario might be the last he sees of his penis before it falls off from gangrene.

Non-ischemic priapism means some blood flow is preserved; those case are less emergent.

There are various underlying mechanisms and treatments for both, ranging from expectant watching to emergent surgical surgery for shunting or clot removal or whatever, depending on the cause.

Causes can often be identified. Sometimes they can’t, and “idiopathic” priapism refers to priapism occurring in otherwise healthy individuals not taking any drugs and not known to have underlying predisposing conditions.

I have no idea if men, on average, worry about this. Certainly an under-educated individual with priapism might be found awake at night, laying…at least until he learns that it might be his last lay. :wink: Then he can switch to lying awake at night, worrying. Couldn’t resist.

No; it’s not common in people without risk factors.

Does anyone else find it odd that priapism would probably cure phimosis?

One time I was taking Bactrim DS and had it for several days. Funny thing is I had taken this medication many times before and months at a time with no side effects.

How do you figure?

(A priapic penis should not be bigger than a regular erection; IIRC many cases of congenital phimosis do resolve over the course of puberty as the developing member gradually shoves the preputial constriction to the sides, but if that doesn’t happen the man can still achieve full erections with an unretracted prepuce, as it will be the skin *behind *the constriction that will stretch and grow over their adolescence. Qadgop?)

Never knew anyone who admitted to worrying about the condition - but now that it’s one of the cautions connected to Viagra, etc., I know I’d never take one of those pills. The notion of having to go to an emergency room with that condition, is the kind of thing that gives me the freaks. If the manufacturers had only left out that one piece of advice, I’d be eatin’ the stuff at every meal.

How often do I get to use the words ‘priapism’ and ‘phimosis’ in the same sentence?

Such is the nature of our gender.

I know I’ve heard of people who say they’d do anything to not be so “quick on the draw” sort of speak - I have to resist reminding them that the opposite isn’t sunshine and lollipops either.

Very interesting and informative answers, guys! How likely is it that ED drugs would actually cause priapism? I’m assuming it’s pretty rare, or the stuff wouldn’t be as popular, or on the market at all, probably. Is it one of those situations where a guy can take, say, Cialis, a number of times with no problems, and then wham-o, Mr. Erecto moves in to stay?

Also, what exactly do doctors DO with a patient who comes in with this problem? I mean, I figure it’s not just a bucket of ice, or nude photos of Ernest Borgnine, but is there an injection, or do they just try to get the blood out of there somehow?

I must admit, I’m glad this isn’t something that happens to women…at least, I’ve never heard of a woman being in an eternal state of arousal, except maybe in those Penthouse Forum letters.

Most guys probably worry about it as much as they worry about having too much money.:smiley:

This probably calls for someone like Qadgop to weigh in, but I believe that I’ve read that one treatment is relief of some of the extra blood and pressure via needle and syringe.

On the contrary, I suspect there is an optimal level of priapism, above which it would not be as popular, but below which it also wouldn’t be as popular, because then you couldn’t advertise the “risks” of an erection lasting longer than 4 hours, which many folks hear and think “hey, I’d KILL for that kind of stamina!”

I’m afraid to ask but: How do they treat an erection that lasts for more than 4 hours?

Ejaculation is not effective in precipitating detumescence for ischemic priapism since the problem is functionally a mechanical blockage of outflow. Prolonged priapism is uncomfortable (a medical term for “hurts a lot”) so sexual activity is not typically top of the list of to-do’s.

I have used direct injection of an alpha-adrenergic (phenylephrine in particular) with reasonable results in an individual who was achieving erection using injectable medication. ( Phenylephrine is a potentially dangerous drug for its actions peripheral to the penis.) I have also given exchange transfusions as well as streptokinase (a clot-lysing agent) to sicklers with priapism.
I have never done an aspiration of blood; while that does create at least temporary detumescence, it does not really treat the underlying problem.

In some cases surgical intervention to shunt the blood physically is necessary; other times if the problem is clotting in the draining veins, removal of the clot is required.