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Priapism - Treating priapism

Treatment for priapism will depend on the type of priapism you have.

High blood flow (non-ischaemic) priapism may not need treatment. Many cases get better on their own after a few hours.

If you have injured your genital area, and you have a painful and persistent erection, try holding an ice pack wrapped in a tea towel against your penis. Climbing up and down stairs may also help.

If your symptoms fail to improve, seek immediate medical assistance from your nearest accident and emergency (A&E) department.

You may need surgery to temporarily prevent the flow of blood into your penis (see below).

If you are diagnosed with low blood flow (ischaemic) priapism, aspiration or sympathomimetic injections may be recommended.

Aspiration

Aspiration is the first treatment recommended for priapism.

Your penis is numbed with a local anaesthetic and a small needle and syringe is used to drain blood from your penis.

In some cases, the blood vessels may be ‘washed out’ with sterile water to get rid of any debris. This is known as irrigation.

Aspiration and irrigation usually help relieve painful symptoms and may result in your erection subsiding. However, you may need a number of treatment sessions before this happens.

Sympathomimetic injections

If your symptoms do not respond to aspiration, the next step is to inject a type of medication known as a sympathomimetic directly into the tissue of your penis.

Sympathomimetics work by squeezing the blood vessels in your penis, helping them push blood out of your penis while also preventing more blood from being pumped in.

A type of sympathomimetic called phenylephrine is usually recommended because it has a lower risk of causing side effects compared with other sympathomimetics.

Side effects of phenylephrine include:

  • an increase in blood pressure, which can make you feel dizzy and lightheaded
  • headache 
  • tachycardia (rapid heartbeat)
  • a noticeably irregular heartbeat

If you have a health condition that could be made worse by an increase in blood pressure, such as heart disease, you will need regular blood pressure checks and electrocardiograms (ECGs). An ECG measures your heart's electrical activity.

Surgery

Surgery may be recommended if your symptoms fail to respond to aspiration or sympathomimetic injections. There are several surgical procedures available, depending on the type of priapism you have.

If you have ischaemic priapism, shunt surgery may be recommended. This involves implanting a small device called a shunt into your penis to re-route the blood supply out of your penis.

A small number of men who have surgery for priapism experience erectile dysfunction afterwards. However, it is difficult to estimate the exact risk of this occurring because there may be other factors relating to erectile dysfunction, such as priapism itself, which confuse the issue.

If you experience erectile dysfunction after having surgery for priapism, you may need further surgery to treat your erectile dysfunction, such as having artificial implants placed inside your penis.

You should discuss the pros and cons of surgery for priapism with your surgeon beforehand.

If you have non-ischaemic (high blood flow) priapism, a surgical technique called embolisation may be used. It aims to stop the flow of blood into your penis by inserting a small device to block the damaged artery.

Surgical ligation is another method used to treat non-ischaemic priapism. During the procedure, the surgeon ties off the damaged artery to restore normal blood flow to your penis.

Read more about how erectile dysfunction is treated.



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