Dr. Benjamin Breyer Urology
San Francisco, CA 94143
Phone: (415) 353-2200

Benjamin Breyer


Urology Practice

400 Parnassus Ave.,
Sixth Floor, Suite A610
San Francisco, CA 94143
Phone: (415) 353-2200
Fax: (415) 353-2641

Hours: Monday to Friday
8 a.m. – 5 p.m.

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Priapism is a violation of male sexual function characterized by abnormal erection unrelated to sexual arousal and stimulation of the penis.

Priapism is diagnosed if nonsexual erection lasts more than four hours. In addition to very prolonged erection, priapism symptoms may include penile pain, swelling of the erectile tissue and ecchymosis.

Priapism is a very rare sexual dysfunction, which occurs unexpectedly for man. Occurrence of priapism can be predicted only in the cases if the man has risk factors of priapism or persistent prolonged erection is a side effect of used medicines.

Priapism can be caused by different groups of drugs, such as:

  • ADHD drugs containing CNS stimulant - Methylphenidate (such as, Ritalin, Methylin, Concerta, Focalin, Daytrana, Aptensio and Metadate).
  • Injectable drugs for the treatment of erectile dysfunction (such as, Phentolamine, Alprostadil, Prostaglandin E1, Papaverine).
  • Drugs from the group of alpha-adrenergic antagonists (such as, Alfuzosin, Paliperidone, Tamsulosin, Risperidone).
  • Antidepressants from the group of SSRIs (such as, Paroxetine, Sertraline, Citalopram, Fluoxetine, Fluvoxamine, Escitalopram).

In addition, priapism can occur in men:

  • Abusing alcohol, marijuana, illegal drugs;
  • Using medical devices to obtain and maintain erection (such as, vacuum pumps);
  • With a history of genitourinary tract injuries (such as, injury of penis, testicles, urethra);
  • With a history of hematologic disorders (such as, anemia, leukemia, myeloma);
  • With a history of penile fibrosis (such as, Peyronie's disease).

Delays in priapism treatment can cause irreversible damage to the erectile tissue and severe erectile dysfunction. Therefore, when occurring unwanted painful erection, a man should immediately inform the doctor about priapism symptoms.

There are two basic types of priapism with the similar signs and symptoms. Before starting the priapism treatment, the type of this disease and the possible causes of its development should be determined.

To diagnose the type of priapism, several diagnostic and laboratory tests are used, such as:

  • Penile arteriography
  • Complete blood count (CBC)
  • Arterial blood gas (ABG) test
  • Color duplex ultrasonography
  • hemoglobin electrophoresis test
  • Urine toxicology screening testing
  • Screening test for detection of psychoactive drugs in the body
  • Screening test for anatomical abnormalities in the cavernous tissue

After getting the results of diagnostic tests, the man can be diagnosed with:

  • nonischemic priapism, which does not require the treatment
  • ischemic priapism, which requires immediate treatment

The use of intracavernous injections of sympathomimetic agents (with or without aspiration irrigation of old blood from the cavernous tissue of the penis) should be considered as the first-line therapy of ischemic priapism.

To cure priapism, injectable alpha-adrenergic sympathomimetics can be used:

  • Norepinephrine (Levophed)
  • Phenylephrine (Vazculep)
  • Metaraminol (Aramine)
  • Epinephrine (Adrenalin)

Each of the listed sympathomimetics helps rapidly reduce erection and cure priapism. Herewith, each of these injectable drugs have advantages and disadvantages.

Norepinephrine has a weak therapeutic effect in the treatment of priapism. Therefore, it is used to reduce persistent, painful penile erection only in the cases if the man has allergy to other sympathomimetics.

The most effective drugs for the treatment of priapism are Epinephrine and Metaraminol. These drugs have a powerful therapeutic effect, but can cause severe cardiovascular side effects. Therefore, Metaraminol or Epinephrine is recommended for the treatment of priapism only in men with healthy cardiovascular system.

Injectable sympathomimetic Phenylephrine has an optimal balance of efficacy and safety. Benefits of Phenylephrine exceed its potential risks for different groups of patients. Therefore, Phenylephrine is used as the first-line therapy of priapism most often than other sympathomimetic agents.

For the treatment of priapism, repeated injections of Phenylephrine in the cavernous tissue of the penis are used. Frequency of using Phenylephrine injections depends on the severity of priapism. When using the standard scheme of priapism treatment, intracavernous injections of Phenylephrine are administered every 5 minutes for an hour.

In low efficiency of first-line therapy, surgical shunting procedure is prescribed to treat priapism. Surgical method of priapism treatment can cause serious complications (such as, erectile dysfunction). Therefore, before using surgery, all available non-surgical methods of priapism treatment should be used.

If unwanted painful erection is caused by a disease, the treatment of priapism should be carried out simultaneously with the treatment of the main disease.

Men predisposed to priapism should remember that only timely treatment of this sexual dysfunction could prevent the development of serious reproductive system disorders, such as irreversible form of erectile dysfunction.

© Dr. Benjamin Breyer