A prolonged erection, medically known as priapism, is a medical condition characterized by a persistent and often painful erection that occurs without sexual stimulation. This condition can last for hours and requires immediate medical attention. Prompt intervention is necessary to prevent potential long-term complications.
Understanding Prolonged Erection
Prolonged erections are classified into two types based on their underlying mechanisms: ischemic (low-flow) and non-ischemic (high-flow). Ischemic priapism, the more common type, occurs when blood becomes trapped in the penis and cannot drain properly, leading to a buildup of deoxygenated blood within the erectile tissues. This blood trapping is often painful and can result from issues with venous outflow or smooth muscle contraction within the penis.
Non-ischemic priapism, in contrast, results from unregulated or excessive arterial blood flow into the penis. This type is less painful and often occurs due to a fistula or pseudoaneurysm, which is an abnormal connection between an artery and the erectile tissue, often caused by trauma. Common causes of ischemic priapism include certain medications, such as those for erectile dysfunction (e.g., phosphodiesterase type 5 inhibitors), some antidepressants like trazodone, and antipsychotics. Blood disorders like sickle cell disease and leukemia can also lead to ischemic priapism due to mechanical obstruction of blood flow.
Trauma to the perineum or spinal cord injuries are often associated with non-ischemic priapism because they can disrupt blood vessels and lead to uncontrolled arterial inflow. Regardless of the cause, both types involve an issue with the normal process of erection and detumescence, where blood flows into the penis during stimulation and then drains out after stimulation ends.
When to Seek Emergency Care
An erection that lasts longer than four hours is considered a medical emergency and requires immediate attention. Prompt treatment is necessary to prevent permanent damage to the penile tissue. Delaying care can lead to irreversible consequences.
Go to the nearest emergency room immediately if a prolonged erection persists beyond this four-hour window. Attempting home remedies or waiting for the condition to resolve on its own is not recommended, as this can exacerbate tissue damage. While physiological changes and microscopic tissue damage may not begin until about six hours after onset, irreversible damage can occur if priapism lasts more than 24 hours.
Medical Treatment Approaches
Medical interventions for prolonged erection vary depending on the type, with ischemic priapism requiring more aggressive and immediate treatment. Initial hospital interventions for ischemic priapism often involve aspiration, where a needle is used to drain excess deoxygenated blood from the penis. This procedure involves inserting a needle into one or both corpora cavernosa, the main erectile bodies of the penis.
Following aspiration, irrigation is performed by flushing the erectile tissues with a saline solution, sometimes mixed with medication, to remove trapped blood and clots. This helps cleanse the corporal bodies and restore proper circulation. After aspiration and irrigation, medication injections are frequently administered directly into the penis.
Alpha-adrenergic agonists, such as phenylephrine, are used because they cause blood vessels to constrict, thereby reducing blood flow into the penis and promoting detumescence. Phenylephrine is injected with monitoring for potential systemic effects. If these less invasive methods do not resolve the erection within 60-90 minutes, surgical shunts may be considered.
Surgical shunts create a channel to divert blood flow from the corpora cavernosa to other areas, allowing the trapped blood to drain. Distal shunts connect the erectile tissue at the tip of the penis to the glans penis or corpus spongiosum. Proximal shunts connect the corpora cavernosa to the corpus spongiosum or saphenous vein at the base of the penis, though these are less commonly used now due to higher complication rates. For non-ischemic priapism, conservative management, including ice packs and observation, may be the initial approach, as many cases resolve spontaneously over several months.
Potential Long-Term Consequences
If a prolonged erection is not treated promptly or effectively, it can lead to irreversible damage to the penile tissues. The trapped blood in ischemic priapism becomes deprived of oxygen, harming the cells within the penis. This lack of oxygen can result in tissue scarring, known as fibrosis, which replaces healthy erectile tissue with inelastic scar tissue.
Fibrosis can impair blood flow and the ability of the penis to become rigid, leading to long-term erectile dysfunction (ED). Studies indicate that priapism lasting longer than 24 hours is associated with permanent impotence in a high percentage of patients. Penile deformity and persistent pain are also potential outcomes.