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"What is priapism? Priapism is a persistent erection, which is usually painful. It&amp;#039;s not necessarily associated with stimulation or sexual desire. Much debate has taken place as to the meaning of &amp;#039;persistent erection&amp;#039;. But the current view is that the erection needs to be present for six hours.  In practice, the usual recommendation is to seek medical help for a painful erection persisting for more than four hours. What causes priapism? A normal erection results from relaxation of the muscles within the penis and an increase in arterial blood flow to the penis. The resulting swelling of the muscles compresses the penile veins, thus trapping blood within the penis.  After ejaculation, the associated adrenaline surge constricts the arteries and relaxes the pressure on the veins, which leads to loss of erection (detumescence). Priapism may be spontaneous or caused by medical treatment (iatrogenic) and can occur in all age groups, including newborns.  However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years. There are two categories of priapism: low-flow and high-flow.  Low-flow This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle cell disease, leukaemia (cancer of the blood) or malaria.  High-flow High-flow priapism is more rare than low-flow and usually not painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.  Medically, the important issue is whether the condition is associated with high blood flow when there is little risk of tissue damage or low blood flow when the risk of damage is higher.  Some 35 per cent of cases are idiopathic (unknown cause) and 21 per cent are associated with drug therapy or alcohol abuse.  Trauma accounts for 21 per cent and blood disorders 8 per cent.  Although controversy exists over the way in which priapism occurs, a widely accepted view is that priapism results from injury or damage to the mechanism that produces detumescence of the penis.  This damage can be caused by:  blood disorders, particularly sickle cell disease, myeloma, thalassaemia and leukaemia. trauma, both accidental and surgical. damage to the nervous system, especially spinal cord injuries, but rarely multiple sclerosis or diabetes (this usually involves an element of overstimulation, resulting in high blood flow to the penis, as well as defective detumescence). drugs used to treat impotence (particularly those given by injection into the penis):  papaverine prostaglandin E1 (alprostadil), which&amp;amp;nbsp;causes increased blood flow by dilating blood vessels in the penis (very rare&amp;amp;nbsp;if given into the urethra or urine tube in the penis) phentolamine sildenafil (Viagra) virtually unknown&amp;amp;nbsp;unless combined with other medication, eg injections such as&amp;amp;nbsp;prostaglandin.   other drugs, especially in overdose:  psychiatric drugs:&amp;amp;nbsp;trazodone and&amp;amp;nbsp;chlorpromazine blood pressure drugs:&amp;amp;nbsp;prazosin and&amp;amp;nbsp;nifedipine anticoagulants:&amp;amp;nbsp;warfarin and&amp;amp;nbsp;heparin miscellaneous:&amp;amp;nbsp;omeprazole,&amp;amp;nbsp;metoclopramide,&amp;amp;nbsp;and&amp;amp;nbsp;tamoxifen alcohol.    How is priapism treated? The presence of a painful erection for longer than four hours justifies a medical assessment by a GP or a visit to the Accident and Emergency Department if this is quicker.  Many cases resolve spontaneously after repeated ejaculation, physical activity or a brisk walk. Oral terbutaline (eg Bricanyl) or salbutamol (eg Ventolin) may help if given early. Blood (50ml) can be removed by a doctor inserting a large bore (19G+) needle into the penis often in conjunction with heparin and saline to reduce clotting. In resistant cases, a reversing agent, metaraminol (1 per cent solution), may be injected into the penis.  In very rare cases, surgery is required to avoid permanent damage to the muscle of the penis.  In cases in which priapism is related to an injection used to treat impotence, alternative therapy should be used in future.  Luckily, with the development of oral drugs, cases of priapism due to impotence treatments are becoming increasingly rare. What are the complications of priapism?  In very rare cases, unresolved priapism can lead to severe damage to the tissues of the penis. If this occurs, erections can be affected.  In this case, an implant or prosthesis can be surgically placed within the penis. Other people also read: Penile discharge: how is the diagnosis made? Penile injury: find out what the symptoms of penile fracture are. Penile prostheses: how do penis prostheses work? Penis size and enlargement surgery: problems with judging penis size. Last updated 10.09.2014 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/conditions/sexual-health/a12000/priapism/>