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Priapism is a topic covered in the 5-Minute Emergency Consult.

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  • Penile erection (engorgement of corpora cavernosa) in the absence of sexual arousal that is prolonged and frequently painful
  • Low-flow priapism:
    • Most common mechanism
    • Poor venous outflow
    • Usually painful
    • Ischemia and thrombosis from stagnant, hypoxic blood can occur after a few hours.
    • Fibrosis and erectile dysfunction are late sequelae.
  • High-flow priapism:
    • Rare
    • Penile arterial laceration with uncontrolled inflow of arterial blood
    • Usually painless
    • Presentation may be later than in low-flow priapism.
    • Ischemia and erectile dysfunction are uncommon.


  • Idiopathic
  • Pharmacologic agents:
    • Intracavernosal injectables for the treatment of erectile dysfunction:
      • Prostaglandin E1
      • Papaverine
      • Phentolamine
    • Psychotropics:
      • Phenothiazines
      • Butyrophenones
      • Trazodone
      • Sedative–hypnotics
      • Selective serotonin uptake inhibitors
    • Antihypertensives:
      • Prazosin
      • Hydralazine
      • Phenoxybenzamine
      • Guanethidine
    • Rarely implicated agents:
      • Phosphodiesterase inhibitors: Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
      • Anticoagulants
      • Cocaine
      • Marijuana
      • Ethanol
      • Androstenedione
    • Toxins (Black Widow, Scorpion)
  • Hematologic disorders predisposing to sludging of blood:
    • Sickle cell anemia (most common cause)
    • Leukemia
    • Multiple myeloma
    • Polycythemia
  • Penile and perineal trauma (arterial laceration and high-flow priapism)
  • Spinal trauma (loss of inhibitory adrenergic tone)
  • Rare causes:
    • Pelvic neoplasms and infections
    • Infiltrative diseases (e.g., amyloidosis)
    • Dialysis
    • Parenteral nutrition solutions containing a fat emulsion

Pediatric Considerations
Sickle cell anemia is the cause of most priapism in children.

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Rosen, Peter, et al., editors. "Priapism." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307457/all/Priapism.
Priapism. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307457/all/Priapism. Accessed April 23, 2019.
Priapism. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307457/all/Priapism
Priapism [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307457/all/Priapism.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Priapism ID - 307457 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307457/all/Priapism PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -