A stepwise approach is usually recommended for the treatment of priapism.
This means that doctors will first try using non-invasive treatments, such as aspiration (see below) and will only ‘step up’ to more invasive treatments, such as surgery, if the initial treatments are unsuccessful.
Aspiration
Aspiration is usually the first treatment option that is recommended for priapism.
First, your penis will be numbed with a local anaesthetic. A small needle and syringe will then be used to drain some blood from your penis.
In some cases, ‘washing out’ the blood vessels with sterile water to clear away any debris may be recommended. This is known as irrigation.
Aspiration and irrigation can usually help to relieve painful symptoms and may result in your erection subsiding. However, you may need a number of treatment sessions before your symptoms start to respond.
Sympathomimetic injections
If your symptoms fail to 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 to push blood out of your penis while also preventing any 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 types of sympathomimetics.
Side effects of phenylephrine include:
- an increase in blood pressure, which can make you feel dizzy and lightheaded
- headache
- rapid heartbeat (tachycardia)
- 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, it is likely that you will be given regular blood pressure and electrocardiogram (ECG) checks. An ECG is a test that measures the electrical activity of your heart.
Surgery
Surgery may be recommended if your symptoms fail to respond to either aspiration or sympathomimetic injections.
Surgery for priapism usually involves implanting a small device called a shunt into your penis. The shunt can be used to re-route the blood supply out of your penis.
A small number of people who have surgery for priapism experience erectile dysfunction after surgery. However, it is difficult to estimate the exact risk of this occurring because there are other factors that may be related to erectile dysfunction, such as priapism itself, which confuse the issue.
If you experience erectile dysfunction after having surgery for priapism, you may need to have further surgery to treat your erectile dysfunction, such as having artificial implants placed inside your penis.
See the Health A-Z page about treating erectile dysfunction for more information.
