How do you stop an unwanted erection?
An erection that does not go away without sexual stimulation is called priapism. The common ischaemic type becomes a medical emergency once it lasts beyond four hours, because irreversible damage to the erectile tissue begins about 48 hours after onset. Draining the trapped blood combined with a vessel-narrowing injection resolves 80% to 100% of cases.
What is priapism?
Priapism is a persistent or prolonged erection in the absence of sexual stimulation that fails to subside. It is divided into ischaemic, non-ischaemic and stuttering types.
Ischaemic priapism, where blood is trapped in a rigid penis, accounts for more than 95% of all episodes. Non-ischaemic priapism makes up only 5% of cases, is often painless and is most often caused by a blunt injury to the penis or the area behind the scrotum. Stuttering priapism means repeated episodes of prolonged erections.
When does an unwanted erection become an emergency?
Ischaemic priapism that lasts beyond four hours behaves like a compartment syndrome, with the blood supply to the erectile tissue cut off. Emergency treatment is needed to prevent tissue death, scarring and permanent erectile dysfunction.
"Acute ischaemic priapism is a medical emergency." Source 1, p. 112
The duration of the episode is the most important predictor of lasting damage. In one study, the risk of erectile dysfunction rose sharply beyond 20 hours, and irreversible damage to the erectile tissue begins to develop about 48 hours after onset. In a series of 50 men followed for a mean of 66 months, those whose priapism lasted more than 48 hours had a significant risk of erectile dysfunction.
How is ischaemic priapism treated?
The first treatment for an episode lasting more than four hours is drawing the trapped blood out of the penis through a needle. Combined with an injection of a drug that narrows the blood vessels, this is the standard of care, and it resolves 80% to 100% of cases, compared with 58% for the injection alone.
These first-line treatments are strongly recommended before any surgery. When they start beyond 48 hours, they still relieve the erection but have little documented benefit for long-term erections. An implant is discussed when presentation is delayed beyond 48 hours or when the episode does not respond to injections and shunt surgery.
Do home measures help with an unwanted erection?
Exercise, ejaculation, ice packs, cold baths and cold-water enemas have all been described historically. The evidence for them is limited, success rates are seldom reported, and they may worsen the condition in men with sickle cell disease.
In one small series, cold-water enemas were followed by the erection subsiding in six of ten cases. In another study, 24.5% of 122 men with episodes lasting more than six hours had their erection subside after cooling of the penis and perineum and walking upstairs. These measures do not replace emergency care once an episode has lasted for hours.
What causes priapism, and can it come back?
Common causes include sickle cell disease, other blood disorders, cancers and some medicines. Priapism occurs in 0.4% to 35% of men after injections of erection drugs into the penis, with a risk below 1% for prostaglandin E1, and antipsychotic medicines account for 33.8% of published drug-related cases.
Stuttering priapism brings repeated emergency visits and a constant risk of a major ischaemic episode. An implant to prevent it is not offered before medical treatment and is used only in carefully selected men as a last resort.