Introduction
Priapism is a condition that many people have heard of but few understand well. It’s when an erection lasts much longer than normal – often for hours or even days. While this might sound like material for jokes, it’s actually a serious medical condition that needs prompt attention.
This article focuses on high-flow priapism, a less common but important type that differs from what most people think of when they hear about priapism.
Whether you’re dealing with this condition yourself, know someone who is, or simply want to be informed, this guide will help you understand what high-flow priapism is, what causes it, and how doctors treat it.
What Is High-Flow Priapism?
High-flow priapism is a rare but serious health issue. It causes a long-lasting erection that won’t go away, even without sexual desire. Unlike the more common low-flow priapism, this type often doesn’t hurt. But you still need to see a doctor right away.
In this condition, too much blood flows into the penis. This happens because of unusual connections between blood vessels. The erection can last for hours, days, or even weeks without treatment.
The key facts about high-flow priapism:
- It’s usually not painful
- It rarely causes permanent damage
- It often happens after an injury to the penis or groin
- The blood flow to the penis stays normal
Though less urgent than low-flow priapism, you should still see a doctor quickly. This helps prevent long-term problems.
What Causes High-Flow Priapism?
Most cases happen after an injury to the genital area. But other things can cause it too.
Injury-Related Causes
- Falls that injure the groin area
- Broken pelvic bones
- Direct injuries to the penis
- Damage during surgery in the pelvic area
Other Causes
- Cancer that has spread to the penis
- Sickle cell disease (though this rarely causes high-flow type)
- Abnormal blood vessel formations
- Some medications, like ED drugs (rare)
The injury creates an abnormal path between an artery and spaces in the penis. This lets blood flow in without proper drainage.
How Doctors Diagnose High-Flow Priapism
Getting the right diagnosis is crucial. The tests help doctors tell high-flow from low-flow priapism. This matters because the treatments differ.
Doctor’s Exam
Your doctor will ask about:
- Any recent injuries
- How long you’ve had the erection
- Whether you feel pain
- Your medical history
Blood Tests
A key test takes a small blood sample from the penis:
- In high-flow priapism: The blood is bright red and has good oxygen
- In low-flow priapism: The blood is dark and lacks oxygen
Imaging Tests
- Doppler ultrasound: Shows blood flow patterns and can find the problem spot
- Arteriography: The best test to pinpoint the exact location of the abnormal connection
- MRI: Used in complex cases
Treatment Options
Since high-flow priapism doesn’t usually cause oxygen loss or tissue damage, treatment isn’t as urgent as with low-flow priapism. Options range from watching and waiting to surgery.
Wait-and-See Approach
Observation For some men, especially with mild symptoms, doctors might suggest watching the condition:
- Regular check-ups
- Ultrasound tests to monitor blood flow
- Learning warning signs that need prompt attention
Ice and Pressure
- Applying ice packs to the penis and groin
- Pressing on the injury site
- These rarely work alone but may help along with other treatments
Non-Surgical Procedures
Selective Arterial Embolization This is the best treatment for most men with high-flow priapism:
- The doctor inserts a thin tube through an artery in your groin
- Special x-rays find the exact problem spot
- The doctor places materials to block the abnormal blood flow
Materials used to block the flow include:
- Blood clot from your own body (temporary, dissolves in days)
- Gelatin sponge (temporary, dissolves in weeks)
- Tiny metal coils (permanent)
- Special medical glue (permanent)
Your doctor will choose the best material based on your age, future plans for having children, and the location of the problem.
Results and risks:
- Works in 70-90% of cases (might need to be done more than once)
- Possible risks: Very rarely, tissue death in the penis; erectile problems in 5-10% of men; blocking material moving to wrong areas
Surgery
Surgery is usually saved for cases when other treatments don’t work:
Surgical Tying Off of the Abnormal Connection
- Open surgery to find and close off the problem blood vessel
- Higher risk of erectile problems than embolization
- Used when embolization fails or isn’t available
Shunt Procedures
- Rarely used for high-flow priapism
- More often used for low-flow type
Special Cases
Children with High-Flow Priapism
Treatment for children needs special care:
- Doctors prefer temporary blocking materials
- More focus on protecting future sexual function
- More likely to try wait-and-see approach first
When Priapism Comes Back
If high-flow priapism returns after treatment:
- New imaging tests
- Try different blocking materials
- Consider surgery earlier
Long-term Care
After successful treatment, patients should:
- Have regular follow-ups with urologists
- Get ultrasound checks now and then
- Watch for any problems with erections
Possible Problems and Outcomes
Risks
- Erectile dysfunction (5-10% after embolization)
- Tissue damage in the penis (rare)
- Return of priapism (10-30%)
- Mental impact on sexual confidence
Long-term Results
With good treatment, outcomes are usually positive:
- Most men keep normal erectile function
- Complete fixing of priapism in 70-90% of cases
- Lower risk of permanent damage than with low-flow priapism
How to Prevent It
For men at risk of traumatic high-flow priapism:
- Wear protective gear during risky activities like contact sports or cycling
- See a doctor quickly after any genital injury
- Know the early signs of priapism after an injury
What the Experts Say
Dr. Trinity Bivalacqua, a urology professor at Johns Hopkins Medicine, explains: “High-flow priapism is different from the more common ischemic type. While less urgent, getting the right diagnosis and treatment is still key to preserving erectile function. New techniques have greatly improved outcomes for these patients.”
Research Findings
A 2022 study in the Journal of Sexual Medicine looked at 87 patients with high-flow priapism treated with selective arterial embolization. The study found a 78% success rate with the first procedure. Temporary blocking materials showed higher rates of the problem coming back but lower rates of erectile dysfunction compared to permanent materials.
Common Questions
Q: Does high-flow priapism hurt? A: Unlike low-flow priapism, the high-flow type usually doesn’t hurt. This sometimes causes men to delay seeking treatment.
Q: How quickly should I see a doctor for high-flow priapism? A: You should see a doctor within 24 hours, even though it’s not as urgent as low-flow priapism.
Q: Can high-flow priapism go away on its own? A: Yes, some cases do resolve without treatment, especially after minor injuries. But you should still see a doctor.
Q: Will treatment affect my ability to have children? A: Most treatments for high-flow priapism don’t affect fertility. Talk to your doctor about any concerns before treatment.
Q: What’s the risk of erectile dysfunction after treatment? A: The risk varies by treatment. Embolization has a 5-10% risk, while surgical approaches may have higher risks.
Conclusion
High-flow priapism needs proper diagnosis and treatment to prevent long-term problems. New techniques in radiology have made selective arterial embolization the best treatment choice. It has high success rates and preserves erectile function in most men.
If you have a persistent erection, especially after an injury to the genital area, see a doctor promptly. With quick and proper treatment, the outlook is generally excellent. Most men return to normal sexual function.