There are two main types of priapism:
1. Ischemic (Low-Flow) Priapism:
o Description: This is the most common and serious form of priapism. It occurs when blood becomes trapped in the penis, unable to flow out. The blood supply to the area is restricted, causing the erection to last longer than normal.
o Cause: Ischemic priapism is usually caused by impaired blood flow, often related to certain medical conditions (e.g., sickle cell disease, leukemia, or other blood disorders), medications, or injury.
o Symptoms: Painful, rigid erection lasting more than 4 hours, usually with little or no sexual arousal.
o Treatment: This type of priapism requires immediate medical intervention. Treatments may include aspiration (draining blood from the penis), injection of medications to constrict the blood vessels, or surgical options to redirect blood flow.
2. Non-Ischemic (High-Flow) Priapism:
o Description: Less common and typically less painful than ischemic priapism. It occurs when there is an excessive blood flow into the penis, usually due to an injury to the arteries in the pelvic region.
o Cause: Non-ischemic priapism is often caused by trauma or injury to the pelvic area, which results in abnormal blood flow into the penis. This type is usually less urgent and often resolves on its own.
o Symptoms: A persistent erection without pain, often less rigid than ischemic priapism.
o Treatment: While non-ischemic priapism is often less urgent, treatment may still be needed to prevent further complications. Options include embolization (a procedure to block the blood vessels supplying the penis) or surgery.

There are several potential causes of priapism, including:
1. Blood Disorders:
o Sickle cell disease: One of the most common causes of ischemic priapism, as the sickle-shaped red blood cells can block blood flow to the penis.
o Leukemia: The abnormal blood cells can affect circulation and lead to priapism.
o Thalassemia: Another blood disorder that may increase the risk of priapism.
2. Medications:
o Erectile dysfunction (ED) medications: Medications like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can, in rare cases, lead to priapism, especially if used inappropriately or in combination with other drugs.
o Alprostadil: This is an injection used to treat ED, but if the dose is too high, it can lead to priapism.
o Antidepressants: Some medications, particularly those affecting serotonin levels (e.g., SSRIs or SNRIs), have been linked to priapism.
o Antipsychotic drugs: Medications such as trazodone, commonly used for depression and insomnia, have been associated with priapism.
3. Trauma or Injury:
o Pelvic or genital trauma: Direct injury to the penis or pelvic area can sometimes lead to high-flow priapism, though this is less common.
4. Neurological Causes:
o Spinal cord injury: Damage to the spinal cord can disrupt the normal regulation of blood flow in the penis, sometimes resulting in priapism.
5. Other Factors:
o Alcohol or drug abuse: Recreational drugs like cocaine or marijuana can contribute to priapism in some cases.
o Hyperthermia: Extreme heat, such as from fever or prolonged exposure to hot environments, can sometimes trigger priapism.
o Idiopathic: In some cases, the cause of priapism cannot be determined.

• A prolonged erection lasting more than 4 hours (typically painful).
• The penis may feel rigid or hard, particularly in ischemic priapism.
• Pain and tenderness in the penile shaft and glans, especially in ischemic priapism.
• For non-ischemic priapism, the erection may not be as rigid or painful but can still persist for several hours.

If left untreated, priapism can lead to several serious complications, including:
• Permanent erectile dysfunction (ED): Prolonged ischemic priapism can lead to tissue damage in the penis, resulting in long-term inability to achieve or maintain an erection.
• Penile tissue damage: Ischemic priapism can cause necrosis (death of tissue) if blood flow is not restored.
• Psychological effects: The distress and pain associated with priapism can contribute to emotional and psychological issues, such as anxiety or depression.