Case history
Case history #1
A 41-year-old man presents to the emergency department with a painful penile erection lasting >24 hours. The patient was recently started on a new insomnia medication by his family physician. The patient has never had priapism before this presenting episode. On physical exam the penis is fully rigid.
Case history #2
A 7-year-old boy presents with a painless erection 36 hours in duration. The patient sustained perineal trauma (straddle injury) 2 days before the priapism developed. Otherwise his medical history is unremarkable. Physical exam shows a complete erection of both corpora cavernosa with a flaccid corpus spongiosum. A small perineal hematoma is also noted.
Other presentations
Some patients may present with recurrent (sometimes called stuttering) priapism. Typically a patient may complain of priapism lasting <4 hours, which may occur weekly or every 2 weeks. Episodes are painful and commonly arise during nocturnal sleep, preceding or following sexual stimulation, and after morning erections. Episodes may escalate in frequency and/or duration. Erections typically detumesce on their own, although in some cases penile edema and partial erection may remain.
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