What is included in the physical exam to evaluate priapism?

Updated: Dec 26, 2019
  • Author: Osama Al-Omar, MD, MBA, FACS, FEBU; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Obvious erection is the key physical finding in any case of priapism. Penile priapism generally involves only the paired corpora cavernosa, with the glans and corpora spongiosum remaining flaccid or softly distended without rigidity. Careful physical examination may reveal specific causal factors. Remember that no single pathology excludes all others; therefore, a thorough history and physical examination should address the patient as a whole.

Points to address in the physical examination are as follows:

  • Penile color, rigidity, and sensation (soft glans vs firm glans)

  • Penile discharge, lesions, or both

  • Evidence of local trauma or injection sites

  • Presence of prosthetic devices (hardware malfunction may cause pseudopriapism)

  • Regional lymphadenopathy (ie, metastatic disease)

  • Rectal tone: High spinal cord lesions or stenosis may cause priapism


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