What substance abuse is associated with priapism?

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Cocaine is the Substance Most Strongly Associated with Priapism

Cocaine (Option C) is the correct answer, as it is explicitly identified in American Urological Association guidelines as an illegal substance associated with priapism and has documented cases of causing refractory, difficult-to-treat priapism. 1, 2

Evidence from Clinical Guidelines

The American Urological Association guidelines on priapism management specifically list cocaine among the drugs that can precipitate priapism episodes, categorizing it alongside other illegal substances that clinicians should inquire about during patient history. 1

Why Cocaine Stands Out Among the Options:

Cocaine has the strongest evidence:

  • Multiple case series document cocaine-associated priapism, including both powder and crack cocaine forms 2
  • A 2024 systematic review found that cocaine-related priapism presents with delayed diagnosis (mean 42.6 hours), requires more procedures to manage (mean 2.4 procedures), and has worse erectile prognosis 3
  • Cocaine can cause particularly refractory priapism that fails standard treatments including intracavernosal aspiration, irrigation, and even cavernous-spongiosal shunting 2

Marijuana is mentioned but with minimal supporting evidence:

  • While AUA guidelines list marijuana among substances associated with priapism 1, only a single case report from 2021 documents cannabis-related priapism 4
  • The evidence base is substantially weaker compared to cocaine

Alcohol and heroin lack guideline-level support:

  • Alcohol is mentioned in one case report involving combined trazodone overdose and cocaine use 5, but is not prominently featured in AUA guidelines as a priapism-causing substance
  • Heroin is not specifically identified in the guideline evidence provided

Clinical Implications

When evaluating priapism patients, urine toxicology screening should be considered to identify cocaine use, as this information is critical for preventing recurrence. 2

Cocaine-associated priapism often presents as a complex clinical challenge requiring multiple interventions and carries risk of severe complications including penile gangrene requiring partial penectomy. 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Cocaine associated priapism.

The Journal of urology, 1999

5
Research

Priapism following trazodone overdose with cocaine use.

Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 1998

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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