Clinical Observations of Psychiatric and Sexual Outcomes in Patients with Trazodone-Associated Ischemic Priapism

Background and objectives: Ischemic priapism is a rare but serious adverse effect of trazodone, associated with a high risk of long-term sexual dysfunction. While its urological consequences are well described, psychiatric and psychosocial outcomes remain insufficiently explored. This study assessed psychiatric and sexual sequelae following trazodone-associated ischemic priapism and compared clinical characteristics with trazodone-treated patients without priapism. Materials and Methods: In this single-center observational study, 268 adult patients receiving trazodone were analyzed, including 17 patients with ischemic priapism and 251 controls. Data on episode duration and urological management were collected. Psychiatric status and sexual functioning were evaluated through structured clinician-led interviews informed by validated psychometric frameworks during hospitalization and at 1-, 3-, and 6-month follow-up. Nonparametric analyses and Spearman rank correlations were applied. Results: Patients with priapism were significantly older than controls (44.1 ± 5.1 vs. 39.0 ± 4.4 years; p < 0.0001), while trazodone dose distribution did not differ between groups. The mean episode duration was 26.5 ± 16 h (median 24 h). Older age and longer ischemic duration were independently associated with increased treatment intensity, whereas trazodone dose was not. Persistent depressive and anxiety symptoms and impaired sexual functioning were observed in a subset of patients during follow-up. Conclusions: Trazodone-associated ischemic priapism is not only an acute urological emergency but may also lead to sustained psychiatric and sexual sequelae. Interdisciplinary follow-up should be considered to address long-term psychosocial outcomes.