Priapism - Causes, Symptoms, Treatment

Priapism is a partial or full erection that lasts for four hours or more without sexual stimulation. Find out the causes, symptoms, and treatment for this condition.

Dr. Laurence Levine
Expert in male sexual health, leading Urologist in USA
by Dr. Laurence Levine Last updated 10/30/2023
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priapism symptoms

Priapism is the partial or full erection of the penis that lasts for hours and is not caused by sexual stimulation.

Ischemic and nonischemic are the main types of priapism, with ischemic priapism being the most serious.

If care isn't sought for the more serious type of priapism, it can result in permanent erectile dysfunction and tissue damage.

This condition mostly affects males over 30 or those who have sickle cell disease.

Quick FAQs

Priapism is a partial or full erection that lasts for four hours or more without sexual stimulation.

While nonischemic priapism isn't painful, ischemic priapism tends to be very painful. Pain typically worsens the longer the erection lasts.

Common causes of priapism include alcohol abuse and illicit drug abuse. Priapism is also a common side effect for individuals with sickle cell disease or other blood disorders.

Here's a closer look at priapism signs and symptoms, causes, treatments and more:

What is Priapism?

As mentioned above, priapism is a prolonged erection that lasts for longer than four hours.

There are two main types of priapism:

Ischemic priapism: Also known as low flow priapism, this occurs when blood cannot leave the penis, usually due to a problem with muscle contraction within the erectile tissue. This is a more dangerous type of priapism, as the penile tissues aren't receiving oxygen and could lead to permanent damage if treatment isn't sought promptly. Ischemic priapism is painful and considered a medical emergency. This is the more common of the two types of priapism.


Nonischemic priapism: Also known as high flow priapism, this type of priapism is typically painless. It's usually caused by either a ruptured artery or injury to the penis that results from unrestricted inflow of blood into the penis. High flow priapism typically goes away over time without treatment. Penile tissues also are likely to continue to receive blood flow and oxygen, so the risk of long-term complications is slim.

    Priapism Symptoms

    There are various symptoms of priapism, including:

    • Prolonged erections that last for longer than four hours and aren't the result of sexual stimulation or sexual thoughts.
    • Worsening pain the longer the erection persists.
    • A penis that's either fully erect or half erect. In some situations, the penis shaft may not be fully erect. In other cases, it's fully rigid.

    Is Priapism Painful?

    Ischemic priapism can be very painful - and pain tends to worsen the longer the erection persists.

    One type of ischemic priapism is stuttering priapism, which is when men have repeated episodes of ischemic priapism most commonly associated with sickle cell disease.

    These erections also have a tendency to be painful and uncomfortable.

    Nonischemic priapism doesn't tend to be painful and will often go away without medical intervention.

    What Can Cause Priapism?

    Priapism is most common in men 30 years and older, though it's a condition that can begin earlier - especially in people who have sickle cell disease.

    Though priapism is uncommon, there are some people who are more at risk for it than others.

    Here's a look at some of the medical conditions and drugs that are likely to cause it:

    Drugs

    Alcohol use and illicit drug abuse are linked to a greater likelihood of ischemic priapism.

    There are also some drugs that cause priapism, namely cocaine.

    Additionally, some mental health and blood thinner medications list priapism as a side effect. For instance, priapism from trazodone is also a common link.

    While it’s been suggested that ED medication (like Viagra, Cialis, Levitra and Stendra) may cause priapism, the Sexual Medicine Society of North America advises the risk is likely over exaggerated.

    In fact, priapism is extremely rare when these drugs are used alone, but if mixed with other drugs or penile injections for ED, the risk goes up.

    Medical Conditions

    Priapism tends to be a common side effect in men with sickle cell disease, as sickling of red blood cells can lead to an erection and blood is unable to leave the penis if it's blocked by sickling blood cells. 

    It's estimated that more than 40 percent of adult men with sickle cell anemia will one day develop priapism.

    Priapism can also occur in people with other blood disorders such as leukemia, thalassemia, and multiple myeloma.

    Other Priapism Causes

    Black widow spider bites and carbon monoxide poisoning are two other things that have been linked to priapism.

    Cancer may also be linked to priapism, especially the types of cancer that alter blood flow.

    As we noted above, a common cause of nonischemic priapism is an injury to the penis.

    This most commonly occurs after a straddle injury where one or both of the main penile arteries are compressed against the pelvic bones causing disruption of the vessel wall.

    How do they Treat Priapism?

    Nonischemic priapism often doesn't require medical treatment and will go away on its own.

    And being that this type of priapism is typically caused by injury to the penis, symptoms will also likely subside as the area heals.

    Ischemic priapism requires immediate medical attention in order to avoid tissue damage and permanent erectile dysfunction.

    Any man who experiences an erection that lasts longer than four hours should seek emergency medical attention.

    If medical attention is necessary, the end goal for a medical professional is to relieve the erection and preserve a man's erectile function in the future.

    Here's a look at some of the common treatments for priapism:

    Medication: If medical attention is sought within four to six hours of the erection, it can almost always be relieved with medication. Decongestant medications may be particularly helpful, as they work to reduce blood flow to the penis. Medication may also be prescribed to treat any underlying causes of priapism so it can be better managed in the future.

    Injection: A common treatment for low flow priapism, this consists of injecting alpha-agonist drugs into the penis, which cause arteries to contract which reduces blood flow into the penis.

    Ligation: Commonly used to treat ruptured arteries that may lead to nonischemic priapism, this involves tying off the artery that is causing irregular blood flow to the penis.

    Shunt: A more intensive type of treatment, one way to divert blood flow from the penis is to surgically insert a shunt into it.

    Aspiration: Another invasive type of treatment for ischemic priapism, this procedure involves numbing the penis and inserting a needle into it to drain it of blood. This also helps reduce pressure and swelling.

      It's important to note that self-treatment should never be done to relieve priapism, whether it's a low flow or high flow priapism.

      As long as medical treatment is sought promptly, the long-term outlook for most people with priapism is very favorable.

      Can I get an erection after priapism?

      If treatments are successful, yes.

      The main goal of any medical professional treating ischemic priapism is not only to relieve the erection, but to ensure that the patient can achieve an erection in the future. 

      It's why it's so important for men to seek treatment within four to six hours of priapism symptoms.

      Nonischemic priapism will often go away on its own without medical intervention.

      Since there's still some level of blood circulation, the penile tissues are still receiving oxygen and men aren't in jeopardy of permanent erectile dysfunction.

      Pro Tip: Vitaflux is clinically proven to increase erectile functioning and can help maintain healthy libido.

      Can priapism damage be reversed?

      Once penile tissues are damaged, the damage cannot be reversed. It underscores the importance of seeking medical attention if a man has ischemic priapism for several hours.

      How do I Know If I Have Priapism?

      Here are a few ways for a man to know whether or not he has priapism:

      • Determine how long the current erection is lasting versus how long a normal erection typically lasts.
      • Determine whether or not the erection was instigated by sexual stimulation or sexual thoughts.
      • Determine if any drugs or medication were taken that may cause priapism.
      • Determine if any injuries to the penis or pelvic area occurred.

      Upon seeking medical treatment for priapism, doctors will typically conduct a brief physical exam and assess the patient's medical history. 

      A blood gas measurement of blood from the penis is also often taken. Following analysis of this sample, doctors can get a better understanding of the type of priapism the man is experiencing.

      They can know how long he's lived with the condition and if any damage to penile tissues has occurred.

      Takeaways

      Priapism is an uncommon medical emergency that consists of a prolonged erection that lasts for several hours and isn't instigated by sexual stimulation.

      It's often the result of sickle cell disease, a side effect from prescription medication, or an aftereffect of alcohol consumption or illicit or recreational drug use.

      The good news is that priapism treatment is effective if medical attention is sought quickly enough.

      If it isn't, men risk long-term damage to penile tissues and are at risk for erectile dysfunction problems in the future.

      Related Article

      Dr. Laurence Levine

      Dr. Laurence Levine

      ​Dr Laurence Levine is a Professor of Urology and practices at Rush University Medical Center in Chicago. He is focused specifically on Male Sexual Health and is past President of the Sexual Medicine Society of North America (SMSNA). Dr. Levine graduated from the University of Colorado School of Medicine where he received his MD and completed his training in Urology at the Harvard Program in Boston.​

      Sources:

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      The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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