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Priapism: Causes, Symptoms & Treatments

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD

Written by Vanessa Gibbs

Published 10/12/2020

Updated 01/18/2024

A long-lasting erection sounds kinda fun, right? But it’s not some kind of superpower. It can actually be very dangerous.

When an erection lasts four or more hours — known as priapism — it’s often painful and needs medical attention, stat.

Below, we’ll dive into what causes priapism, what symptoms to look out for and the treatments available.

Priapism is a prolonged erection that continues beyond or is unrelated to sexual stimulation. This usually applies to an erection lasting four hours or longer.

It happens when blood flow to or from your penis is disrupted. These long-lasting erections may be painful, and sometimes, they’re a serious medical emergency.

There are three types of priapism: 

  • Ischemic (sometimes called low-flow priapism)

  • Recurrent ischemic (aka stuttering priapism)

  • Nonischemic (or high-flow priapism)

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Read on for a breakdown of each type.

Ischemic Priapism

Ischemic priapism is the most common type of priapism.

With ischemic priapism, there’s little to no blood flow in the tissues of your penis. Blood flows in fine enough but becomes trapped, creating a painful erection that won’t go away.

You need to seek medical advice ASAP to avoid permanent penile tissue damage and subsequent erectile dysfunction (ED). The stats are scary — ischemic priapism lasting longer than 24 hours has up to a 90 percent chance of causing ED.

Recurrent Ischemic Priapism

Recurrent ischemic priapism is when you experience recurring but short-lived episodes of priapism. These episodes may last less than four hours and go away on their own. 

This type of priapism is common in patients with sickle cell disease and often occurs at night and before or after sexual stimulation. Erections caused by recurrent stuttering priapism may last longer and become more frequent — and they can still cause serious damage down there.

Nonischemic Priapism

Nonischemic priapism is less common, and it’s usually caused by trauma or injury. There’s less chance of high-flow priapism causing damage, as blood still flows to your penis — it’s just unregulated.

What to Do If You Think You’re Experiencing Priapism

It can be hard (ahem, sorry) to tell which type of priapism you’re experiencing. That’s why you should seek immediate medical advice if an erection lasts four hours or longer or is painful. 

Thankfully, priapism is rare. It affects 1.5 out of every 100,000 people. 

The condition can affect all age groups, even newborn babies. But it’s more likely to happen between ages five to 10 and 20 to 50.

Getting early treatment is vital for recovery. If left untreated, priapism can cause erectile tissue damage, fibrosis (tissue scarring) and permanent erectile dysfunction.

And the longer the erection, the greater the damage to penile tissue. So no hangin’ around.

If you’re curious, we’ve covered more on how long erections last.

The symptoms of priapism depend on which type of priapism you have.

Ischemic Priapism (Low-Flow Priapism) 

Ischemic priapism symptoms include: 

  • An erection lasting four hours or longer 

  • Painful erections

  • Rigid corpora cavernosa (the erectile tissues in your penis) 

  • Soft or only slightly engorged glans (head of the penis)

Let your healthcare provider know if you’re experiencing any of these signs.

Recurrent Ischemic Priapism (Stuttering Priapism) 

Recurrent ischemic priapism symptoms include: 

  • A prolonged erection lasting fewer than four hours

  • A prolonged erection that goes away on its own

These may not be medical emergencies, but you’re still wise to check in with your healthcare provider about them.

Nonischemic Priapism (High-Flow Priapism) 

Nonischemic priapism symptoms include: 

  • A prolonged erection that lasts four or more hours

  • An erect but not totally hard penis

  • No pain with erections 

This type of priapism kinda resembles hard flaccid syndrome.

If you experience any of these symptoms, get medical help. A healthcare professional can determine which type of priapism you have and whether you need immediate treatment.

Choose your chew

There are many potential causes of priapism — some are more scary-sounding than others.

Blood Disorders 

Erections are all about blood flow, so it makes sense that hematologic disorders (blood disorders) can cause them to go wrong. 

Priapism can be caused by blood disorders such as: 

  • Sickle cell anemia  

  • Leukemia 

  • Multiple myeloma 

  • Paroxysmal nocturnal hemoglobinuria 

  • Thalassemia 

  • Thrombocythemia 

  • Henoch-Schonlein purpura 

Sickle cell disease is the most common cause of priapism in kids. In adults, some reports state it could cause 40 to 80 percent of cases.

Medications 

Some medications can cause priapism as a side effect. 

These include:

  • Antidepressants like trazodone and citalopram 

  • Anticoagulants like heparin and warfarin 

  • Antihypertensives like dihydralazine and labetalol 

  • Alpha blockers like tamsulosin and doxazosin

  • Antipsychotics like chlorpromazine

  • Erectile dysfunction drugs like phosphodiesterase type 5 inhibitors (PDE5 inhibitors) and intracavernous injections (like papaverine)

Vasoactive drugs, like ED drugs, may cause at least 25 percent of all priapism cases. But before you ditch the little blue pills, it’s not as common as it sounds. 

Priapism caused by PDE5 inhibitors — like sildenafil (generic Viagra®) and tadalafil (generic Cialis®) — is pretty rare. Antipsychotics and antidepressants like trazodone are more than twice as likely to cause priapism than PDE5 inhibitors. 

You can learn more in our guide to the side effects of Viagra

Penile Injuries

Penile injuries and trauma are the main causes of nonischemic priapism. 

You can sustain an injury through sport, an accident, during sexual activity or from surgery. 

Alcohol and Recreational Drugs 

Recreational drugs can also cause priapism. Common culprits include cocaine and marijuana. Alcohol can also mess with your penis and cause a prolonged erection. 

It’s thought that alcohol and recreational drugs contribute to up to 21 percent of ischemic priapism cases.

Other Priapism Causes 

The list of priapism causes goes on. 

Other potential offenders include:

  • Metabolic disorders like diabetes, gout and amyloidosis

  • Tumors 

  • Neurological disorders 

  • Cancer, including prostate, renal and bladder cancer

  • Spider bites (as if we need another reason to be scared of spiders)

  • Spinal cord injuries 

And for some, there’s no known cause for priapism. Like a zit before date night, it just pops up out of nowhere.

A four-hour erection is hard to ignore. So you’ve probably got a good idea if you have priapism.

Still, it’s important to seek medical attention to determine which type of priapism you have and get immediate medical treatment if needed.

A healthcare provider will probably ask about your medical, sexual and surgical history.

You may be asked:

  • How long your erection has lasted so far

  • If you’ve taken any treatment or injections

  • What your erection was like before the priapism episode 

  • If you’ve had priapism treatment before 

  • Whether you’re experiencing pain

They might also run the following tests:

  • Physical exam. A doctor may examine your genitals, perineum and abdomen to check for trauma, bruising or signs of cancer.

  • Blood gas test. This test measures the levels of oxygen and carbon dioxide in your blood. The numbers are different for ischemic and nonischemic priapism.

  • Blood test. A blood test can help diagnose medical conditions that could be causing priapism.

  • Sickle cell test. A urologist might request this test for men with a higher risk of sickle cell disease.

  • Duplex ultrasound. This can measure blood flow in your penis. No blood flow in the cavernosal arteries can be a sign of ischemic priapism, while normal or increased blood flow can indicate nonischemic priapism.

  • Magnetic resonance imaging (MRI). An MRI can detect cancer or thrombosis (blood clots).

  • Drug toxicology and blood alcohol test. As you can probably guess, this test allows healthcare providers to check for alcohol and drug use to see if they’re contributing to priapism.

Priapism can be scary, but treatments are available. And remember, the quicker you seek treatment, the better your chances of having normal erections in the future. 

Treatments for ischemic priapism include: 

  • Medication. A doctor may prescribe drugs like pseudoephedrine to help with priapism. Medication isn’t always successful, though, so you might be given drugs along with other treatments.

  • Aspiration and normal saline irrigation. This involves drawing blood out from the penis and irrigating it with saline solution. This combo is successful in 66 percent of cases.

  • Intracavernosal drug therapy. A doctor may inject a drug like phenylephrine into your penis to reduce the erection. Hold tight — you might need several injections to make this happen.

  • Surgery. If medical therapy doesn’t work, you could need surgery. This usually involves a shunt, which creates a passageway between the corpora cavernosa and the corpus spongiosum (tissue surrounding the urethra) to help blood drain away. If you’ve had an erection for a very long time, a doctor may recommend a penile prosthesis (penile implant) to help with future sexual activity. 

You’ll probably need to go in for a follow-up to make sure the treatment has been successful.

Some of the same treatment options may be used for recurrent ischemic priapism, focusing on getting that erection down ASAP. A healthcare provider may also prescribe medication to help with the management of priapism to reduce the chances of future episodes. 

For nonischemic priapism, there’s less chance of penile damage, so treatment may include the humble ice pack. Since injections and surgery are generally ineffective, these invasive procedures are usually avoided.

Men with nonischemic priapism are likely to be kept in for observation by a healthcare professional because this type of prolonged erection goes away on its own in 60 percent of cases.

If treatment is required, selective arterial embolization (blocking a blood vessel) is one option. This is successful in up to 89 percent of patients with nonischemic priapism. We like those odds.

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Long-lasting erections sound like every man’s dream — but they can be painful and cause serious damage, including permanent erectile dysfunction.

Here’s what you need to know:

  • Seek immediate medical attention. If your erection is painful or lasts four hours or longer, call 911 or head to your nearest hospital emergency room. The quicker you get treatment, the better your chances are of recovery.

  • Priapism has many, many causes. Sickle cell disease, antidepressants, marijuana and penile injuries — just to name a few — can cause priapism. 

  • Treatments depend on the type of priapism. For ischemic and recurrent priapism, the goal is to get rid of the erection ASAP. Aspiration, penile injections or surgical shunts are all options here. Those with nonischemic priapism are chillin’ (literally) with an ice pack.

If all this priapism talk has you worried, check out our guide to keeping a healthy penis.

And if you’re battling ED, we offer erectile dysfunction medications online. 

Just a (major) heads up, though: Guys with a history of priapism should be careful with ED drugs like PDE5 inhibitors. Your provider might tell you not to take them at all.

Speak to a healthcare provider to make sure these drugs are right for you. If not, they can recommend other ED treatments and ways to boost your sexual performance.

6 Sources

  1. Levey, H. R., Segal, R. L., & Bivalacqua, T. J. (2014). Management of priapism: an update for clinicians. Therapeutic advances in urology, 6(6), 230–244. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236300/
  2. Silberman, M., Stormont, G., Leslie, S. W., Hu, E., W. (2023, May 30). Priapism - StatPearls. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK459178/
  3. Idris, I. M., Burnett, A. L., & DeBaun, M. R. (2022). Epidemiology and treatment of priapism in sickle cell disease. Hematology. American Society of Hematology. Education Program, 2022(1), 450–458. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9820196/
  4. Cherian, J., Rao, A. R., Thwaini, A., Kapasi, F., Shergill, I. S., & Samman, R. (2006). Medical and surgical management of priapism. Postgraduate medical journal, 82(964), 89–94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596691/
  5. Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022). (n.d.). https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-management-of-priapism-aua/smsna-guideline-(2022)
  6. Bassett, J., & Rajfer, J. (2010). Diagnostic and therapeutic options for the management of ischemic and nonischemic priapism. Reviews in urology, 12(1), 56–63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859143/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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