Understand the symptoms, possible causes and treatment of prolonged erection of the penis, including when to seek emergency care.
Priapism is a prolonged erection of the penis. The full or partial erection continues hours beyond or isn't caused by sexual stimulation. The main types of priapism are ischemic and nonischemic. Ischemic priapism is a medical emergency.
Although priapism is an uncommon condition overall, it occurs commonly in certain groups, such as people who have sickle cell disease. Prompt treatment for priapism is usually needed to prevent tissue damage that could result in the inability to get or maintain an erection (erectile dysfunction).
Priapism most commonly affects males in their 30s and older, but can begin in childhood for males with sickle cell disease.
Priapism symptoms vary depending on the type of priapism. The two main types of priapism are ischemic priapism and nonischemic priapism.
Ischemic priapism, also called low-flow priapism, is the result of blood not being able to leave the penis. Blood is trapped in the penis because it cannot flow out of the veins of the penis or there is a problem with the contraction of smooth muscles within the erectile tissue of the penis. Ischemic priapism is the more common type of priapism and requires immediate medical care to prevent complications caused by not getting enough oxygen to the penile tissue.
Signs and symptoms include:
Stuttering priapism — also called recurrent or intermittent priapism — is a form of ischemic priapism. An uncommon condition, stuttering priapism describes repetitive episodes of prolonged erections and often includes episodes of ischemic priapism. It occurs more often in males who have an inherited disorder characterized by abnormally shaped red blood cells (sickle cell disease). Sickle cells can block the blood vessels in the penis. In some cases, the condition starts off with unwanted and painful erections of short duration and might progress over time to more-frequent and more-prolonged erections. Stuttering priapism may begin in childhood.
Nonischemic priapism, also known as high-flow priapism, occurs when blood flow through the arteries of the penis isn't working properly. However, the penile tissues continue to receive some blood flow and oxygen. Nonischemic priapism often occurs due to trauma.
Signs and symptoms include:
If you have an erection lasting more than four hours, you need emergency care. The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism.
If you experience recurrent, persistent, painful erections that resolve on their own, see your doctor. You might need treatment to prevent further episodes.
An erection normally occurs in response to physical or psychological stimulation. This stimulation causes certain smooth muscles to relax, increasing blood flow to spongy tissues in the penis. As a result, the blood-filled penis becomes erect. After stimulation ends, the blood flows out and the penis returns to its nonrigid (flaccid) state.
Priapism occurs when some part of this system — the blood, vessels, smooth muscles or nerves — changes normal blood flow, and an erection persists. The underlying cause of priapism often can't be determined, but several conditions may play a role.
Blood-related diseases might contribute to priapism — usually ischemic priapism, when blood isn't able to flow out of the penis. These disorders include:
The most common associated diagnosis in children is sickle cell disease.
Priapism, usually ischemic priapism, is a possible side effect of a number of drugs, including:
Alcohol, marijuana, cocaine and other drugs can cause priapism, particularly ischemic priapism.
A common cause of nonischemic priapism is trauma or injury to your penis, pelvis, or the region between the base of the penis and the anus (perineum).
Other causes of priapism include:
Ischemic priapism can cause serious complications. The blood trapped in the penis is deprived of oxygen. When an erection lasts for too long — usually more than four hours — this lack of oxygen can begin to damage or destroy tissues in the penis. Untreated priapism can cause erectile dysfunction.
If you have stuttering priapism, to prevent future episodes your doctor might recommend:
If you have an erection lasting more than four hours, you need emergency care.
The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to happen as soon as possible.
To determine what type of priapism you have, your doctor will ask questions and examine your genitals, abdomen, groin and perineum. Your doctor might be able to determine what type of priapism you have based on whether you're experiencing pain and the rigidity of the penis. This exam might also reveal the presence of a tumor or signs of trauma.
Diagnostic tests might be needed to determine what type of priapism you have. Additional tests might identify the cause of priapism. In an emergency room setting, your treatment will likely begin before all test results are received.
Diagnostic tests can include:
Ischemic priapism — the result of blood not being able to exit the penis — is an emergency situation that requires immediate treatment. After pain relief, this treatment usually begins with a combination of draining blood from the penis and using medications.
If you have sickle cell disease, you might receive additional treatments that are used to treat disease-related episodes.
Nonischemic priapism often goes away with no treatment. Because there isn't a risk of damage to the penis, your doctor might suggest a watch-and-wait approach. Putting ice packs and pressure on the perineum — the region between the base of the penis and the anus — might help end the erection.
Surgery might be necessary in some cases to insert material, such as an absorbable gel, that temporarily blocks blood flow to your penis. Your body eventually absorbs the material. You might also need surgery to repair arteries or tissue damage resulting from an injury.
If you have an erection lasting more than four hours, you need emergency care. If you experience recurrent, persistent, partial erections that resolve on their own, see your doctor. Treatment might be needed to prevent further episodes. The doctor might suggest that you make a follow-up appointment with a specialist in the urinary tract and male reproductive system, such as a urologist or andrologist.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
Questions for the doctor might include:
Don't hesitate to ask other questions that occur to you.
Your doctor is likely to ask you a number of questions. Being ready to answer them might allow time later to cover other points you want to address. Your doctor might ask:
Your doctor might order lab tests to determine if a health condition is causing priapism.
Don't stop taking any prescription medications without consulting your doctor.