Despite what many popular commercials for Viagra have, you might think long-lasting erections are not as common as they seem, even in men who regularly take erectile dysfunction medications. The Journal of Sexual Medicine[1] mentions that over the space of 4 years, only approximately 8,700 men attended an emergency room for priapism.

Even though these lengthy erections are infrequent, they can have serious outcomes if left untreated; both for male genitalia and future sex life.

These painful types of erections are generally not considered normal, and individuals who begin to experience this condition should pay attention to the duration of the erection.

There are a wide variety of causes such as circulation and blood flow, medication’s negative effects, trauma, and urethritis.

In this article, we’ll look into priapism treatments, causes, and other information of interest to better understand this condition and know what to look out for in the future.

The Origins Of Priapism And What It Is

The origins of the word[2] priapism are derived from Priapus, the ancient Greek god of fertility and lust- depicted in Greek Mythology as being gifted with a generously sized phallus.

Nowadays, priapism is a word used to define a long-lasting erection of the penis, which may not be linked to sexual desire or stimulation. Most research[3] show varying opinions regarding the indicated time frame for an erection to be considered a case of priapism. Nevertheless, four hours seems to be the established average.

Priapism symptoms develop when blood flow to the penis becomes trapped and is incapable of draining. If the condition is not treated early enough, it can become a medical emergency, leaving the patient with scarring, trauma, and permanent erectile dysfunction.

Priapism has been routinely found to affect sexual function, quality of life, and other forms of physical wellness.

Different Types Of Priapism

Types Of Priapism
Priapism is a rare condition though it can emerge in all age groups and is especially common in sickle cell disease patients. It’s classified as either ischemic or nonischemic. The main difference between the two is that ischemic priapism is considered a urologic emergency, whereas nonischemic isn’t.

There are a few different kinds of priapism:

  • Ischemic – Also referred to as low-flow priapism. This type ensues when blood is unable to leave the penis post-erection. Ischemic priapism is the most common type, accounting for nearly all cases.
  • Recurrent – This form of ischemic priapism is referred to as stuttering priapism or recurrently. It’s pretty uncommon and can usually be seen in individuals with sickle cell anemia.
  • Nonischemic – Also commonly referred to as high-flow priapism, is a type of priapism induced by inadequately regulated blood flow to the penis.

What Causes Priapism?

What are the common priapism causes?

An erection occurs when the penis fills with blood flow. When men become aroused, the brain begins to send signals to different parts of the body, creating a series of events.

These produce an enhanced blood flow to the penis while simultaneously signaling the arteries and surrounding tissues to relax.

After this, the valves on the blood vessels that carry the blood to the penis begin to slowly close, trapping blood in the penis region and making it rigid and swollen.

You can encounter a case of priapism when there is too much blood trapped within the penis. This can occur due to many different reasons.

The main priapism causes include:

  • Medications – Certain medications can impact the nerves in the body, including but not limited to the penis. These nerves dilate the arteries that equip the penis, allowing it to engorge and become erect.
  • Drugs – The usage of certain recreational drugs has been linked to cases of priapism, some of which include cocaine, marijuana, and ecstasy.
  • Injury – Long-lasting damage to the penile artery can surface after an injury to the perineum or penis. This damage can prevent blood from circulating correctly. Injury is one of the most common causes of non-ischemic priapism.

  • Sickle cell anemia – Unconventionally shaped red blood cells can induce blockages to the penile main artery. According to recent research out of the Cleveland Clinic[4], 42% of adult males with sickle-cell anemia will develop priapism.
  • Cancers – In certain cases, priapism can arise from cancerous growths, especially if these restrict the penile artery or nerve, producing blockages.
  • Blood disorders – Some blood disorders can lead to priapism. In particular, thalassemia, leukemia, and myeloma have been linked to cases of priapism.

Priapism causes can vary greatly, and as mentioned above, all ages can be affected. Nevertheless, most cases are present in males aged 20-50 years.

What Are The Most Common Symptoms Of Priapism?

Priapism symptoms can vary and are pretty unique to each individual. However, some commonalities are dependent on whether the patient is experiencing high-flow or low-flow priapism.

With low-flow priapism, individuals may experience:

  • Erections that last longer than 4 hours
  • A stiff penile shaft
  • Pain in the penis region

Ischemic or low-flow priapism can quickly become a recurrent disorder. When symptoms begin to appear, spontaneous erections might only last for a couple of minutes. As time goes on, erections appear more frequently and begin to last for longer.

When it comes to high-flow priapism, many of the symptoms are somewhat similar to those of low-flow priapism. The primary difference is that discomfort and pain don’t arise in high-flow cases.

It is important to note that an erection that lasts longer than four hours without some form of sexual stimulation is deemed a medical and urological emergency.

How To Diagnose Priapism

Diagnose Priapism
Diagnosing priapism is unique to each individual but would begin with a detailed medical history review and physical examination. The healthcare practitioner will assess the groin and genital area to determine whether there are any signs of trauma.

1. Diagnosing Ischemic Priapism

This type of diagnosis involves a medical record and physical examination to define any priapism causes and the time of the erection. During the examination, the doctor will evaluate the level of pain, hardness of the penis, and the lack of blood flow to certain areas of the penis. This process will also incorporate inspecting the abdomen and rectum for signs of abnormalities or growths that can be indicative of cancer. Moreover, a blood sample will be collected and analyzed to exclude the presence of thalassemia, leukemia, and sickle cell disease.

2. Diagnosing Nonischemic Priapism

The diagnosis of nonischemic priapism starts the same as with ischemic cases – an examination of medical history and physical checks. What differs is that the doctor will perform a Doppler exam, which helps to measure blood flow to the penis. Another option could include the insertion of a small needle to draw blood for lab analysis. This can help to determine what type of priapism the patient is encountering.

Occasionally, blood tests are prescribed to gain further information. The process for this is as follows:

  • a sample of blood is taken from the penis area
  • if the blood is of the color black, it’s indicative of ischemic priapism
  • if the blood is a bright red color, then it’s presumably nonischemic priapism

A healthcare professional may also request:

  • further blood tests
  • urine toxicology
  • ultrasound

Aside from determining the presence of priapism, different examinations and tests help rule out the root cause of the condition.

Best Treatment Routes For Priapism

Treatment Routes For Priapism
The treatment for priapism, similarly to that of the diagnosis, depends on what type the patient is experiencing. In cases of low-flow priapism, the doctor might use a needle to remove surplus blood from the penis.

This method is known to relieve pain and reduce erections. In the case of high-flow priapism, instant priapism treatment may not be necessary as this type is known to often go away on its own. Cold therapy in the form of ice packs is the first route that is recommended.

While prolonged erections aren’t all that frequent of an occurrence, they are considered a medical emergency. Priapism can lead to tissue damage, which can potentially result in permanent erectile dysfunction due to disfigurement.

This is why it’s so important to seek medical attention early enough. In severe cases, medical practitioners may prescribe surgery to halt blood flow to the penis or fix damaged arteries.

The objectives of any priapism treatment plan are to relieve erection and prevent tissue damage. Treatment options include:

  • Ice packs – Treating nonischemic priapism is done via a combination of ice, observation, and exercise. With this type of priapism, it is not uncommon for the penis to become flaccid without the use of treatment. Therefore, patients can monitor for improvement. Ice packs can help slow blood flow, and walking can improve circulation.
  • Clearing the blood – If this priapism treatment is prescribed, the doctor will numb the penis and use a syringe to drain surplus blood from the region to ease swelling and pain.
  • Prescription medications – For low-flow priapism cases, a doctor may inject drugs known as alpha-agonists into the penis. These prescription medications narrow the blood vessels that restrict blood flow to the area and ease swelling. These medications can be prescribed in pill form as well.
  • Blocking the arteries – Another priapism treatment option is to restrict the blood vessel that’s driving the problem, a process referred to as arterial embolization. Embolization consists of blocking the blood flow by utilizing a small plug. This procedure is done in a surgical environment with local anesthesia.
  • Tying the artery – In cases where the root cause is a ruptured artery, the doctor will perform surgery to tie it off, a process known as surgical ligation.
  • Surgical shunt – This method involves the surgeon creating a passageway to allow the surplus blood a chance to drain out of the penis. This procedure is used mostly in cases of low-flow priapism, yet the negative side effect that can result from this surgery is a higher risk of erectile dysfunction in the future.

If you or a loved one believes they are experiencing priapism, don’t try to treat it alone. Get emergency attention as soon as possible.

When instances of priapism are recurrent, it is worthwhile for the patient to talk to their medical provider regarding medications such as phenylephrine, which can help to reduce routine blood flow to the penis as a preventative treatment option.

Moreover, there are various hormone prescription medications for erectile dysfunction that have proven to be successful in preventing recurrent priapism.

How To Prevent Priapism?

If you or a loved one is experiencing recurrent incidences of priapism, it’s vital to treat the root cause and underlying condition to avoid unnecessary future flare-ups.

While it may not be possible to prevent priapism completely, there are certain steps individuals can take to reduce the risk of further episodes.

It’s important to take medications, and seek medical attention when you notice a link between prescriptions and priapism events. Some medications are known to produce circulatory issues that can trigger priapism.

Several hormone medications can control priapism. Talk to your healthcare provider to learn more.


Hopefully, this article has given you some peace of mind on what to expect or be on the lookout for when it comes to priapism. Priapism treatment has shown to be successful in cases that receive early medical attention, so it’s important to be proactive and seek medical care when needed.

The longer priapism is left without medical care, the higher the chances it will cause damage to the penis. Tissue damage, scarring, and injury can form around hours 5-6 of a lengthy erection. Any damage incurred to the penile tissue can’t be reversed and is considered permanent.

For the best outcome, males experiencing erections lasting longer than 4 hours without sexual stimulation should seek help. This is especially true if the root cause is not injury, if the problem is constant, and if the erection doesn’t respond positively to treatments such as ice therapy.

If priapism is left untreated, individuals run the risk of permanent erectile dysfunction.