Priapism is a prolonged, often painful erection that lasts longer than four hours and is not related to sexual stimulation. It is a medical emergency, especially the ischemic form, because delayed treatment can cause permanent erectile dysfunction. This guide provides a comprehensive, educational, and medically accurate explanation of priapism, including causes, symptoms, risks, diagnosis, treatment, and prevention.

Table of Contents

1. Key Takeaways
2. What Is Priapism?
3. Types of Priapism
4. Priapism Symptoms
5. Priapism Causes
6. Risk Factors for Priapism
7. How Priapism Affects Men’s Health
8. Priapism Complications
9. Priapism Diagnosis
10. Priapism Treatment
11. Safety, Communication, and Prevention
12. When to Seek Professional Help
13. Frequently Asked Questions About Priapism
14. References and Further Reading
15. Disclaimer

Key Takeaways

• Priapism is a prolonged erection lasting over four hours without sexual stimulation.
• Ischemic priapism is the most dangerous form and requires emergency treatment.
• Non ischemic priapism is usually less painful and often caused by trauma.
• Delayed treatment increases the risk of permanent erectile dysfunction.
• Common causes include blood disorders, medications, and penile injection therapies.
• Priapism symptoms include persistent rigidity, pain, and penile tenderness.
• Diagnosis typically involves physical exams, blood tests, and penile ultrasound.
• Treatment can include aspiration, medication, or surgical shunting.
• Men with conditions like sickle cell disease are at higher risk.
• Early intervention improves outcomes and helps preserve sexual function.

What Is Priapism?

Priapism refers to a persistent erection that continues beyond four hours without sexual interest or arousal. The erection typically does not subside after ejaculation or normal arousal patterns. It is considered a urologic emergency, especially when blood becomes trapped inside the penis and cannot drain properly.

This condition affects men of all ages but is particularly common in individuals with certain hematologic disorders, such as sickle cell disease. Because untreated priapism can lead to tissue damage, urgent evaluation is essential.

Types of Priapism

Priapism is categorized into three main types.

Ischemic Priapism

• The most common and most dangerous form.
• Occurs when blood becomes trapped in the penis and cannot flow out.
• The penis is rigid and painful.
• Requires immediate emergency treatment.

Non Ischemic Priapism

• Caused by uncontrolled blood flow into the penis, often after trauma.
• The penis is partially erect and usually not painful.
• Often resolves on its own but still requires medical evaluation.

Recurrent (Stuttering) Priapism

• Repeated episodes of ischemic priapism.
• Common in men with sickle cell disease.
• Episodes can last minutes to hours and may progress to full ischemic priapism.

Priapism Symptoms

• Erection lasting longer than four hours
• Penile pain or throbbing (common in ischemic priapism)
• Rigid shaft but soft glans (ischemic pattern)
• Partially firm penis with little or no pain (non ischemic pattern)
• Dark or bluish discoloration (ischemic)

Priapism Causes

Common causes include:

• Blood disorders such as sickle cell disease or leukemia
• Medications for erectile dysfunction (injections or tablets)
• Antidepressants, antipsychotics, and some blood thinners
• Penile or pelvic trauma
• Recreational drugs (e.g., cocaine)
• Metabolic disorders affecting blood flow

Risk Factors for Priapism

• Hematologic diseases (sickle cell disease, thalassemia)
• Prior episodes of priapism
• Use of erectile dysfunction medications
• Spinal cord injury
• Alcohol or drug use
• Certain mental health medications

How Priapism Affects Men’s Health

Priapism can significantly impact physical and sexual health. Prolonged lack of oxygen damages penile tissue, increasing the risk of erectile dysfunction. Anxiety and fear about recurrence are common and may affect sexual confidence and relationships. Men may avoid intimacy due to concern about triggering another episode, leading to emotional distress.

Priapism Complications

• Permanent erectile dysfunction
• Penile scarring (fibrosis)
• Recurrent priapism episodes
• Emotional distress, anxiety, or avoidance of sexual activity
• Tissue ischemia and long-term damage

Priapism Diagnosis

Diagnosis typically includes:

• Physical examination
• Blood gas testing from penile blood to determine ischemic vs. non ischemic type
• Doppler ultrasound to assess blood flow
• CBC test for blood disorders
• Medication review

Priapism Treatment

Treatment depends on the type.

Treatment for Ischemic Priapism

• Aspiration of trapped blood from the penis
• Injection of vasoconstrictive medications
• IV hydration and oxygen therapy (often used in sickle cell patients)
• Surgical shunting if other treatments fail

Treatment for Non Ischemic Priapism

• Observation and icing
• Ultrasound-guided embolization
• Treating underlying trauma

Long-Term Management

• Medication adjustments
• Preventive therapies for recurrent priapism
• Collaboration with hematology for sickle cell-related cases

Safety, Communication, and Prevention

• Discuss any erectile medications with your doctor before use.
• Avoid recreational drugs that increase risk.
• Monitor for early signs of prolonged erections.
• Men with sickle cell disease should have an emergency plan.
• Partners should communicate openly about symptoms without shame.

When to Seek Professional Help

Urgent medical care is required when:

• An erection lasts longer than four hours.
• Severe penile pain occurs.
• Color changes or numbness develop.
• Symptoms occur after trauma. Men with recurrent episodes should consult a urologist for prevention strategies.

Frequently Asked Questions About Priapism

What does priapism mean in men’s sexual health?

Priapism refers to a prolonged, often painful erection unrelated to arousal. It is a medical emergency when blood cannot drain from the penis.

Is priapism dangerous?

Yes. Ischemic priapism can cause permanent erectile dysfunction if not treated quickly.

What is the difference between ischemic and non ischemic priapism?

Ischemic involves blocked blood flow and severe pain; non ischemic involves uncontrolled inflow, is typically painless, and is often caused by trauma.

Can priapism cause erectile dysfunction?

Yes. Long-lasting ischemia damages penile tissue and reduces future erectile function.

What causes priapism in men?

Common causes include sickle cell disease, certain medications, penile injections, and trauma.

How is priapism diagnosed?

Doctors use a physical exam, blood gas testing, and ultrasound imaging.

What is the best treatment for priapism?

Ischemic priapism requires aspiration, medication injections, and sometimes surgery.

Can medications cause priapism?

Yes. Certain antidepressants, antipsychotics, and erectile dysfunction treatments can trigger it.

Is priapism always painful?

Ischemic priapism is painful; non ischemic typically is not.

Can priapism go away on its own?

Non ischemic priapism sometimes resolves without intervention. Ischemic priapism does not.

What should I do if I have priapism?

Seek emergency medical treatment if an erection lasts longer than four hours.

Can priapism occur during sleep?

Yes, and this is common in recurrent or sickle cell-related cases.

How can men prevent priapism?

Avoid risky medications, manage chronic conditions, and use erectile treatments as prescribed.

Does sickle cell disease increase priapism risk?

Yes. Sickled red blood cells obstruct penile blood vessels.

When should I see a urologist?

Any episode of priapism or recurring symptoms requires professional evaluation.

References and Further Reading

• Major urology association guidelines on priapism
• National health service information on prolonged erections
• Educational resources from sexual health nonprofits
• Peer-reviewed research on sickle cell-associated priapism
• Academic articles on erectile dysfunction and penile blood flow

Disclaimer

This article is for informational and educational purposes only and is not a substitute for professional medical advice. Individuals experiencing symptoms should consult a qualified healthcare provider.