Overview

Priapism is a prolonged erection of the penis. The persistent erection continues hours beyond or isn't caused by sexual stimulation. Priapism is usually painful.

Although priapism is an uncommon condition overall, it occurs commonly in certain groups, such as people who have sickle cell anemia. 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 is most common in men in their 30s.

Symptoms

Priapism symptoms vary depending on the type of priapism. The two main types of priapism are ischemic and nonischemic priapism.

Ischemic priapism

Ischemic priapism, also called low-flow priapism, is the result of blood not being able to leave the penis. It's the more common type of priapism. Signs and symptoms include:

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation
  • Rigid penile shaft, but the tip of penis (glans) is soft
  • Progressive penile pain

Recurrent or stuttering priapism, a form of ischemic priapism, is an uncommon condition. It's more common in males who have an inherited disorder characterized by abnormally shaped red blood cells (sickle cell anemia). Sickle cells can block the blood vessels in the penis. Recurrent priapism describes repetitive episodes of prolonged erections and often includes episodes of ischemic priapism. 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.

Nonischemic priapism

Nonischemic priapism, also known as high-flow priapism, occurs when penile blood flow isn't regulated appropriately. Nonischemic priapism is usually painless. Signs and symptoms include:

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation
  • Erect but not fully rigid penile shaft

When to see a doctor

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 be done as soon as possible.

If you experience recurrent, persistent, painful erections that resolve on their own, see your doctor. You might need treatment to prevent further episodes.

Causes

An erection normally occurs in response to physical or psychological stimulation. This stimulation causes certain blood vessels and smooth muscles to relax and/or expand, increasing blood flow to spongy tissues in the penis. Consequently, 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, blood vessels, smooth muscles or nerves — changes normal blood flow. Subsequently, the erection persists. While the underlying cause of priapism often can't be determined, several conditions are believed to play a role.

Blood disorders

Blood-related diseases might contribute to priapism — usually ischemic priapism, when blood isn't able to flow out of the penis. These disorders include:

  • Sickle cell anemia
  • Leukemia
  • Other hematologic dyscrasias, such as thalassemia, multiple myeloma and others

The most common associated diagnosis in children is sickle cell anemia.

Prescription medications

Priapism, usually ischemic priapism, is a possible side effect of a number of drugs, including:

  • Medications injected directly into the penis to treat erectile dysfunction, such as alprostadil, papaverine, phentolamine and others
  • Antidepressants, such as fluoxetine (Prozac), bupropion (Wellbutrin), and sertraline
  • Alpha blockers including prazosin, terazosin, doxazosin and tamsulosin
  • Medications used to treat anxiety or psychotic disorders, such as hydroxyzine, risperidone (Risperdal), olanzapine (Zyprexa), lithium, clozapine, chlorpromazine and thioridazine
  • Blood thinners, such as warfarin (Coumadin) and heparin
  • Hormones such as testosterone or gonadotropin-releasing hormone
  • Medications used to treat attention-deficit/hyperactivity disorder (ADHD), such as atomoxetine (Strattera)

Alcohol and drug use

Alcohol, marijuana, cocaine and other illicit drug abuse can cause priapism, particularly ischemic priapism.

Injury

A common cause of nonischemic priapism — a persistent erection caused by excessive blood flow into the penis — is trauma or injury to your penis, pelvis or perineum, the region between the base of the penis and the anus.

Other factors

Other causes of priapism include:

  • A spider bite, scorpion sting or other toxic infections
  • Metabolic disorders including gout or amyloidosis
  • Neurogenic disorders, such as a spinal cord injury or syphilis
  • Cancers involving the penis

Complications

Ischemic priapism can cause serious complications. The blood trapped in the penis is deprived of oxygen. When an erection lasts for too long, this oxygen-poor blood can begin to damage or destroy tissues in the penis. As a result, untreated priapism can cause erectile dysfunction.

Prevention

If you have recurrent or stuttering priapism, to prevent future episodes your doctor might recommend:

  • Treatment for an underlying condition, such as sickle cell anemia, that might have caused priapism
  • Use of oral or injectable phenylephrine
  • Hormone-blocking medications — only for adult men
  • Use of oral medications used to manage erectile dysfunction