Priapism: Symptoms. Why It Happens & Treatment

Updated in April 2023

Priapism is a painful, persistent erection which can be an emergency situation. It can occur as a result of use of certain medications, or blood disorders, like a clot, sickle cell disease or leukemia. 

If an erection persists and is left untreated, it may lead to a penile injury due to excess blood accumulation in the organ. Treatment should be initiated as quickly as possible in a hospital setting. 

Generally, men can expect a full recovery from this condition with no complications. However, a painful erection that does not resolve should be assessed in the emergency room promptly to prevent injury.

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Common symptoms

Symptoms of priapism can vary depending on the type presenting. Ischemic priapism is more dangerous, and can cause symptoms like: 

  • A hard erection for more than 4 hours, even without any sexual desire 
  • A very hard glans, but with a soft head 
  • Intense pain that worsens with time

The symptoms of non-ischemic priapism are similar, however it does not cause pain. Both situations can put that patient at risk for permanent penile injury, which can lead to erectile dysfunction. Men are advised to proceed to the hospital if an erection is painful and lasts for more than an hour after stimulation. 

Why it happens 

An erection is a natural process that occurs with a physical and psychological stimulant. The stimulant triggers blood to accumulate in the penis, leading to its increase in size. Normally, an erection disappears and the penis reduces in size after the sex or stimulation terminates, as the the veins relax and blood exits the penis.  

Some health conditions, like sickle cell disease or other blood disorders, can interfere with normal circulation to the genitals. This can lead to difficulty in the erection disappearing on its own. 

Drug use, direct trauma and some medication (like sexual stimulants, antidepressants or anticoagulants) can also put men at greater risk for priapism. 

Treatment options

Treatment for priapism may include:

  • Cold compresses applied to the penis, to relieve swelling and reduce accumulated blood 
  • Removal of blood, which is done under local anesthetic. The doctor inserts a needle and aspirates the excess blood to relieve pain and swelling. 
  • Alpha-agonist medication, which causes vasoconstriction to decrease the amount of blood that reaches the penis.

In more severe cases in which priapism does not resolve with these techniques, the doctor may perform surgery to obstruct the artery bringing blood into the penis, or to drain the blood from the organ. 

Generally, men can recover completely from priapism with not complications, however they are advised to go to an emergency room as quickly as possible to ensure a positive prognosis. 

Possible complications

Blood that remains in the penis and does not circulate will start to lose its oxygen, which can cause micro-injuries. If the erection lasts for a long time, the injuries can worsen and lead to erectile dysfunction.