Priapism or Prolonged Erections:

Symptoms, Causes, and Treatments

Priapism, or prolonged erection, can be a potential danger, and it is considered a medical emergency. We will get to more details about priapism right away.

Men with erectile dysfunction (Ed) have difficulties getting or maintaining an erection long enough for the whole sexual encounter. That’s why they seek treatments, and some might end up with the magic blue pill or any other medications for ED.

To be able to get an erection after taking the pills is a good thing and the reason why men with ED seek treatment. But, in some cases, the erection lasts for hours or causes pain or discomfort. This is called priapism, AKA prolonged erection.

In the case of priapism, you need to seek medical attention immediately.

This article takes a thorough look at Priapism: The causes of priapism, symptoms of priapism, treatments of priapism, and more. We will also take a look at what you need to do in case you get a prolonged or painful erection after taking ED medications.

Priapism or prolonged erection is a potential danger, and you need to seek immediate medical attention.

In this article, we discuss:

• What Is Priapism & What Are the Different Types of It?
• What Are the Symptoms of Priapism?
• What Causes Priapism?
• You Got A Prolonged Erection, Now What?
• How Common Is Priapism Caused by ED Medications?

What Is Priapism & What Are the Different Types of It?

As mentioned briefly above, priapism is when a full or a partial erection goes on for hours, either beyond or at times without sexual stimulation.

Priapism is not that common. But, it happens to specific groups of people, like people with sickle cell disease or males in their 30s. Males with sickle cell disease can also develop priapism in childhood.

Priapism or prolonged erection needs immediate medical help to prevent damages to the tissue of the penis. If left untreated, priapism can lead to erectile dysfunction (Ed).

There are three types of priapism that we will discuss below: Ischemic priapism, nonischemic priapism, and recurrent ischemic priapism.

Priapism is when a full or partial erection goes on for hours, beyond or even without sexual stimulation. Priapism, or prolonged erection, needs immediate medical attention to prevent tissue damages to the penis.

Low-Flow Priapism or Ischemic Priapism

This type of priapism needs the most immediate medical emergency. A high percentage of men who experience priapism fall under this type. In other words, it is the most common priapism among the three.

Low-flow priapism, or ischemic priapism, is when the blood is trapped in the penis and cannot leave the veins of the penis. The intracorporeal pressure rises, and the pain begins. The increased intracorporal pressure results in:

• tissue ischemia (reduced nutrient supply),
• hypoxia (low oxygen levels),
• cavernosal acidosis (too much acid in erectile tissue),
• and penile pain

Low-flow priapism (ischemic priapism) needs the most medical emergency and is the most common type of priapism.

High-Flow Priapism or Nonischemic Priapism

Contrary to ischemic priapism, in nonischemic or high-flow priapism, there is continuous blood flow to the penis. But the blood flow is unregulated, and it is not adequately trapped in the penis. In nonischemic, the penis is not fully erect.

High flow priapism (nonischemic priapism) is not an immediate medical issue. This type of priapism is caused by trauma to the penis. In this case, the penis or perineum (the area between the anus and genitals) gets affected.

High flow priapism (nonischemic priapism) is not a medical issue.

Stuttering Priapism or Recurrent Ischemic Priapism

Stuttering priapism or recurrent ischemic priapism is a prolonged erection that usually lasts for three hours and fades away on its own. It is painful and needs medical attention.

Stuttering priapism (recurrent ischemic priapism) is common among males with sickle cell disease. It usually happens a few times during the night, and each time the duration increases.

stuttering priapism (recurrent ischemic priapism) often needs medical help. It is painful and happens multiple times during the night.

What Are the Symptoms of Priapism?

The symptoms of priapism are different depending on their type. The amount of pain, hardness of the penis and the duration of the prolonged erection varies in the different types.

In low-flow priapism (ischemic priapism), there are some warning symptoms, and if you notice any one of them, you need to seek immediate medical help:

• If the erection lasts for more than four hours, it is a sign of priapism. In the low-flow type, the prolonged erection is usually due to no sexual stimulation or imagination.
• In ischemic priapism, the pressure increases as the blood get trapped in the penis. With the rise in blood pressure, the pain starts and gets worse. This type of priapism is usually painful right from the start.
• In this type of priapism, the glans (tip of the penis) and corpus spongiosum (bottom of the penis) typically stay soft, whereas the penis gets hard. The reason behind that is that the drainage system of the glans is different from that of the erectile tissue of the penis.

If you see any symptoms of low-flow priapism (ischemic priapism) mentioned above, seek immediate medical help.

In high-flow priapism (nonischemic priapism), on the other hand, the symptoms usually are milder and not painful. The penis is sort of firm but not totally rigid. Nonischemic priapism is generally with a bit of discomfort.

What Causes Priapism?

The leading causes of priapism include:

• Sickle cell disease: Researches suggest that almost half of men with sickle cell disease develop priapism at some point.
• Medications: Some medications can also cause priapism, either as a side-effect or when misused. Medications like some antidepressants, for instance, fluoxetine, bupropion, sertraline, and lithium. Medicines that treat ED also may cause priapism.

Other causes include:

• Blood disorders: Some blood disorders, like hypercoagulability (a tendency to produce blood clots), may lead to priapism.
• Trauma: Some trauma to the penis and genital areas, in general, can cause priapism. These injuries can occur due to general everyday life injuries, sex injuries, or surgeries.
• Alcohol use disorder and illicit drugs: Some drugs, like cocaine and cannabis, and alcohol use disorder increase the risk of priapism.

You Got A Prolonged Erection, Now What?

Getting a hard erection for a bit longer than usual is not a concern. It happens to many now and then. But, when the erection is painful, or it takes more than four hours, you should immediately seek help.

In case of a prolonged erection (erections lasting four hours or more), call 911 or go to the nearest hospital’s emergency room.

There, the nurses and the doctor examine your penis and ask you specific questions, one of which is if you have any pain.

There are different tests to perform and diagnose if your prolonged erection is, in fact, priapism. If yes, there are also various treatments discussed a bit further.

One or several of the following will be done in the hospital to see if you have priapism or not:

• Doppler ultrasound: With Doppler ultrasound, the level of the blood flow to the penis is measured. It will determine if the blood vessels are narrowed or if there is a blockage.
• Blood gas analysis on Peniale Samples: In blood gas analysis, a blood sample is drawn from your penis with a small needle. Then the level of carbon dioxide and oxygen gas will be analyzed to see if it’s ischemic priapism.
• Magnetic resonance imaging (MRI): This type of test, multimodality magnetic resonance imaging, looks for blood clotting or tumours.
• Blood test: A simple blood test might diagnose conditions that may cause ischemic priapism, like sickle cell disease or certain forms of cancer.
• Toxicology test: They might also ask you to provide a blood or urine sample for a toxicology test at the hospital. This test detects drugs, medications or other substances that may cause priapism.

Priapism due to taking erectile dysfunction medications is possible but highly unlikely.

In case low-flow priapism (ischemic priapism) was detected, it has to be treated immediately. There are different treatments available to perform for you in the hospital. The treatments include:

• Aspiration: The doctor or the healthcare provider drains the blood of your penis with a small needle. This way, they can also see the colour of your blood and determine the damage done to your penis.
• Medications: One of the treatment options is to give you medicines that help with blood drainage from your penis, like phenylephrine. These medications narrow other vessels that supply blood to your penis.
• Surgery: This is the last option, and in case none of the treatments above worked. In this surgery, they control the blood flow to your penis.

If the type of priapism was nonischemic, you wouldn’t have to be treated in the hospital. Your healthcare provider might suggest different treatments, including putting an ice pack on your penis or bed resting till the symptoms are gone.

How Common Is Priapism Caused by ED Medications?

It is not true that priapism is a common side-effect of medications used to treat erectile dysfunction (ED).

It is true, though, that one of the very uncommon side-effects of ED medications is priapism. But, it only happens to a very low percentage of men using these medications.

Dr. Ira Sharlip, clinical professor of urology at the University of California at San Francisco and spokesperson for the American Urological Association, says that during more than 10 years of prescribing viagra to his patients, he has never encountered a patient of his having priapism due to taking Ed medications. Though, he believes it should be mentioned to patients as an uncommon side-effect of ED medications.

Disclaimer

This article is written for informational purposes only and does not constitute medical advice. The information provided in the articles cannot and should not replace advice from a healthcare professional. Talk to your healthcare provider about any physical or mental health concerns or the risks and benefits of any treatment or medication.