Everything You Need to Know About Priapism

October 22,2020 |
Male doctor going over chart with male patient

Priapism is the medical term for an erection that lasts for abnormally long periods of time, is presented with pain, or occurs without reason. Priapism is different from an erection as it will not be treated through orgasm and instead requires medical attention. There are many different reasons behind priapism, and it can occur in boys during pre-pubescent years and men aged 20 to 50. For a better understanding of this medical condition, here’s everything you need to know about priapism.

Types of Priapism and Their Symptoms

There are two main types of priapism—each with different symptoms. The two types of priapism that occur most often are ischemic priapism and nonischemic priapism.

Ischemic Priapism

Ischemic priapism is a medical condition that occurs when blood is unable to leave the penis. It’s also known as low-flow priapism and is the most common type of priapism experienced by men. Some of the most common signs and symptoms of ischemic priapism include:

  • An erection lasting more than four hours
  • An erection unrelated to sexual interest or stimulation
  • Rigid penile shaft, with soft tip of penis (glans)
  • Progressive penile pain

Recurrent priapism, also referred to as stuttering priapism, is a type of ischemic priapism and is very rare. It occurs primarily in males who have sickle cell anemia and can develop or change over time.

Nonischemic Priapism

Nonischemic priapism, also known as high-flow priapism, occurs when arterial flow is not properly regulated. This results in an above average amount of blood flow to the penis. It’s often less painful than ischemic and includes the following symptoms:

  • An erection lasting more than four hours
  • An erection unrelated to sexual intercourse or stimulation
  • An erect, but not fully rigid penile shaft

When to See a Doctor

In many cases, priapism does not improve without medical condition. Because of this, it’s important to see your doctor as soon as you notice any symptoms of either type of priapism listed above—especially if your erection lasts longer than four hours.

Complications of Priapism

When priapism is treated early, there are usually no complications. However, if you don’t seek care quickly, the penile tissue becomes deprived of oxygen and can lead to permanent damage or even destruction of the cells. If you do not get prompt medical treatment, you will likely experience varying degrees of permanent nerve damage, which results in erectile dysfunction. Since penile tissue is sensitive, damages cannot be reversed.

Priapism can cause serious, long-term damage, so it’s important to see a doctor immediately if you have an erection lasting over four hours or if you experience any of the symptoms above. If you experience recurrent, partial erections that seem to go away on their own, you should still schedule a visit with your doctor to rule out any underlying causes and take the proper precautions. Make sure that you come with a list of any medications you’re currently taking and be prepared to discuss your symptoms with your doctor.  


Causes of Priapism

The cause of priapism varies from person to person, however it’s important to understand that an erection that occurs in response to physical or psychological stimulation is not the same thing. A healthy erection occurs when smooth muscles relax due to stimulation and blood flow increases. Once the stimulation is over, the muscles constrict and the blood flows out. Priapism occurs when normal blood flow is changed due to an underlying cause. Some cause of priapism are as follows.

Blood Disorders

Blood disorders and diseases can change the way circulation occurs in the penis and lead to restrictive arteries or veins. Blood related disorders that can cause priapism include sickle cell anemia, leukemia, and hematologic dyscrasias.

Prescription Medications

Certain prescriptions can cause priapism as a side effect. If you’re taking any of the following medications, make sure that you talk to your doctor about your risk factors. If you experience priapism as a result from your medication, it’s important to find a suitable alternative. Medications that can lead to priapism include:

  • Antidepressants like fluoxetine (Prozac), trazodone HCL (Desyrel), bupropion (Wellbutrin), and sertraline
  • Certain alpha blockers
  • Medications to treat anxiety or psychotic disorders such as hydroxyzine, risperidone (Risperdal), olanzapine (Zyprexa), chlorpromazine (Thorazine), lithium, clozapine, or others
  • Blood thinners
  • Hormones from hormone replacement therapy
  • Erectile dysfunction pills or shots
  • Certain attention-deficit/hyperactivity disorder (ADHD) medications

Alcohol and Drug Use

The use of certain narcotics and heightened alcohol intake can cause a man to experience priapism.


Physical injury or trauma to the penis, pelvis, or perineum area can lead to nonischemic priapism. You can also experience priapism from certain toxic infections or bites such as black widow bites and carbon monoxide poisoning or neurogenic disorders that are either caused by disease or injury. Tumors can also lead to priapism.

Preventing Priapism

If you’re experiencing recurrent priapism, it’s important to treat the underlying condition to avoid future episodes. While it might not be possible to completely prevent priapism, there are certain things you can do to reduce your risk of episodes. Make sure that you’re taking all of your medications properly and talk to your doctor if you are taking anything that might cause priapism. There are certain hormone pills that can be taken to help prevent priapism alongside the use of phenylephrine. Talk to your doctor to learn more.  

How to Diagnose Priapism

While the symptoms of priapism make a diagnosis seem fairly straightforward, it’s important to understand which type of priapism needs to be treated. Ischemic and nonischemic priapism are treated using different methods so the following diagnostic tests are conducted to get more detail on the exact type of the condition.

Blood Gas Measurement

During this procedure, your doctor will insert a needle into your penis to collect a blood sample directly from the source. Upon examining the blood, your doctor will be able to determine the amount of oxygen present, thus determining whether it’s low-flow or high-flow priapism.

Blood Tests

Your doctor may request a more traditional blood sample to test your blood for underlying conditions. If you have any of the blood diseases that commonly cause priapism, you will need to ensure that proper course of treatment alongside any medications or procedures to treat the priapism.


An ultrasound is used for doctors to measure the blood flow in the penis more accurately. Ultrasounds are also helpful in determining what, if any, kind of trauma or injury occurred and if so, how severe it is.

Toxicology Test

Since priapism is commonly associated with drug abuse, your doctor will order a toxicology report. This is often included in a routine exam in order to rule out any direct causes.

Treating Ischemic Priapism

Ischemic priapism is considered a medical emergency and will not resolve itself without medical assistance. Because of this, it’s important to see a doctor and begin treatment immediately to avoid serious complications or loss of use. There are a number of different treatment options for ischemic priapism which include the following:

  • Blood Removal – your doctor will numb the penis and then use a needle to drain blood from the area in an effort to ease pain and swelling.
  • Medicine – there are certain medications that can be injected directly into your penis to help narrow the blood vessels and ease swelling. These drugs, alpha agonists, are also available to some men in the form of pills depending on your doctor’s recommendations and the immediacy of the situation.
  • Blocking the Artery – in an effort to reduce more blood flow, your doctor may block the blood vessel that’s causing the problem through a procedure called arterial embolization. This is also used in nonischemic priapism treatment.
  • Tying off the Artery – if a ruptured artery leads to priapism, your doctor will need to tie it off using surgical ligation.
  • Surgical Shunt – a surgical shunt can be inserted that allows drainage. This is a good option for recurrent cases but can lead to problems with erectile dysfunction later on.

Treatment is important to ensuring a full recovery. If you have any questions or concerns about treatment options, talk to your doctor.

Treating Nonischemic Priapism

Treating nonischemic priapism is usually done through a combination of observation, ice, and exercise. In this type of priapism, the penis may become flaccid on its own without any treatment so you can merely monitor the situation for signs of improvement. Ice packs may help slow down the blood flow to the penis while walking can help improve circulation.

If that doesn’t work, you may need to treat nonischemic priapism with embolization or surgery. Embolization is the process of blocking the blood flow to the penis using a small plug. Surgery is done to tie off part of a blood flow in your penis in an attempt to control blood flow.

To learn more about the importance of maintaining good urologic health and how you can access discrete, urologic supplies, contact Byram Healthcare today.