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Priapism

What Is Priapism?

Priapism is a prolonged erection lasting more than four hours that is not related to sexual arousal. While it may seem like a minor issue, priapism is often a medical emergency. Without prompt treatment, it can result in long-term damage to the penis and affect sexual function.

Types of Priapism

There are several types of priapism, and understanding the difference is important:

  • Ischemic Priapism (Low-Flow)
    The most common and urgent type. Blood becomes trapped in the penis and cannot drain. It is typically painful and requires emergency treatment to prevent tissue damage.
  • Non-Ischemic Priapism (High-Flow)
    A less common and usually painless type, often resulting from an injury to the groin or perineum. Though not a medical emergency, it still requires evaluation by a urologist.
  • Stuttering Priapism
    Seen most commonly in patients with blood disorders like sickle cell disease. This involves recurrent, <4 hours, yet painful erections that come and go and that can lead to ischemic priapism if not addressed.

Priapism Symptoms

  • Erection lasting longer than 4 hours
  • Painful, rigid erection (more typical of ischemic priapism)
  • Painless or partially rigid erection (more typical of non-ischemic priapism)
  • Recurrent, short episodes of painful erections (stuttering priapism)
     
If you are experiencing any of these symptoms—especially if the erection is painful or has lasted more than four hours—seek immediate medical care, even if that means going to the emergency room.
 
The longer an episode of ischemic priapism, the more likely there is permanent damage that impacts short and long-term erectile function.

Common Causes of Priapism

  • Certain medications (e.g., trazodone, antipsychotics, injectable ED drugs)
  • Blood disorders such as sickle cell anemia or leukemia
  • Trauma to the penis or pelvic region can result in high-flow priapism
  • In many cases, the cause may be unknown

Diagnosis of Priapism

To determine the type of priapism and to guide treatment, your urologist may perform:
  • A physical exam
  • Blood gas analysis (drawing blood from the penis to assess oxygen levels)
  • Review of medical history and medications
  • Blood tests to check for underlying blood disorders

Treatment Options

Ischemic Priapism (Emergency):

  • Draining trapped blood from the penis, after providing local anesthesia
  • Injecting medication to reverse the erection
  • Surgical interventions such as distal shunts or penoscrotal decompression if conservative treatments fail
  • Penile implant/prosthesis surgery may be necessary if there is permanent damage—early referral can help preserve penile length and function

Non-Ischemic Priapism:

  • Observation (it may resolve on its own)
  • Interventional radiology embolization if the condition persists
  • Follow-up with sexual health specialist important to evaluate whether impact on erectile function

Stuttering Priapism:

  • Medication management to reduce the frequency and severity of future episodes
  • Multi-disciplinary care is very important for patients with sickle cell disease, hematology interventions can also help reduce recurrence of episodes

Why Early Treatment of Priapism Matters

Prompt care is essential—especially for ischemic priapism—to preserve erectile function and avoid irreversible damage. Even if long-term effects occur, treatment options such as penile implants can restore sexual function and quality of life.

 Key Takeaways

  • Priapism is an erection lasting more than 4 hours without sexual arousal
  • Ischemic priapism is painful and requires emergency care
  • Non-ischemic priapism is less urgent but evaluation is critical to confirm type of priapism and follow-up
  • Effective treatment depends on the type and cause
  • Don’t delay—early evaluation improves outcomes

If you or someone you care for is experiencing priapism, don’t wait—contact your urologist or go to the nearest emergency department. Early action can make all the difference.