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Understanding Priapism: What You Need to Know and When to Get Help

Priapism is a prolonged and often painful erection that lasts for more than four hours without sexual arousal. While this might sound harmless, it’s actually a medical emergency. If not treated in time, priapism can lead to permanent damage and long-term erectile dysfunction (ED).
The most important thing to know is this: if you experience an erection that doesn’t go away after four hours, head to your nearest emergency room immediately. Early treatment can prevent complications.
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Types of Priapism: High-Flow vs. Low-Flow

Not all priapism is the same. There are two main types:
Low-Flow (Ischemic) Priapism – The most common type.
  • This happens when blood gets stuck in the penis and can’t drain out.
  • It’s painful and an emergency.
  • If untreated, it can damage the tissue and cause permanent ED.
High-Flow (Non-Ischemic) Priapism – Less common.
  • Usually caused by trauma or injury, like a blow to the groin.
  • Blood flow is unregulated, but it’s usually not painful or as urgent.
  • Still, it’s important to get checked out.

Common Causes of Priapism

1. Medication-Induced Priapism

Some medications can trigger priapism as a side effect, especially those affecting blood flow or neurotransmitters. Common culprits include:
  • Erectile dysfunction medications (like Viagra)
  • Antidepressants and antipsychotics (such as trazodone and risperidone)
  • Certain recreational drugs, like cocaine
If you’re on these medications and experience prolonged erections, tell your doctor. They may adjust your dosage or switch your medication.

2. Injection Therapy for Erectile Dysfunction

Patients using penile injection therapy (like alprostadil or papaverine) for erectile dysfunction are at higher risk of developing low-flow priapism.
  • This happens when too much medication is injected or when the blood flow fails to return to normal after the treatment.
It’s crucial to follow injection guidelines carefully and seek help if your erection lasts longer than expected.

3. Blood Disorders

Certain medical conditions can make priapism more likely:
  • Sickle cell disease (a major risk factor, especially in children and teens)
  • Leukemia and other cancers
  • Thalassemia

4. Trauma or Injury

An injury to the groin or pelvis can lead to high-flow priapism by damaging blood vessels.

Symptoms to Watch For

  • An erection lasting more than four hours
  • Pain in the penis (especially in low-flow priapism)
  • The shaft feels hard, but the tip remains soft
  • Possible difficulty urinating
Don’t wait to see if it goes away on its own. The longer you wait, the higher the risk of permanent damage.

Treatment Options for Priapism

1. Ischemic (Low-Flow) Priapism Treatment

This type requires emergency treatment to restore blood flow:
  • Aspiration: A doctor drains the trapped blood with a needle, which usually provides quick relief.
  • Medication Injections: Drugs like phenylephrine are injected to help shrink the blood vessels and reduce blood flow.
  • Surgery (Shunt Procedure): In severe cases, a surgeon creates a new pathway for blood to flow out of the penis.

2. Non-Ischemic (High-Flow) Priapism Treatment

  • This type often resolves on its own.
  • Applying ice packs or light compression may help.
  • In rare cases, surgery may be needed to repair damaged blood vessels.

The Long-Term Risk: Erectile Dysfunction

One of the most serious complications of untreated priapism is long-term erectile dysfunction.
  • Ischemic priapism can damage the smooth muscle tissue in the penis. Once the tissue is damaged, it loses its ability to function normally.
  • In severe cases, the damage is irreversible, leading to chronic ED.
That’s why early treatment is critical. The sooner blood flow is restored, the lower the risk of permanent damage.

What Should You Do if You Have Priapism?

Don’t wait it out! Here’s what to do:
  • If your erection lasts more than four hours, go to the nearest emergency room immediately.
  • Avoid trying home remedies. Cold showers or physical activity won’t help and may make things worse.
  • Bring a list of any medications you’ve taken recently. This will help doctors diagnose and treat you faster.

FAQs About Priapism

Can priapism go away on its own?
Non-ischemic (high-flow) priapism sometimes resolves without treatment. However, ischemic priapism requires immediate medical care.
Low-flow priapism is usually painful, but high-flow priapism often isn’t. Either way, get checked out.
Yes, especially erectile dysfunction medications, antidepressants, and certain antipsychotics.
Treatment depends on the type. For low-flow priapism, doctors may drain blood, inject medication, or perform surgery if necessary.
Yes, untreated low-flow priapism can lead to permanent erectile dysfunction.
If you’re on medication that increases the risk, talk to your doctor about alternatives. If you use injection therapy, follow instructions carefully.

Conclusion: Early Treatment Saves Function

Priapism may seem like a rare or embarrassing condition, but it’s one you can’t afford to ignore. The risk of permanent erectile dysfunction is real, especially if treatment is delayed. If you have an erection lasting longer than four hours, go to the emergency room immediately. The faster you get help, the better your chances of a full recovery.

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