Priapism: Symptoms, Types, Causes, and Treatment

What is Priapism?

Priapism is a prolonged or persistent erection of the penis that isn’t caused by sexual stimulation and lingers for hours. Priapism is usually painful and commonly occurs in people with sickle cell anemia. Lack of swift medical attention could lead to tissue damage, caused by the inability to get or maintain an erection (erectile dysfunction). Priapism is most common in men in their 30s.

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The signs and symptoms of priapism vary depending on the type of priapism. There are two main types of priapism: ischemic and nonischemic priapism.

Ischemic priapism

Ischemic priapism or low-flow priapism occurs when blood is not able to leave the penis. It’s the more common type of priapism. Signs and symptoms include:

  • Progressive penile pain
  • Erection lasting more than four hours which is not related to sexual stimulation
  • Rigid penile shaft, but the tip of penis (glans) is soft

Nonischemic priapism

Nonischemic priapism or high-flow priapism, occurs when penile blood flow is not properly regulated. Nonischemic priapism is usually painless. Signs and symptoms include:

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation
  • Erect but not fully rigid penile shaft

A form of ischemic priapism which involves repetitive episodes of prolonged erections is called recurrent or stuttering priapism. It is more common in males who have an inherited disorder associated with abnormally shaped red blood cells (sickle cell anemia). The penis blood vessels can become blocked due to sickle cells. Recurrent priapism may begin with painful erections of short duration and might progress over time to more prolonged and frequent.

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Causes of Priapism

Normally, an erection occurs in response to physical or psychological stimulation which causes certain blood vessels and smooth muscles to relax and expand, thereby increasing blood flow to spongy tissues in the penis. The engorged or blood-filled penis becomes erect. At the end of stimulation, the penis returns to its flaccid state after blood flows out.

Now, priapism occurs when this normal system changes blood flow causing the erection to still linger. Several conditions are believed to be responsible for priapism.

Blood disorders

Blood-related diseases might contribute to priapism. These include:

  • Leukemia
  • Sickle cell anemia
  • Other hematologic dyscrasias, such as thalassemia, multiple myeloma and others

The most common associated diagnosis in children is sickle cell anemia.

When to see a doctor

It may become a case of emergency if an erection lasts more than four hours. The treatment for ischemic priapism or nonischemic priapism are different. So, the doctor will check to know which condition you have.

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Consult your doctor if you have persistent, recurrent, painful erections that resolve on their own.

Prescription medications

Ischemic priapism is a possible side effect of a number of drugs, including:

  • Medicines injected directly into the penis to treat erectile dysfunction, such as papaverine, alprostadil and others.
  • Alpha blockers such as terazosin, doxazosin, prazosin, and tamsulosin
  • Blood thinners, such as warfarin (Coumadin) and heparin
  • Medications used to treat attention-deficit/hyperactivity disorder (ADHD), such as atomoxetine (Strattera)
  • Antidepressants, such as fluoxetine (Prozac), bupropion (Wellbutrin), and sertraline Hormones such as testosterone or gonadotropin-releasing hormone

Alcohol and drug use

Ischemic priaspism can be caused by alcohol, marijuana, cocaine and other illicit drug abuse.


A trauma or injury to the penis can cause nonischemic priapism.

Other factors

Other factors that may cause priapism include:

  • Toxic infections from a spider bite, scorpion sting or others
  • Cancers affecting the penis
  • Metabolic disorders including gout or amyloidosis
  • Neurogenic disorders, such as a spinal cord injury or syphilis


If left untreated for long, ischemic priapism can cause erectile dysfunction. This is because when the trapped blood is deprived of oxygen, it can start destroying tissues in the penis.


To prevent future episodes of recurrent priapism, your doctor might recommend:

  • Use of oral medications used to manage erectile dysfunction
  • Use of oral or injectable phenylephrine
  • Treatment for an underlying condition
  • Hormone-blocking medications

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