Priapism is a condition in which the penis remains erect for prolonged periods of time. Persistent erections can persist for hours after sexual stimulation, sometimes even unrelated to sexual stimulation at all. Priapism is usually painful.

Although priapism is uncommon overall, certain groups of people are susceptible to it, such as those with sickle cell anemia. Priapism is usually treated as soon as possible to prevent tissue loss that can lead to inability to get or maintain an erection (erectile dysfunction).

Priapism is most common in men 30 years of age and older.


Symptoms of priapism vary by type. Priapism is mainly divided into two types: ischemic priapism and non-ischemic priapism.

Symptoms of priapism

ischemic priapism

Ischemic priapism, also known as low-flow priapism, is caused by the inability of blood to flow out of the penis. This type of priapism is more common. Signs and symptoms include:

  • Penile erection that persists for more than four hours, or erection without sexual desire or stimulation
  • The body of the penis is hard, but the glans (the glans) is soft
  • progressive penile pain

Recurrent or intermittent priapism is an uncommon type of ischemic priapism. The disorder is more common in men with a genetic disorder characterized by an abnormally shaped red blood cell called sickle cell anemia. Sickle cells can block blood vessels in the penis. Recurrent priapism refers to repeated episodes of prolonged penile erection, usually an ischemic priapism. The patient’s condition begins with involuntary and painful brief erections, which become more frequent and longer over time.

nonischemic priapism

Nonischemic priapism, also known as high-flow priapism, occurs when blood flow to the penis is not properly controlled. In general, nonischemic priapism is less painful than ischemic priapism. Signs and symptoms include:

  • Penile erection that persists for more than four hours, or an erection that occurs without desire or stimulation
  • The penis is erect, but the sides are not completely firm


An erection is usually a response to physical or psychological stimulation. This stimulation causes certain smooth muscles to relax, increasing blood flow to the cavernous tissue of the penis. Thus, the blood-filled penis becomes erect. After stimulation is over, blood flows and the penis return to its soft (flabby) state.

Priapism occurs when some part of this system (blood, blood vessels, smooth muscle, or nerves) alters normal blood flow and an erection persists. The underlying cause of priapism is often undetermined, but can be caused by several conditions.

blood disease

Blood-related disorders may cause priapism (usually an ischemic erection in which blood cannot flow out of the penis). These diseases include:

  • sickle cell anemia
  • leukemia
  • Other blood system diseases, such as thalassemia, multiple myeloma, etc.


Priapism (usually ischemic priapism) is a possible side effect of many medications, including:

  • Drugs injected directly into the penis to treat erectile dysfunction, such as alprostadil, papaverine, phentolamine, etc.
  • antidepressants, such as fluoxetine (Prozac), bupropion (Wellbutrin), and sertraline
  • Alpha-blockers, including pyrazosin, terazosin, doxazosin, and tamsulosin
  • Medications used to treat anxiety or psychosis, such as hydroxyzine, risperidone (Risperdal), olanzapine (Zyprexa), lithium, clozapine, chlorpromazine, and thioridazine
  • blood thinners, such as warfarin (Coumadin) and heparin
  • hormones, such as testosterone or gonadotropin-releasing hormone
  • Medications used to treat attention deficit hyperactivity disorder (ADHD), such as amoxetine (Strattera)

alcohol and drug use

Symptoms of priapism

Abuse of alcohol, marijuana, cocaine, and other illicit drugs causes priapism, especially ischemic priapism.


A common cause of nonischemic priapism (a persistent erection caused by excessive blood flow to the penis) is trauma or injury to the penis, pelvis, or perineum (the area between the base of the penis and the anus).

other factors

Other causes of priapism include:

  • Spider bites, scorpion stings, or other poisonous infections
  • Metabolic disorders, including gout or amyloidosis
  • Neurogenic disorders, such as spinal cord injury or syphilis
  • penile cancer


Ischemic priapism can cause serious complications. The blood in the penis is deprived of oxygen. When erections take too long, this oxygen-poor blood can start to damage or destroy tissue in the penis. Therefore, untreated priapism can cause erectile dysfunction.


If you have recurrent or intermittent priapism, to prevent future episodes, your doctor may recommend:

  • Treat underlying conditions that may cause priapism, such as sickle cell anemia
  • Oral or injectable phenylephrine
  • Hormone-blocking drugs—for adult men only
  • Oral medications for erectile dysfunction

When to see a doctor

If your erection lasts longer than four hours, you need emergency care. The emergency room doctor will confirm whether you have an ischemic priapism or a non-ischemic priapism. 


This step is necessary, because the treatment of different symptoms will be different, if it is ischemic priapism, it needs to be treated as soon as possible.Click here for more details.

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