Priapism is a condition of persistent and painful erections that can last for 4 hours or more without sexual stimulation. It often requires treatment to prevent permanent damage, which may involve cold therapy, medications, or surgery.

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Priapism can be caused by certain medications and health conditions. It is uncommon, but when it occurs, it typically affects males in their 30s.

There are two main types of priapism:

  • Low flow priapism: Also known as ischemic priapism, this occurs when blood becomes stuck in the erection chamber.
  • High flow priapism: This type is caused by a broken artery that prevents proper blood circulation in the penis, causing high flow or nonischemic priapism. This could be due to an injury.

An erection that lasts longer than 4 hours is a medical emergency. The oxygen-deprived blood in your penis can damage tissue in the penis. Untreated priapism can result in damage or destruction of the penile tissue and permanent erectile dysfunction.

The symptoms of this condition vary depending on whether you experience low flow or high flow priapism.

Ischemic priapism

If you have low flow or ischemic priapism, you may experience the following:

  • erections lasting for more than 4 hours
  • rigid penile shaft with a soft tip
  • penis pain

Low flow or ischemic priapism can become a recurrent condition and may start and stop, which is known as stuttering priapism.

When symptoms begin, involuntary erections may only last for a few minutes or a short length of time. As time moves on, these erections occur more frequently and last longer.

Nonischemic priapism

If you have high-flow priapism, you’ll have some of the same symptoms as low-flow priapism, including:

  • erections lasting for more than 4 hours
  • rigid penile shaft and tip

The main difference between low-flow and high-flow priapism is that pain doesn’t occur with high-flow priapism.

A healthy penile erection occurs because of physical or physiological stimulation. An increase in blood flow to the penis causes an erection. Once the stimulation ends, there’s a decrease in blood flow, and the erection goes away.

With priapism, there’s a problem with blood flow to your penis. This can be caused by certain blood disorders, medications, and several other factors.

Blood disorders

Different conditions affect how blood flows in and out of the penis. These disorders and diseases include:

  • sickle cell anemia
  • leukemia
  • multiple myeloma

Sickle cell anemia, a disorder affecting red blood cells, is one of the most common causes of priapism.

In fact, it’s estimated that ischemic priapism affects about 33% of adults with sickle cell anemia.


According to a 2021 review, drug-induced priapism is the most common cause of priapism. What’s more, antipsychotic medications are considered one of the main drugs that cause priapism and are believed to account for about 50% of all cases of drug-induced priapism.

Other prescription medications that may affect blood flow to the penis include:

  • medications for erectile dysfunction
  • antidepressants
  • alpha blockers
  • medications for anxiety disorders
  • blood thinners
  • hormone therapy
  • medications for attention deficit hyperactivity disorder

Other factors

Several other conditions can cause priapism, including:

  • Alcohol and drug use: It’s believed that alcohol intoxication and the use of illegal drugs, including cocaine, are responsible for about 21% of cases of ischemic priapism.
  • Injury: Nonischemic priapism can be caused by direct injury or trauma to the penis.
  • Spider bites: Black widow spider bites are believed to contain toxins that can cause ischemic priapism.
  • Carbon monoxide poisoning: High levels of carbon monoxide in the blood can cause priapism. Some research suggests that carbon monoxide may play a role in certain pathways involved in priapism pathophysiology.
  • Metabolism disorders: Some metabolic disorders are believed to cause priapism, including amyloidosis and gout.
  • Neurogenic disorders: Priapism can be caused by spinal cord injuries and lumbar spinal stenosis, which is a narrowing of the spinal canal.
  • Cancer: Certain types of cancer may cause priapism, including leukemia, melanoma, and cancers of the prostate, kidneys, or bladder.
  • COVID-19: Though more research is needed, some studies suggest that priapism could be a possible complication of COVID-19.

Even though both types of priapism have similar symptoms, a doctor has to run diagnostic tests to determine whether you have low-flow or high-flow priapism. The treatment options differ depending on the exact type and cause of the condition.

Sometimes, doctors can diagnose priapism based on symptoms and a physical examination of the genital area. Tests used to determine the cause and type of priapism may include:

Blood gas measurement

This procedure involves inserting a needle into your penis and collecting a blood sample.

If the sample reveals that blood in your penis is deprived of oxygen, you have low-flow priapism. But if the sample reveals bright red blood, you have high flow priapism.

Blood tests

Since priapism can be caused by other diseases and blood disorders, a doctor may also collect a blood sample to check your level of red blood cells and platelets.

This can help them diagnose blood disorders, cancers, and sickle cell anemia.

Toxicology test

Priapism is also associated with drug misuse, so a doctor may collect a urine sample to look for drugs in your system.


Doctors use an ultrasound to measure blood flow in the penis. This test also helps the doctor determine whether trauma or injury is the underlying cause of priapism.

Treatment depends on whether you have low flow or high flow priapism.

Ischemic priapism

If you have low-flow priapism, a doctor may use a needle and syringe to remove excess blood from your penis. This can relieve pain and stop involuntary erections.

Another treatment method involves injecting medication into your penis. The medication will shrink the blood vessels carrying blood into your penis and expand the blood vessels carrying blood out of your penis. Increased blood flow can reduce an erection.

If neither of these therapies works, a doctor may recommend surgery to help blood flow through your penis.

Nonischemic priapism

If you have high flow priapism, immediate treatment may not be necessary, as it often resolves on its own.

A doctor may check your condition before prescribing a treatment. Cold therapy with ice packs can get rid of an involuntary erection. Sometimes, doctors suggest surgery to stop blood flow to the penis or to repair arteries damaged by an injury to the penis.

Recurrent priapism

When priapism is recurrent, you can also talk with a doctor about taking a decongestant such as phenylephrine (Neo-Synephrine) to reduce blood flow to the penis. They may also use hormone-blocking medications or medications for erectile dysfunction.

If an underlining condition causes priapism, such as sickle cell anemia, a blood disorder, or cancer, seek treatment for the underlying problem to correct and prevent future occurrences of priapism.

What is the main cause of priapism?

Priapism is often caused by the use of certain medications, including antipsychotics.

It also commonly affects people with sickle cell disease and can be caused by other blood disorders, alcohol or drug use, and injuries.

How do you fix priapism at home?

Nonischemic priapism can often be treated at home by placing ice and pressure on the perineum, which can help ease symptoms.

However, ischemic priapism requires immediate medical attention. Therefore, it’s best to talk with a doctor about erections lasting longer than 4 hours, especially if symptoms are persistent and don’t improve with cold therapy.

Can priapism go away on its own?

Nonischemic or high-flow priapism usually resolves independently and may improve with cold therapy. However, ischemic or low-flow priapism is considered a medical emergency and requires treatment, which may involve aspiration to remove excess blood, medications, or surgery.

The outlook for priapism is good if you receive prompt treatment.

For the best possible outcome, it’s important that you seek help for prolonged erections, especially if the problem is persistent, not caused by an injury, and doesn’t respond to ice therapy.

If left untreated, the risk of tissue damage and permanent erectile dysfunction may increase.