Priapism means an erection that persists without you being aroused, and that does not go away on its own. From four hours on, doctors call it priapism. If it hurts, it is an emergency: call the out-of-hours GP service or go to the emergency department.
This is the one topic in this series where the clock genuinely counts. In the painful form the erectile tissue is missing oxygen, and the longer that lasts, the greater the chance of lasting damage (Broderick, 2010).
No panic, but do move. That is the whole advice.
What is priapism exactly?
Priapism is a prolonged erection unrelated to arousal or stimulation. Blood flows into the erectile tissue but can no longer get out. So the erection stays up because the drainage falters, not because your body wants it.
The name comes from Priapus, a Greek fertility god with a permanent erection. The mythology is funnier than the condition.
Notably: in the classic form the glans is often soft while the shaft is rock hard. Only the erectile bodies are stuck, the rest is not.
It is rare. But for the men who get it, the outcome depends heavily on how fast they seek help.
How do you know if it is urgent?
Pain is the key distinction. There are two main forms, and they feel different. The ischemic form hurts and is an emergency. The non-ischemic form is usually painless, follows an injury, and is less urgent.
| What you notice | Ischemic (emergency) | Non-ischemic |
|---|---|---|
| Pain | Yes, and it increases | Usually none |
| How hard | Very rigid, tense | Partly rigid |
| Onset | Often at night, for no reason | After a blow or fall, sometimes days later |
| What to do | Seek help immediately | Make contact the same day |
Torn between the two columns? Then treat it as the left one. That is the safe bet, and you disappoint nobody by calling too soon.
The rule of thumb urologists hold: with the ischemic form every hour counts. Broderick describes that the chance of preserving erectile function drops as the episode lasts longer (Broderick, 2010).
What causes it?
The best known causes are sickle cell disease, certain medications, and agents injected into the penis for erection problems. Some antidepressants and antipsychotics are also known for it. In a share of men no cause is found.
The Farmacotherapeutisch Kompas lists priapism as a rare side effect of several agents. If you started something new and this happens, mention it straight away when you call.
Erection pills from a webshop belong here too. You do not know what is in them, nor the dose.
That is my position on this whole topic, incidentally. The risks of self-medicating with agents from the internet are badly underrated, and this is exactly where that ends up.
What happens at the hospital?
With the ischemic form a doctor first draws blood from the erectile tissue to see how much oxygen is in it. That confirms which form it is. Then the pooled blood is drained, and sometimes you get an agent injected that widens the vessels.
That sounds rougher than it is for most men. Anaesthetic is used.
If that does not help, a small procedure to create a drainage route sometimes follows. That is rare and only happens if the rest fails.
With the non-ischemic form, watchful waiting is often the policy. It regularly resolves on its own.
What does it mean for your erections afterwards?
That depends heavily on how long the episode lasted. A short ischemic episode treated quickly has a more favourable course than one lasting a full day. Prolonged oxygen shortage can damage the tissue of the erectile bodies, and that can cause erection problems later.
Which is exactly why postponing costs more here than embarrassment does.
If you are left with erection problems, that is a conversation with your GP or urologist. What the word impotence covers and which causes play a role, we worked out separately. Erection problems are common: 52 percent of men between 40 and 70 dealt with them to some degree (Feldman, 1994).
They are also a signal to take seriously. Men with erection problems later developed cardiovascular disease more often (Thompson, 2005).
What can you have measured?
For priapism itself, nothing in advance, because it is an acute event. Afterwards a doctor sometimes looks at your blood count to rule out sickle cell disease or a blood disorder. That happens in hospital, not on your own initiative.
What you can do yourself: do not use erection agents from the internet.
If less drive or a weaker erection plays alongside, our overview on less interest in sex and your hormones is a logical starting point. Discuss your complaints with your GP: how that conversation runs is in discussing erection problems with your GP.
The Men's Hormones panel maps your male hormones if there is reason for it.
But to be clear: if you have a painful erection right now lasting over four hours, close this article and call the out-of-hours GP service. In an emergency, call 112.
References
- Broderick GA, Kadioglu A, Bivalacqua TJ, et al. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;7(1 Pt 2):476-500. PMID: 20092449.
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. PMID: 8254833.
- Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. PMID: 16414947.
- Farmacotherapeutisch Kompas. Priapism as a rare side effect. Zorginstituut Nederland.
Disclaimer
Caliberhealth works with BIG-registered doctors who assess your blood results. This article gives general information and does not replace medical advice from your GP or specialist. A blood test is a tool, not a diagnosis on its own. With serious complaints, contact your GP, or call 112 in an emergency.
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