What is priapism?

Originally Published: March 28, 1997 - Last Updated / Reviewed On: February 27, 2009
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Dear Alice,

What is priapism?

Dear Reader,

In basic terms, priapism is a prolonged and painful erection that can last from several hours up to a few days. Contrary to popular belief, this condition is not associated with sexual thoughts or sexual desire, even though the etymology of the word itself comes from the Greek male fertility god, Priapus.

In the normal erection process blood flows into the penis and, usually following an orgasm, drains out of the penis without discomfort. When priapism occurs the blood is unable to drain as it would normally. Because there is little room in the penis for blood to circulate, it becomes stagnant and begins to lose oxygen. Without oxygen, red blood cells become stiff, making proper penis drainage even more problematic.

While priapism can occur without an obvious cause, most cases of priapism have clear medical explanations. Penile drug injections — sometimes used to treat erectile dysfunction — can lead to priapism, especially if more of the drug is used than is recommended. Certain psychiatric medications, like anti-depressants, can also lead to priapism, though it is not totally understood why.

There are also some medical conditions that can cause painful and prolonged erections. Any bodily ailment that causes blood to thicken or causes red blood cells to lose their flexibility and mobility can lead to priapism. Having sickle-cell anemia or leukemia or suffering a ruptured spine or paralyzation are all conditions that can exacerbate priapism.

Priapism can scar the penis and lead to impotence if not treated in a timely fashion, usually within four to six hours. Some men opt to treat priapism through medications that constrict blood vessels to decrease the amount of blood in the penis. Another common treatment option is aspiration, or having the penis gently drained of excess blood, sometimes followed by a saline flush of the penile blood vessels. Both of these treatments alleviate the immediate pain of having an engorged member. For men who suffer from priapism as a result of a ruptured penile artery due to trauma, such as paralyzation, surgery is also an option to restore normal penile function.

Penises (and the men attached to them!) are not machines; there is a lot of variety between men in how long their erections last, in amounts of blood that flows into their penis, and when erections become painful. For information on the full range of penis behavior, check out Erection comes and goes in the Go Ask Alice! archive. A general rule of thumb is to pay close attention to excess swelling or pain in the penis and to seek out care sooner rather than later if you suspect something is up (no pun intended)! Columbia students can visit Open Communicator or call x4-2284 to make an appointment with a primary health care provider. If you suspect the situation may be an emergency, you may also contact Urgent After Hours Care by calling x4-9797.

The god Priapus may have been quite a stud, but priapism is certainly no picnic!

Alice

September 7, 2004

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Alice, Wow. I just read your description of priapism. I never knew that there were some very serious causes. A couple of years ago, I had priapism that lasted many, many months. I didn't consider...
Alice, Wow. I just read your description of priapism. I never knew that there were some very serious causes. A couple of years ago, I had priapism that lasted many, many months. I didn't consider going to a doctor, and at times, it was painful. I was eventually diagnosed with leukemia. I was treated and the priapism went away. Only recently have my erections returned to "normal." I guess that was one gift-horse I should have looked into directly.

May 16, 2004

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Alice, As a prostate cancer survivor, I was prescribed a papavarine mix and as you said in your article, overdosed. Scared the heck out of me and very painful. The urologist said that prolonged...
Alice, As a prostate cancer survivor, I was prescribed a papavarine mix and as you said in your article, overdosed. Scared the heck out of me and very painful. The urologist said that prolonged erection (over 4 hours) was very rare and to go to any hospital emergency if it happens. He did not explain the condition. After about 11 hours, I attended an emergency clinic at a hospital. I waited and waited, expecting it to go down. The attending had to research the rx (good), and it was flushing with saline solution and a small amount of adrenaline. What an experience! I have been concerned because I did not know what permanent damage could/had occurred. Your site helped and I thank you for that. The overdose (35 units rather than 20): papavarine is not a toy. Regards, Brad

July 27, 2001

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Dear Alice, As an emergency responder, one of the chief signs we look for in a suspected injury to the lower spinal column includes (for males) priapism. When the spinal cord is injured below a...
Dear Alice, As an emergency responder, one of the chief signs we look for in a suspected injury to the lower spinal column includes (for males) priapism. When the spinal cord is injured below a certain point on the sacral spine, priapism is often an obvious sign. It has to do with nerves controlling blood flow to the area. Thought I'd share! Sincerely, an Emergency Medical Technician