What is priapism?

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 Condom kills erection 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)!

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

Last updated Jul 28, 2015
Originally published Mar 28, 1997

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