Priapism, also called a prolonged erection, is an erection that lasts a long time without sexual stimulation and will not go away, often with pain. Many people describe it as an erection that won’t go away. It is not a sign of sexual strength; it is a urologic emergency that needs prompt treatment.
During an erection the spongy tissue of the penis fills with blood. If the blood cannot drain, it stays trapped in the tissue for hours and the tissue is starved of oxygen and damaged. The later it is treated, the more likely it is to leave lasting problems, and in serious cases it can lead to erectile dysfunction.
This article covers the types of priapism, common causes, tests and treatment, and when to go to the hospital straight away. If you already have erection problems, you may also want to read about the causes of erectile dysfunction.
Key points: Priapism is an erection that lasts a long time without sexual stimulation and often hurts. An erection lasting more than four hours needs emergency care at a hospital; people with a blood disorder such as sickle cell disease should seek care if a painful erection lasts more than one hour. Delayed treatment can damage penile tissue and cause long-term erectile dysfunction. Do not wait for it to go away, and do not use ice, masturbation or sex to deal with it; go to the emergency department right away.
What Is Priapism? How Long Is a Prolonged Erection Too Long?
Priapism is a prolonged erection that does not go away and is not caused by sexual stimulation. In general, an erection that lasts more than four hours needs hospital treatment right away; people with a blood disorder such as sickle cell disease should seek care if a painful erection lasts more than one hour.
What types of priapism are there?
Ischemic priapism is the more common type. Blood cannot leave the penis, the erection is usually hard and painful, and it becomes more obvious over time; this is an emergency. Non-ischemic priapism is less common and is usually linked to an abnormal blood flow after an injury; the erection is usually not very painful and its firmness can vary. There is also stuttering (intermittent) priapism, with repeated painful erections that each last a shorter time but can turn into the ischemic type; it needs to be told apart from an erection that wakes you from sleep.
How many hours of a painful erection before going to the hospital?
There is no need to wait for four hours. If the erection is painful and getting harder, go to the emergency department as soon as possible rather than watching the clock. The earlier it is treated, the better the chance of protecting penile function.
What Causes Priapism and an Erection That Won’t Go Away?
Ischemic priapism often has no clear cause, but common related factors include blood disorders, medicines and recreational substances. Sickle cell disease is a particular one: the changed shape of the red blood cells makes them more likely to block blood flow, and episodes can recur.
Some treatments for erectile dysfunction can also cause priapism, for example medicine injected directly into the penis or certain oral treatments. If you use this kind of treatment, follow your doctor’s instructions and learn in advance what to do if an erection lasts too long; see medication for erectile dysfunction and injection treatment (Chinese page).
Other possible causes include blood-thinning medicines, some antidepressants and some blood pressure medicines, alcohol and recreational drugs, and other blood disorders such as leukemia. A blunt injury to the penis or the area between the legs can cause non-ischemic priapism, and symptoms sometimes appear a few weeks after the injury.
Can masturbation or sex make priapism go away?
No, and it may delay getting help. Continuing to masturbate or have sex will not make a prolonged erection go away, and embarrassment should not make you wait. If you are worried about masturbation and erectile function, see masturbation and erectile dysfunction, but if you have a painful erection that will not go down, get medical care first.
| Possible cause | Common features | Possible assessment |
|---|---|---|
| Blood disorders such as sickle cell disease | Painful erections that recur, usually the ischemic type | Ask about blood disease history, blood tests if needed |
| Erectile dysfunction treatment (penile injection or oral treatment) | Erection that will not go down after use, usually painful | Ask about the treatment and dose, emergency care right away |
| Blood-thinning, antidepressant or blood pressure medicines | Erection that will not go down while taking the medicine | Review all medicines; the doctor decides whether to change them |
| Alcohol and recreational drugs | Erection that will not go down after use | Ask about use, emergency care if needed |
| Injury to the penis or the area between the legs | Erection after injury, usually less painful, firmness may vary | Examination, ultrasound and blood flow assessment |
| Unknown cause | Most ischemic cases have no clear cause | Treatment comes first; the cause is looked for afterwards |
What Tests Are Done for Priapism?
At the hospital, the doctor first works out whether the priapism is ischemic or non-ischemic, because the speed and type of treatment are different. The doctor will ask how long the erection has lasted, whether it hurts, which medicines or recreational substances were used, whether you have a blood disorder, whether you were injured, and whether you have had similar episodes and how they were handled.
Examination and blood gas analysis
The doctor checks whether the erection is completely rigid and whether it hurts. If needed, a small sample of blood is drawn from the penis for blood gas analysis; in ischemic priapism the blood usually has a low oxygen level and is more acidic, which helps tell it apart from the non-ischemic type.
Ultrasound and blood tests
Penile Doppler ultrasound shows blood flow and helps decide whether the priapism is non-ischemic and whether there is an injury-related vessel problem. Blood tests may check for a blood disorder. Tests should not delay treatment; if the priapism looks ischemic, it is usually treated first.
| Test | Main purpose | Possible limits |
|---|---|---|
| History | Find out duration, pain, medicines, blood disorders and injury | Needs honest information about any medicines or substances used |
| Examination | Check whether the erection is fully rigid and painful | Cannot tell the types apart on its own |
| Penile blood gas analysis | Helps tell ischemic from non-ischemic priapism | Blood is drawn by a doctor under local anesthesia |
| Penile Doppler ultrasound | Shows blood flow and vessel problems in non-ischemic priapism | Needs interpretation by a trained professional |
| Blood tests | Look for a blood disorder | Cannot replace treatment; read together with symptoms |
What to Do When an Erection Won’t Go Away: Treatment and Prevention
Ischemic priapism is an emergency and needs hospital treatment. A doctor may draw out the trapped blood under local anesthesia, give medicine into the penis if needed, and, if that does not help, may need surgery to create a channel for blood to drain. Non-ischemic priapism may be watched or treated depending on the situation, and the doctor decides based on the tests.
On the way to the hospital you can try passing urine, taking a warm bath or shower, drinking water, or gentle activity such as a walk or squats, while getting ready to go. Do not apply ice or cold water, especially if you have sickle cell disease, because cold can make things worse; do not drink alcohol or smoke. These steps are only a help and cannot replace medical care, so do not delay leaving because you are trying them.
How can I lower the chance of it happening again?
If you have had priapism, talk with your doctor about the cause and a prevention plan. If you use erectile dysfunction treatment, use it as your doctor instructed and learn beforehand what to do if an erection will not go down; other options may also be worth considering, such as a penile vacuum device (Chinese page) and the different choices described in erectile dysfunction treatment options.
If you have a blood disorder, keep up regular follow-up and stay in touch with both your hematology and urology doctors; avoid alcohol and recreational drugs, and tell every doctor who prescribes for you that you have had priapism.
When to Go to the Emergency Department for Priapism
Priapism is an emergency. In any of these situations, go to the emergency department right away and do not wait:
An erection without sexual stimulation lasts more than four hours and has not gone down.
You have a blood disorder such as sickle cell disease and a painful erection lasts more than one hour.
The pain from the erection is getting worse, or the penis feels completely rigid.
The erection will not go down after penile injection or an erectile dysfunction medicine.
An erection that will not go down appears after an injury to the penis or the area between the legs.
You keep having painful, long erections, even if each one goes down by itself.
If an erection will not go down, ask someone to go with you or call your local emergency number for an ambulance, and do not drive yourself to the hospital.
An erection without sexual stimulation that lasts more than four hours and has not gone down needs hospital treatment right away; people with a blood disorder such as sickle cell disease should seek care if a painful erection lasts more than one hour. If the pain is clear, there is no need to wait for the time limit.
A brief erection may go down by itself, but a painful erection that will not go down should not be left. Delayed treatment can damage penile tissue, so go to the emergency department early.
It can. The longer ischemic priapism lasts, the higher the risk that the tissue is damaged and erectile dysfunction follows, so earlier treatment is better.
Go to the emergency department right away and tell the doctor what treatment you used and when. Do not wait it out or use the treatment again, and do not use ice.
This is not recommended. Ice may make things worse, and masturbation or sex will not make the erection go away. It is better to pass urine, drink water, move around gently and go to the emergency department as soon as possible.
Go straight to an emergency department that has a urologist. The emergency team will assess the type and start treatment, and a urologist will then follow up on the cause and future prevention.
Medical information references
- NHS: Priapism (painful erections)
- European Association of Urology (EAU): Guidelines on Sexual and Reproductive Health — Priapism
- MedlinePlus (U.S. National Library of Medicine): Penis pain
- NHS: Sickle cell disease
- MedlinePlus (U.S. National Library of Medicine): Sickle cell disease
Advice from the urologist
- If an erection without sexual stimulation lasts more than four hours, or the pain is clear, go to the emergency department right away and do not wait.
- If you have a blood disorder or use erectile dysfunction treatment, learn in advance what to do if an erection will not go down.
- Do not use ice, masturbation or sex to deal with it, and do not let embarrassment delay care.
- If you have had priapism, tell every doctor who prescribes for you and discuss a prevention plan together.
A prolonged erection is not something to be embarrassed about; it is a urologic emergency where time matters. The earlier it is treated, the better the chance of protecting erectile function. If an erection will not go down, go to the emergency department right away so that a urologist can assess you in person.
