- Priapism is a prolonged and painful erection of the penis that can cause damage if left untreated.
- Erections that last longer than 4 hours need emergency treatment.
- There are two types of priapism: Ischemic or nonischemic.
- It’s very rare to experience priapism as a result of taking erectile dysfunction medication.
Rock Hard Erections For Hours!
Sounds like a claim made by some dodgy ‘male enhancement’ pill, right? Well, erections that last for hours on end are real, but they’re not always a good thing. In fact, they can be REALLY harmful.
Priapism is a condition in which a painful erection is sustained constantly for hours on end, sometimes not even caused by sexual stimulation. If the erection lasts for more than 4 hours and isn’t treated, priapism can cause permanent damage to the penis, including erectile dysfunction.
The Two Types Of Priapism
What is actually happening to the penis during priapism?
One type of priapism is called ischemic, or low flow priapism. Low flow priapism happens when blood can’t leave the penis during erection. In this type of priapism, the shaft of the penis is rigid while the tip may be soft. It’s the most painful form of priapism, and the most damaging.
A rarer form of priapism is known as nonischemic, or high flow priapism. In this type, the penis is being oversupplied with blood through an artery, typically due to a damaged blood vessel. High flow priapism is usually far less painful, and often the penis shaft isn’t fully rigid.
Low flow priapism is the most dangerous kind, but both types should be taken seriously. The emergency treatment will depend on what type of priapism you are diagnosed with.
What Causes Priapism?
The most common cause of priapism is having sickle cell disease – nearly half of all men with sickle cell disease will experience priapism in their lifetime .
Injuries that damage blood vessels can cause high flow priapism, while damage to the spinal cord or complications of genital cancer can cause low flow priapism.
In some rarer cases priapism has been linked to blood thinning medicines including Warfarin  and SSRI antidepressants such as Citalopram . It’s also possible that alcohol and recreational drugs such as cocaine and cannabis could induce priapism in rare cases .
Do Erectile Dysfunction Pills Such As Viagra Cause Priapism?
Drugs both medical and recreational are often accused of causing priapism, particularly erectile dysfunction (ED) pills. But licensed ED pills very rarely lead to any form of priapism.
ED medication such as Viagra (Sildenafil) stimulates erections by relaxing the blood vessels in the penis, increasing blood flow when aroused. The common myth surrounding ED pills is that they immediately give you a raging, uncontrollable hard on! This isn’t the case: you still need to become physically aroused in order for the Viagra to be effective. It simply makes it easier to achieve and maintain an erection when aroused.
If you’re taking licensed ED medication as prescribed, it’s exceedingly rare to experience priapism as a side effect. The majority of cases of ED pill induced priapism are due to people taking unsafe doses recreationally, or consuming dangerous unlicensed drugs that are advertised as ED medication .
How Is Priapism Treated?
If your erection hasn’t subsided after a couple hours and you’re becoming concerned, there are a few things you can do at home that may help.
You could try:
- Having a warm shower
- Exercising, such as jogging or squats
- Staying hydrated
- Putting ice packs on your penis 
- Drinking alcohol
- Having sex or masturbating
If the erection doesn’t subside after four hours or becomes painful, it’s time to take a trip to the emergency room. There are a variety of treatments for priapism available, depending on the type of priapism and the severity of the situation.
For low flow priapism, there are two main forms of treatment. Intracavernous injection involves an injection of alpha-agonist drugs into the penis, which narrow the arteries and reduce blood flow. There is also a surgical shunt, a passageway that is inserted into the penis under general aesthetic. It works by diverting the blood flow, allowing normal circulation to resume.
Doctors may also drain blood from the penis using a needle, while the area is numbed under local anesthetic. None of these sound particularly attractive as treatments, but it’s certainly better than leaving priapism untreated, which would likely cause permanent damage. When treated promptly, the outlook for priapism is generally very good.
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- Treatments for Priapism in Boys and Men with Sickle Cell Disease | NCBI
- Stuttering Priapism Complicating Warfarin Therapy in a Patient with Protein C Deficiency | NCBI
- Citalopram-induced Priapism | NCBI
- Cocaine Associated Priapism | NCBI
- Priapism Caused by “Rhino 7 Platinum 3000” an Over-the-Counter Male Enhancement Supplement | NCBI
- Priapism Do and Don’t | NHS