Priapism causes vary depending on a male’s age and other factors. First, however, it’s important to understand what priapism is. Priapsim is characterized by a persistent erection and a painful penis that develops when blood in the penile chambers becomes trapped and cannot drain out. It most often affects males ages 5 to 10 years and 20 to 50 years.
Priapism is a serious medical condition that represents too much of a good thing. Although many men desire a long-lasting, harder erection, a four-hour erection without sexual stimulation—which is the definition of priapism–is not only excessive, it is dangerous. Failure to treat priapism immediately can result in scarring of the penile tissue and permanent erectile dysfunction.
Priapism types and causes
Men can develop one of three different types of priapism.
- Low-flow (ischemic) priapism occurs when blood is trapped in the erection chambers of the penis. Although otherwise healthy men can get low-flow priapism for no apparent reason, this painful erection can also occur in men who have malaria, leukemia, or sickle-cell anemia.
- High-flow (non-ischemic) priapism is much less common than the low-flow form. Men who develop high-flow priapism typically have experienced an injury or some type of pelvic or perineal blunt trauma to the penis or the area between the scrotum and anus (the perineum) that causes a rupture in an artery, which in turn prevents normal blood circulation in the penis.
- Stuttering priapism, in which a man experiences a persistent erection on recurring occasions.
Many men are not aware of what causes priapism. Several factors can trigger a four-hour erection and penis pain, and some of them may surprise you. Here are causes of priapism of which men should be aware.
What causes priapism?
One of the more common priapsim causes is, ironically, pills and drugs for erectile dysfunction treatment. A possible side effect of both the oral drugs (i.e., sildenafil [Viagra], tadalafil [Cialis], and vardenafil [Levitra]), and the injectable drugs (e.g., papaverine) to treat erectile dysfunction is priapism.
Other priapism causes include:
- Use of drugs to treat depression or mental illness, such as fluoxetine (Prozac), bupropion (Wellbutrin), and trazodone (Desyrel), and chlorpromazine (Thorazine)
- Use of blood thinners, such as heparin and warfarin (Coumadin)
- Use of abused drugs, including marijuana, cocaine, alcohol (excessive), or recreational use of erectile dysfunction drugs
- Sickle cell anemia, an inherited disorder in which individuals have abnormally shaped red blood cells. The abnormal shape can interfere with normal blood flow. Sickle cell anemia is the most common cause of priapism in boys. Approximately 42% of males with sickle cell anemia experience priapism.
- Malaria
- Trauma to the pelvis, perineum, or genitals. This can result in non-ischemic priapism
- Spinal cord injury
- Carbon monoxide poisoning
- Blood clots
- Bite from a black widow spider or scorpion
- Cancer that blocks blood flow to or in the penis (rare)
A four-hour erection is not common, so many men are not aware of priapism causes, signs, and symptoms.
Signs and symptoms of priapism
Among the obvious signs and symptoms of priapism is a persistent, four-hour erection, but symptoms actually differ depending on the type. If you experience low-flow priapism, your signs and symptoms will include
- Persistent, unwanted erection that lasts longer than 4 hours
- An erection that persists after sexual stimulation or one that is not related to sexual stimulation
- A rigid penile shaft but with a soft tip (glans)
- Penis pain
The signs and symptoms of high-flow priapism are:
- Persistent, unwanted erection that lasts longer than 4 hours
- An erection that persists after sexual stimulation or one that is not related to sexual stimulation
- An erect but not rigid penile shaft
- Absence of penis pain (usually)
In stuttering priapism, the prolonged erection occurs off and on, is usually painful, and typically lasts several hours
Men who experience a four-hour erection and penis pain should seek immediate medical treatment for priapism or risk permanent complications.
Treatment for priapism
Seek emergency medical treatment if you have an erection that lasts four hours or longer. Put aside any feelings of embarrassment: without prompt treatment of priapism, you can experience permanent erectile dysfunction and scarring of the penile tissue.
If you experience a persistent, painful erection that disappears in less than four hours, make an appointment to see your doctor because you may need treatment to prevent recurring priapism.
When you see a doctor for priapism, it is important that you provide him or her with the following information:
- How long you have had the erection
- If this is a recurring situation, how long your erection usually lasts
- Any medications (over-the-counter and prescription) or drugs (legal or illegal) you have used
- Any trauma you may have experienced to your pelvic region
The doctor will conduct a physical examination and extract a blood sample from the penis, which will be analyzed to provide clues about any priapism causes and how much damage has occurred.
If treatment is initiated within four to six hours, medication nearly always can reduce penis pain, resolve the erection, and help preserve a man’s ability to get an erection. Here are the treatment options for priapism:
- Ice packs applied to the penis and perineum can reduce penis pain and swelling
- For men with low-flow priapism, drugs called alpha-agonists can be injected into the penis. The drugs cause the veins to become narrow, which reduces blood flow to the penis and allows the swelling to subside.
- For an erection that has lasted less than four hours, decongestant medications can reduce blood flow to the penis
- Doctors can insert a surgical shunt into the penis to divert the blood flow and allow circulation to normalize. This approach can be used for low-flow priapism
- Doctors can insert a needle into the penis and aspirate blood, which reduces swelling and penis pain.
- For high-flow priapism, doctors can tie off the ruptured artery and thus restore normal blood flow
The secret to successful treatment of priapism is speed: the sooner a persistent painful erection is treated, the greater the chance of avoiding permanent erectile dysfunction and scarring of the penile tissue. Although it is not possible to completely avoid priapism, there are lifestyle steps on how to prevent a painful penis and priapism all men can follow.
How to prevent priapism
All men should be aware of what causes priapism and preventive measures. Especially important are healthy lifestyle habits that promote good blood flow and circulation and attention to sexual health. Thus, here are some lifestyle steps to prevent priapism.
- Communicate with your healthcare provider: If you have a medical condition that is associated with a high risk of priapism, talk to your healthcare provider about your concerns. Make sure you are being treated optimally for your disease to reduce your risk of developing priapism.
- Increase fruit and vegetable intake: A diet rich in vitamins, minerals, antioxidants, and phytonutrients help support healthy circulation, and fruits and vegetables provide these necessary nutrients.
- Pick healthy fats: Healthy fats, which include omega-3 fatty acids and monounsaturated fats, support blood circulation and a healthy heart.
- Select plant protein over animal protein: Plant protein has advantages over animal protein, especially because it does not contain saturated fat and cholesterol, which can contribute to poor blood flow. In fact, plant protein contains something animal protein does not—fiber—which lowers cholesterol and thus promote circulation. If you need help making a switch to plant protein, see.
- Drink green tea: Green tea contains potent antioxidants called catechins, which support heart and prostate health.
- Eat omega-3 rich foods: The omega 3 fatty acids fight inflammation, which is a hallmark of heart disease, and also help support the immune system.
- Avoid foods and additives that are harmful to health: It’s important to recognize which foods to avoid because they may harm your health, but don’t forget there are also supplements, food additives and nutrients that may damage you as well. Some of these items may surprise you.
- Consider supplements for erectile dysfunction. One cause of priapism is the use of medications for treatment of erectile dysfunction. An alternative to these medications is natural erectile dysfunction remedies. Consult a knowledgeable healthcare provider before using supplements for erectile dysfunction.
- Hydrate often: Water is a major component of blood, so make sure to drink pure water as part of a healthy diet.
- Achieve and maintain a healthy weight. Being overweight and carrying too much body fat are risk factors for heart disease and can also affect circulation.
- Exercise regularly. Healthy blood circulation and a strong heart are the positive side effects of regular exercise, and in turn you can help prevent the possibility of priapism.
- Manage stress. When you practice stress management techniques, you are taking steps to prevent heart disease, stroke, high blood pressure, and many other serious medical conditions. Your efforts may also translate into prevention of priapism.
- Don’t smoke. Smoking hinders blood circulation and is a risk factor for heart disease, stroke, and erectile dysfunction.
- Curb alcohol use. Excessive use of alcohol is one of the causes of priapism.
- Maintain hormone balance. When you maintain hormone balance, you help keep your entire body in harmony. This means there is less stress on the heart and circulation, and less possibility of developing priapism.
- Maintain a healthy sex life. Regular sexual activity is an essential part of overall physical and emotional health. Be sure to follow the healthy lifestyle recommendations provided here and seek immediate medical help if you do experience a four-hour erection and penis pain.
- Avoid exposure to toxins. Exposure to chemicals and other toxins can have a negative impact on your heart health, circulation, and overall well-being.
Read more in our Erectile Dysfunction Health Center.
