Priapism is a prolonged erection lasting longer than four hours that occurs without continued sexual stimulation. Rapid treatment prevents permanent tissue damage and long-term erectile dysfunction.
Types of Priapism
- Ischemic (low-flow): Painful, rigid erection caused by trapped, deoxygenated blood—accounts for most cases and requires urgent care.
- Non-ischemic (high-flow): Usually painless and partially rigid after trauma; still needs specialist evaluation.
Common Triggers
- Intracavernosal injection therapy with alprostadil, papaverine, or combination agents.
- Sickle cell disease or other hematologic disorders.
- Certain antidepressants, antipsychotics, or recreational drug use.
Emergency Response Steps
- If erection exceeds four hours, go to the emergency department—do not wait overnight.
- Bring the medication vial or list of drugs you used to help clinicians plan treatment.
- Apply cold packs and walk gently while en route, but do not attempt to drain the penis yourself.
Hospital Treatment
- Corporal aspiration to remove trapped blood followed by saline irrigation.
- Intracavernosal injection of alpha-adrenergic agents such as phenylephrine.
- Surgical shunting if initial measures fail to restore blood flow.
Prevention for Injection Users
- Use the lowest effective dose and avoid re-dosing within 24 hours.
- Rotate injection sites and follow sterile technique.
- Keep decongestant tablets (pseudoephedrine) on hand per physician guidance for early intervention.
Rapid recognition and treatment of priapism preserves erectile tissue. Review emergency procedures with your urologist when starting injection or vacuum therapy.