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Priapism (Prolonged Erection)

Painful or painless erection lasting longer than 4 hours, unrelated to sexual stimulation; a urological emergency.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Priapism (Prolonged Erection)?

Priapism is a pathological erection state lasting at least 4 hours, often painful, occurring independent of sexual stimulation, and which can lead to permanent erectile dysfunction if untreated. There are two main types: ischemic (low-flow, veno-occlusive) priapism and non-ischemic (high-flow, arterial) priapism. The ischemic type is far more common and is a true urological emergency.

Ischemic priapism is characterized by blood pooling, hypoxia, acidosis, and tissue damage due to impaired venous return from the corpus cavernosum. Ischemia exceeding 24 hours leads to cavernosal fibrosis and permanent ED. Causes include sickle cell anemia, hematological malignancies, intracavernosal injection therapies, phosphodiesterase-5 inhibitors, and certain psychiatric medications.

Non-ischemic priapism usually develops following perineal trauma due to fistula formation in the cavernosal artery. It is painless, the penis is not fully rigid, and does not require emergency intervention; it can be treated with selective embolization.

Symptoms

Erection lasting longer than 4 hours
Erection unrelated to sexual intercourse or stimulation
Severe penile pain in ischemic type
Rigidity of penile shaft, glans remaining soft
Painless partial erection in non-ischemic type
May accompany sickle cell crisis
History of perineal trauma (in non-ischemic type)

Risk Factors

Sickle cell anemia and thalassemia
Leukemia and multiple myeloma
Phosphodiesterase-5 inhibitors (sildenafil, tadalafil)
Intracavernosal injection therapy (papaverine, alprostadil)
Some psychiatric drugs (trazodone, chlorpromazine)
Cocaine and other illicit drug use
Pelvic or perineal trauma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Erection exceeding 4 hours (immediate emergency department visit)
  • Persistent erection after sexual intercourse
  • Prolonged erection after intracavernosal injection
  • Rigidity developing after perineal trauma
  • Prolonged erection in a man with sickle cell anemia

Treatment Methods

01
Emergency evaluation: differentiation of ischemic-non-ischemic with cavernosal blood gas and Doppler US
02
Cavernosal aspiration and irrigation in ischemic priapism
03
Phenylephrine intracavernosal injection: under cardiovascular monitoring
04
Surgical shunt in refractory ischemic cases (Winter, Ebbehoj, Al-Ghorab)
05
Hydration, oxygenation, and transfusion in sickle cell crisis
06
Selective pudendal artery embolization in non-ischemic priapism

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.