How to Manage Prolonged Erections
For most men with erectile dysfunction (ED), getting an erection after using ED medication is a good thing.
However, when an erection lasts for hours or causes pain and discomfort, it’s usually a sign that something isn’t right. And in some cases, it can even become a medical emergency.
For most men with erectile dysfunction (ED), getting an erection after using ED medication is a good thing.
However, when an erection lasts for hours or causes pain and discomfort, it’s usually a sign that something isn’t right. And in some cases, it can even become a medical emergency.
Although uncommon, prolonged erections are a known side effect of medications used to treat erectile dysfunction, such as sildenafil (the active ingredient in Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (sold as Stendra®).
Referred to as priapism, prolonged erections only affect a tiny percentage of men who use ED medications.
However, because this side effect can damage your penis, it’s important that you seek emergency medical attention if it ever affects you.
Read on to learn more about prolonged erections, including what priapism is, common symptoms and the main factors that can cause this type of long-lasting, potentially damaging erection to occur.
We’ve also provided information on what you should do if you develop a long-lasting erection that doesn’t go away on its own.
What Is Priapism?
Priapism is a disorder in which the penis stays erect for a prolonged period of time without any form of sexual stimulation.
While it’s normal — and perhaps a sign of good sexual health — to maintain strong erections during sex, priapism isn’t healthy.
In fact, when priapism causes pain, it’s a serious medical emergency that requires immediate attention.
There are three main types of priapism: ischemic priapism, nonischemic priapism and recurrent, or stuttering ischemic priapism.
Ischemic Priapism (Low-Flow Priapism)
Ischemic priapism, or low-flow priapism, occurs when there’s little or no blood flow in the tissue of your penis.
As blood becomes trapped inside your penis, the intracorporeal pressure begins to rise, potentially causing pain and discomfort.
This type of priapism is a medical emergency. If left untreated, the increasing pressure and lack of blood flow can lead to hypoxia (low oxygen levels), tissue ischemia (reduced nutrient supply) and acidosis (buildup of acid in the tissue of your penis).
Ischemic priapism is the most common form of priapism, accounting for around 95 percent of all priapism cases.
Nonischemic Priapism (High-Flow Priapism)
Nonischemic priapism, or high-flow priapism, occurs when there’s continuous blood flow to the penis, but blood flow is unregulated and does not become fully trapped inside the penis.
Unlike ischemic priapism, which can be painful, nonischemic priapism usually involves a weaker erection that isn’t fully rigid.
Nonischemic priapism is typically caused by trauma that affects the penis or perineum (the area between the anus and genitals).
This type of priapism generally doesn’t cause damage to the erectile tissue of the penis and isn’t considered a medical emergency.
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Recurrent Ischemic Priapism (Stuttering Priapism)
Recurrent ischemic priapism, or stuttering priapism, is a form of priapism that involves painful, prolonged erections that subside on their own.
These erections usually last three hours or less, and often require medical attention.
This type of priapism is more common in people with sickle cell disease. It often occurs during the night and may involve multiple erections of increasing duration.
Symptoms of Priapism
The symptoms of priapism can vary in type and severity depending on the type of priapism you have. If you have an ischemic priapism, you may develop the following symptoms:
Prolonged erections unrelated to sexual arousal. You may experience a prolonged erection that occurs without physical sexual contact or erotic imagery. An erection that lasts for more than four hours is generally considered priapism.
A firm, rigid penis, with a soft glans. Priapism causes your penis to become firm, but the glans (tip of the penis) and corpus spongiosum (the area at the bottom of the penis) may remain soft.This difference in firmness occurs because these areas of tissue have their own venous drainage system that’s separate from the main erectile tissue of the penis.
Pain that may worsen over time. Ischemic priapism is usually painful. Your penis may begin to hurt after it becomes erect, with pain worsening as the level of pressure in your erectile tissue increases.
Ischemic priapism is a serious medical emergency. If you notice any of the symptoms above, it’s important to seek medical care as soon as you can.
Nonischemic priapism, or high-flow priapism, causes slightly different symptoms than ischemic priapism.
With this type of priapism, your penis may feel firm but not totally rigid. Nonischemic priapism is usually not painful, with minimal tenderness or discomfort.
What Causes Priapism?
Several different things can cause priapism, from physical damage to your penile tissue caused by injury, to blood disorders, prescription medications and even recreational drugs.
The following factors may increase your risk of developing priapism:
Sickle cell disease. As mentioned above, priapism is more common in men with sickle cell disease, a group of disorders that affect the red blood cells. According to research, around 11 percent of priapism cases are associated with sickle cell disease.
Other blood disorders. Other disorders that affect the blood — particularly disorders that cause hypercoagulability (a tendency to produce blood clots) — may increase your risk of developing priapism.
Vasoactive medications. Medications that affect your blood vessels, such as some ED medications, can contribute to priapism. Experts estimate that medications play a role in approximately 25 percent of all priapism cases.
Trauma that affects the penis and/or perineum. Priapism can often occur as a result of trauma that affects the genitals or surrounding area. This type of damage can occur during surgery or as a result of everyday injuries.
Alcohol and illicit drugs. Some illicit drugs, such as cocaine and cannabis are linked with an increased risk of priapism. You may also have an increased risk of priapism if you suffer from an alcohol use disorder.
Other causes. Many other conditions and diseases can increase your risk of priapism, including neurologic disorders, fat embolisms, Fabry disease, amyloidosis and several forms of cancer.
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Priapism from ED Medication Isn’t Common
If you’ve ever read news articles about Viagra and other ED medications, you might have seen mentions of “four-hour erections” and other cases of prolonged erections.
In fact, based on media coverage, it’s easy to get the impression that prolonged, painful erections are a common side effect of ED medication.
This isn’t accurate. Although medications like Viagra can cause side effects, priapism is a highly uncommon issue. In fact, it only affects a fraction of a percentage of men who use ED medication.
Experts estimate that in total, only about 0.73 cases of priapism occur per 100,000 men every year.
To put these numbers in perspective, an estimated 30 million men in the United States have ED, with millions of men using medications such as Viagra, Cialis and their generic equivalents on a frequent basis.
What to Do if You Develop a Prolonged Erection
It’s normal to sometimes get random erections without sexual stimulation. And sometimes, you may notice that your erections take longer than usual to go away, especially if you use medication to treat ED. We have tips on how to stop male arousal here.
While the occasional long-lasting erection usually isn’t an issue, it’s important to seek immediate medical help if you have a painful erection or an erection that lasts longer than four hours.
If you think you may have ischemic priapism, you should call 911 or go to your nearest hospital emergency room.
At the emergency department, a healthcare provider may inspect your penis to determine whether you have an ischemic or nonischemic priapism.
The healthcare staff may ask you certain questions about your symptoms, including about whether your erection is painful.
Several tests are used to diagnose and treat priapism and you may need to undergo one or several of the following at the hospital:
Doppler ultrasound. This type of test uses high-frequency sound to measure the level of blood flow in the blood vessels of your penis. It may reveal narrowed blood vessels, a blockage, abnormal blood flow or an aneurysm (bulge in a blood vessel).
Penile blood gas analysis. This test involves taking a sample of blood from your penis using a small needle. The staff at the hospital will analyze the blood and check the level of carbon dioxide and oxygen gas, which can signal an ischemic priapism.
Magnetic resonance imaging (MRI). This type of test may help to detect blood clotting or tumors. Magnetic resonance angiography (MRA), another type of test, may be used to evaluate blood vessels inside your penis.
Blood test. You may be asked to provide a blood sample. This assists in detecting and diagnosing conditions that may cause ischemic priapism, such as sickle cell disease or certain forms of cancer.
Toxicology test. You may be asked to provide a blood or urine sample for a toxicology test. This test helps to detect drugs, medications or other substances that may cause priapism.
If you have an ischemic priapism, you’ll likely need to undergo emergency medical treatment to remove blood from your penis and protect your erectile tissue.
One procedure that’s used to treat ischemic priapism is aspiration. A doctor or other healthcare provider may use a small needle and syringe to drain blood from your penis.
Aspiration allows the healthcare providers to check the color of your blood and identify possible damage.
You may be treated with medication to improve blood drainage from your penis. One medication commonly used as a treatment for priapism is phenylephrine, which works by constricting blood vessels that supply blood to your penis.
If these treatment options aren’t successful, you may need to undergo surgery to control blood flow to your penis and drain blood from your erectile tissue.
Because ischemic priapism can potentially result in damage to your penis — including permanent erectile dysfunction — it’s important to seek prompt treatment if you experience symptoms.
If you have nonischemic priapism, you’ll likely won’t need to have treatment in a hospital. Your healthcare provider may aspirate your penis as part of the diagnostic process.
Most of the time, surgery isn’t recommended for this type of priapism due to the risk of complications.
Your healthcare provider might suggest applying an ice pack to your penis, or simply getting bed rest until your symptoms improve on their own.
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Handling a Prolonged Erection
Priapism, a type of persistent erection, is a rare condition that can cause permanent damage to your penis if it isn’t treated urgently.
Although priapism isn’t common, it may develop as a side effect of some ED medications such as ED injections or oral PDE5 inhibitors.
If you develop a prolonged erection that’s painful, uncomfortable or unusually persistent, it’s important to seek immediate emergency care.
You can do this by calling 911 or going to the nearest hospital for treatment.
By responding as quickly as possible to priapism, you’ll receive the care you need and cut your risk of dealing with permanent complications.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment or medication.