Priapism: When Erection Lasts Hours After Intimacy

If an erection lasts for more than 4 hours, venous return in the corpora cavernosa is obstructed, preventing blood from flowing out and causing ischemia and hypoxia in the corpora cavernosa. After 6-12 hours, irreversible fibrosis may occur in the corpora cavernosa. After 24 hours, erectile function is almost permanently lost. Many patients, due to embarrassment or wanting to “wait and see,” arrive at the hospital too late.

What are the common causes?

Common causes include blood disorders, especially sickle cell anemia, which is prevalent in certain populations. Some antihypertensive drugs, antidepressants, and anticoagulants can also induce priapism. Patients with spinal cord injuries may experience erections that fail to subside due to abnormal neural regulation. Long-term drug users, especially those using cocaine or marijuana, are also at higher risk. A small number of patients have no identifiable cause, a condition known as idiopathic priapism.

How to handle and treat emergencies

At home, you can try applying an ice pack to the perineum, walking around gently, urinating after strenuous exercise, and taking a warm sitz bath. If these methods are ineffective, or if the erection has exceeded the recommended time, you must go to the emergency room or urology department of a hospital immediately. Do not wait any longer.

Doctors will take different approaches depending on the situation. Low-lying corpus cavernosum puncture is a routine procedure to remove accumulated dark blood, providing rapid pain relief. If puncture is ineffective, an alpha-receptor agonist may be injected into the corpus cavernosum. For refractory priapism, surgical shunt may be necessary, but by then the corpus cavernosum has often already suffered irreversible damage.

Will I need to take medication for life?

Priapism caused by medication usually does not recur after discontinuation of the medication. Priapism caused by underlying diseases such as sickle cell anemia requires long-term management targeting the primary disease. If fibrosis has occurred in the corpora cavernosa, penile prosthesis implantation may be necessary to restore function.

Erectile dysfunction is the inability to get an erection, while priapism is the inability to go soft. The former is chronic, while the latter is acute. If it doesn’t subside after 4 hours, don’t hesitate to go to the hospital for a checkup.