'My erection won't go down' FAQs

An erection that won't go down is called priapism. It needs treatment if it lasts 4 hour or more.
What is it?

A prolonged erection that, if left untreated, can damage the penis. It's definitely no joke.

What are the main symptoms?
  • Persistent erection for more than four hours in the absence of sexual stimulation.
  • Penile pain. 
What's the risk?

Priapism can affect men of all ages but the risk is very small, although it's slightly greater for men with an underlying blood disorder (e.g. sickle cell anaemia) or those who are using injection treatments for erectile dysfunction (impotence).

What causes it?

Most cases (60%) are idiopathic (i.e. the cause is unknown). The remaining 40% of cases are usually caused by:

  • Reactions to drugs, especially those prescribed to treat erectile dysfunction (impotence), but also including antidepressants such as chlorpromazine.
  • In childhood leukemia the white blood cells can block the outflow of blood from the penis.
  • In sickle-cell anaemia the blood receives low levels of oxygen, causing it to thicken. This makes the outflow of blood from the penis sluggish.
  • Injury to the penis or to the area underneath the penis between the genitals and the anus known as the perineum.
  • Spinal cord injuries.
  • In rare cases cancers may affect the penis and prevent the outflow of blood.
  • A blocked or ruptured blood vessel can also affect blood flow in the penis. 
How can I prevent it?

You can't. 

Should I see a doctor?

You need to see a doctor as soon as you think there is a problem (i.e. if your erection hasn't disappeared after four hours). The visit will involve a physical examination and questions about any drugs you have been taking. The doctor may also take a blood gas measurement of the blood from the penis. This provides a clue as to how long the condition has been present and how much damage has occurred. A small needle is placed in the penis and blood is collected.

What are the main treatments?

If a patient gets treatment within four to six hours, the erection can almost always be reduced with medication. Decongestants can reduce the flow of blood to the penis.

If this fails, the old blood can be released from the penis through a small needle. The area will be cleaned first and numbed with a local anaesthetic.

If this treatment is performed in the first few hours, it may be all that is needed to correct the problem. However, if the erection persists or recurs, you will be given drugs that cause the blood vessels to constrict to prevent priapism.

If this is unsuccessful a minor surgical operation called shunting can be performed. This allows blood to drain from the erectile tissue into the glans and other tissues. As this procedure can result in permanent and irreversible impotence, it is essential that you go to your doctor as soon as you think you may have a problem. If necessary, go to the nearest accident and emergency department.

How can I help myself?

The most important thing to do is to seek medical help quickly. However, putting ice-packs on your penis can ease the pain of priapism. Running up and down stairs or using an exercise bicycle might also be worth a try. 

What's the outlook?

Providing that the priapism is dealt with quickly the outlook is very good. After prolonged priapism there is a very real risk of permanent impotence.

Who else can help?

Don't waste time contacting organisations or surfing the web: see a doctor as soon as possible.

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Date published 02/04/14
Date of last review 02/04/14
Date of next review 02/04/17


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