Summary
Definition
History and exam
Key diagnostic factors
- hx of current systemic disease
- hx of vasoactive medication or drug use
- prolonged erection of >4 hours' duration
- painful rigid penis
- penis not fully rigid and not painful
- hx of perineal or genitourinary trauma
Risk factors
- hemoglobinopathy
- vasoactive drugs
- perineal or penile trauma
- malignancies or local infection
- spinal cord disease
Diagnostic investigations
1st investigations to order
- corpus cavernosum blood sampling
- CBC and differential
- Hb-solubility testing
- medication/toxicology urine screen
Investigations to consider
- color duplex ultrasonography
- ultrasound
- penile arteriography
- Hb electrophoresis
Treatment algorithm
Contributors
Authors

Urology Resident
Department of Urology
University of Rochester Medical Center
Rochester
NY
Disclosures
HRL declares that she has no competing interests.
Professor of Urology
Director of the Sexual and Reproductive Medicine Fellowship
Memorial Sloan-Kettering Cancer Center
New York
NY
Disclosures
JM declares that he has no competing interests.
Dr Helen Levey and Dr John Mulhall would like to gratefully acknowledge Dr Trinity Bivalacqua, Dr Onder Canguven, and Dr Arthur L. Burnett, previous contributors to this topic. TB is an author of a number of references cited in this topic. ALB has been reimbursed by Pfizer Inc. and Lilly LLC for attending symposia, speaking, organizing education, and consulting, and has received research grants that support laboratory staff. OC declares that he has no competing interests.
Peer reviewers
Professor of Urology
Department of Urology
Tulane University Health Sciences Center
New Orleans
LA
Disclosures
WH declares that he has no competing interests.
Assistant Professor
Division of Pediatric Urology
University of Utah
Primary Children's Medical Center
Salt Lake City
UT
Disclosures
SO declares that she has no competing interests.
Associate Professor
Section Head of Minimally Invasive Surgery
The University of Texas Medical Branch
Galveston
TX
Disclosures
GR declares that he has no competing interests.
Director
Center for Male Fertility
Glickman Urological and Kidney Institute
Cleveland
OH
Disclosures
ES declares that he has no competing interests.
Professor of Urology
Division of Andrology
Department of Urology
Faculty of Medicine
Istanbul University
Istanbul
Turkey
Disclosures
AK declares that he has no competing interests.
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