Priapism

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 4 Jun 2025

Last updated: 06 Sep 2022

Priapism is a pathologic condition of persistent penile erection (>4 hours) in the absence of sexual excitation.

Classified as ischemic, nonischemic, or recurrent/stuttering.

Diagnosis is based on history, clinical findings, and assessment of cavernous blood gases and/or color duplex ultrasound.

Treatment of priapism should progress in a stepwise fashion.

Ischemic priapism warrants emergency management. First-line therapy includes therapeutic aspiration of blood with intracavernous injection of diluted alpha-adrenergic sympathomimetic agents. Surgical shunt procedures are performed in refractory cases.

Nonischemic priapism is managed by observation. If a patient desires active treatment, selective cavernosal artery embolization may be considered.

Acute episodes of recurrent or stuttering priapism are managed the same as ischemic priapism, followed by treatment of any underlying condition (e.g., sickle cell disease).

Complications include penile fibrosis and erectile dysfunction.

Definition

Priapism is defined as a prolonged and persistent penile erection lasting >4 hours, unassociated with sexual interest or stimulation.[1] It is a true medical emergency with complications potentially resulting in permanent erectile dysfunction.[2] In stuttering or recurrent priapism, individual priapic episodes may last <4 hours.

History and exam

Key diagnostic factors

history of current systemic disease
history of vasoactive medication or drug use
prolonged erection of >4 hours' duration
painful rigid penis
penis not fully rigid and not painful
history of perineal or genitourinary trauma

Full details

Risk factors

hemoglobinopathy
vasoactive drugs
perineal or penile trauma
malignancies or local infection
spinal cord disease

Full details

Diagnostic tests

1st tests to order

corpus cavernosum blood sampling
CBC and differential

Full details

Tests to consider

color duplex ultrasonography
MRI
Hb-solubility testing
Hb electrophoresis
medication/toxicology urine screen
coagulation profile

Full details

Treatment algorithm

ACUTE

ischemic or recurrent (stuttering) priapism

nonischemic priapism

ONGOING

recurrent (stuttering) priapism

Contributors

Authors

Martin S. Gross, MD

Assistant Professor of Surgery (Urology)

Section of Urology

Dartmouth-Hitchcock Medical Center

Lebanon

Disclosures

MSG is a consultant for Coloplast. MSG is an author of a reference cited in this topic.

Acknowledgements

Dr Martin S. Gross would like to gratefully acknowledge Dr Helen R. Levey Bernie, Dr John Mulhall, Dr Trinity Bivalacqua, Dr Onder Canguven, and Dr Arthur L. Burnett, previous contributors to this topic.

Disclosures

HRLB and JM declare that they have no competing interests. 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

Wayne Hellstrom, MD

Professor of Urology

Department of Urology

Tulane University Health Sciences Center

New Orleans

Disclosures

WH declares that he has no competing interests.

Siam Oottamasathien, MD

Assistant Professor

Division of Pediatric Urology

University of Utah

Primary Children's Medical Center

Salt Lake City

Disclosures

SO declares that she has no competing interests.

Gabriel Rodriguez, MD

Associate Professor

Section Head of Minimally Invasive Surgery

The University of Texas Medical Branch

Galveston

Disclosures

GR declares that he has no competing interests.

Edmund Sabanegh, Jr, MD

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

Disclosures

ES declares that he has no competing interests.

Ates Kadioglu, MD

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Bivalacqua TJ, Allen BK, Brock GB, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism: an AUA/SMSNA guideline. J Urol. 2022 Jul;208(1):43-52.Full text Abstract

European Association of Urology. Guidelines: sexual and reproductive health. 2022 [internet publication].Full text

National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease: expert panel report, 2014. Sep 2014 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Peyronie disease
- Penile implant
More Differentials
Guidelines
- Sexual and reproductive health: priapism
- Sexual and reproductive health: priapism
More Guidelines
Patient information
Erection problems
More Patient information
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Priapism

Summary

Definition

History and exam

Key diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

ischemic or recurrent (stuttering) priapism

nonischemic priapism

recurrent (stuttering) priapism

Contributors

Authors

Martin S. Gross, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Wayne Hellstrom, MD

Disclosures

Siam Oottamasathien, MD

Disclosures

Gabriel Rodriguez, MD

Disclosures

Edmund Sabanegh, Jr, MD

Disclosures

Ates Kadioglu, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice