Priapism (Greek πριαπισμός, the erection) is a painful and potentially harmful medical condition in which the erect penis (erection) does not return to its flaccid state (despite the absence of both physical and psychological stimulation) within four hours.

Priapism is a medical emergency and needs proper treatment by a qualified medical practitioner.

Causes

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The causative mechanisms are poorly understood but involve complex neurological and vascular factors. Priapism may be associated with prolonged sexual activity, leukaemia, Fabry's disease, haematological disorders (such as sickle-cell disease), cerebrospinal disease (such as syphilis), genital infection, some spinal injuries, or inflammation (Beers & Berkow, 1999). Priapism can be caused by drugs such as certain antidepressants, antihypertensives, anticoagulants and corticosteroids. It can also be a withdrawal symptom of drugs such as heroin. Priapism is often present in spinal injuries or trauma to the spinal cord. This is partly because much of the spinal cord's efferent signals to the genitals are inhibitory: once these are removed the penis is disinhibited and will become erect. Of note is the fact that in copulating praying mantises the act by the female of eating the head of the male causes disinhibition of the mating end of the male and more effective copulation. It is also said a hanged man will get an erection and may ejaculate. This is, however, not caused by disinhibition of the penis, but rather due to blood rushing to the bodily extremities upon hanging.

One of the more significant classes of drugs which may precipitate priapism are the phosphodiesterase type-5 (PDE5) inhibitors such as sildenafil (popularly Viagra), tadalafil and vardenafil. Injected erectile-dysfunction therapies such as alprostadil are also significant. The antidepressant/sedative trazodone has also been associated with priapism.

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