We are sure you have heard the commercials about erection-inducing drugs and the dangers of producing a rock-hard cock that lasts longer than four (4) hours. This might seem like a minor problem, but if this occurs to you, you could be in for a very long night or even days of pain.

Having an erection that lasts through foreplay and sexual intercourse is our goal. If this hardon lasts just a bit longer for a second or third round, that can be fine too. But, there does become a point when it can outlast its usefulness and become a different sort of pain in the ass.

Many drugs are known to create this condition, from over-the-counter and prescription to illicit/illegal ones. Sometimes the combination of medications can also create priapism—also injuries to the penis and groin area as well as blood disorders such as sickle cell anima. Most concerning to us is the usage of party drugs and chem sex to purposefully cause long-lasting erections with injections directly into the penis shaft.

Since priapism is rare but considered a medical emergency if it happens, we will break it all down for you, from the causes and symptoms to treatment options and possible long-term side effects.

Let’s begin…

What is priapism?

Priapism is a persistent erection that lasts more than four hours and is not relieved by orgasm. Erections with this condition can be painful and are not always related to sexual activity and named for Priapus, the Greek god of fertility who sported an oversized, eternally-erect penis (so large he used it to frighten away anyone who tried to plunder his gardens).

The proliferation of erectile dysfunction medications like Viagra and Cialis into the social vocabulary has increased their availability to almost any gay man that wants them. When an attending physician prescribes these medications, they are done with all the proper warnings regarding safe usage. But, when provided by friends/sexual partners or even purchased online, the warnings about long-lasting erections are either not given or fall on deaf ears. In this respect, these medications fall into the “party drug” category.

Priapism can occur in all age groups, including newborns. However, it usually affects males in two different age groups: between the ages of 5 and 10 and 20 and 50.

Like most things in life, not all long-lasting erections are the same.

Ischemic priapism

Ischemic priapism, also called low-flow priapism, results from blood being unable to leave the penis. Blood is trapped in the penis because it cannot flow out of the veins of the penis, or there is a problem with the contraction of smooth muscles within the erectile tissue of the penis. Ischemic priapism is the more common type of priapism and requires immediate medical care to prevent complications caused by not getting enough oxygen to the penile tissue.

Ischemic priapism can also cause serious complications. The blood trapped in the penis is deprived of oxygen. When an erection lasts for too long — usually more than four hours — this lack of oxygen can begin to damage or destroy tissues in the penis. Untreated priapism can cause erectile dysfunction.

Signs and symptoms include:

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation
  • Rigid penile shaft, but the tip of the penis (glans) is soft
  • Progressively worsening penile pain

Stuttering priapism — also called recurrent or intermittent priapism — is a form of ischemic priapism. Stuttering priapism is an uncommon condition that describes repetitive episodes of prolonged erections and often includes episodes of ischemic priapism. It occurs more frequently in males with an inherited disorder characterized by abnormally shaped red blood cells (sickle cell disease). Sickle cells can block the blood vessels in the penis. In some cases, the condition starts with unwanted and painful erections of short duration and might progress to more frequent and prolonged erections. Stuttering priapism may begin in childhood.

Currently, there is no good medical management approach for treating stuttering priapism, as most therapies fail to prevent the underlying cause and focus on the acute management of the condition.

Nonischemic priapism

Nonischemic priapism, also known as high-flow priapism, occurs when blood flow through the arteries of the penis isn’t working correctly. However, the penile tissues continue to receive some blood flow and oxygen. Nonischemic priapism often occurs due to trauma.

Signs and symptoms include:

  • Erection lasting more than four hours or unrelated to sexual interest or stimulation
  • Erect but not fully rigid penile shaft
  • Usually not painful

No matter which type of priapism you believe you, or your partner, may have, it is essential to get to a doctor IMMEDIATELY for a complete and accurate evaluation. This is still true if your erection goes down on its own or due to some other intervention, to ensure that you do not experience another episode.

Causes

As strong and steady as the penis is, it is still a muscle that can be injured in various ways. We must always take care of our member so that he may take care of us and our partners.

Injury

A common cause of nonischemic priapism is trauma or injury to your penis, pelvis, or the region between the base of the penis and the anus (perineum).

Priapism can also be associated with injury to any part of the spinal cord, from the foramen magnum to the conus. A turgid semi-erect or erect priapism is always associated with a complete (American Spinal Injury Association A) motor and sensory paraplegia.

Other factors

  • A spider bite, scorpion sting, or other toxic infections
  • Trauma to the spinal cord or the genital area

*Erect even after death

Following judicial hanging in men, there may be a complete or partial erection with or without ejaculation (the terminal or death erection). Judicial hanging was thought to cause death via spinal cord and/or brainstem injury secondary to fracture and/or dislocation of the cervical spine.

However, post-mortem examination of 34 cases of execution by judicial hanging (1882–1945) demonstrated an axis (‘hangman’s) fracture in only six patients (18%) and cervical fracture in only 1 case. In those persons (the majority) with no cervical fracture following judicial hanging, loss of consciousness and death are probably the consequences of lacerations to, and hemorrhage from, the carotid or vertebral arteries.

Priapism has also been associated with fatal gunshot wounds to the brainstem or spinal cord.

Other medical issues

Overall, sickle-cell anemia is the most common reason for males of color to develop a case of priapism. This serious hereditary disease of the blood cells is most common among African-Americans and Hispanics of Caribbean ancestry. The condition cannot be cured, but treatments exist to help the pain and slow the death rate. Approximately 42% of all adults with sickle cell will eventually develop priapism.

But, other blood diseases (hematologic dyscrasias) such as thalassemia, multiple myeloma, and leukemia can also cause this condition.

Metabolic disorders, including gout or amyloidosis, may also cause priapism, carbon monoxide poising, penile cancer, and even syphilis.

Legal medications

More and more, people around the world are becoming increasingly medicated. Factors such as increased access to treatment and healthcare insurance are a couple of reasons, but so is overtreatment of illnesses that were once left to “run their course.” Due to these new methods and others, medications themselves may cause priapism as well as drug interactions.

Priapism, usually ischemic priapism, is a possible side effect of several drugs, including:

  • Medications injected directly into the penis to treat erectile dysfunction, such as alprostadil (Caverject, Edex, others), papaverine, phentolamine (Oraverse), and others
  • Antidepressants, such as fluoxetine (Prozac), bupropion (Wellbutrin XL, Wellbutrin SR), trazodone, and sertraline (Zoloft)
  • Alpha blockers including prazosin (Minipress), terazosin, doxazosin (Cardura) and tamsulosin (Flomax)
  • Medications used to treat anxiety or psychotic disorders, such as hydroxyzine (Vistaril), risperidone (Risperdal), olanzapine (Zyprexa), lithium (Lithobid), clozapine (Clozaril), chlorpromazine and thioridazine.
  • Blood thinners, such as warfarin (Jantoven) and heparin
  • Hormones such as testosterone or gonadotropin-releasing hormone
  • Medications used to treat attention-deficit/hyperactivity disorder (ADHD), such as methylphenidate (Concerta, Ritalin, others) and atomoxetine (Strattera)

No conversations about medically induced erections would be complete without mentioning Viagra, Cialis, or Levitra. These phosphodiesterase type 5 inhibitors (PDE5is) are prescribed to treat erectile dysfunction. One of the possible warning signs associated with these medications is priapism. But new research wonders if this precaution is being overblown.

The study used national-level data to identify drug-induced priapism cases. Reported and published cases of drug-induced priapism. They concluded that PDE5i-induced priapism is a rare event, and Drug-induced priapism should be attributed to a broader spectrum of medications that can cause this condition.

Rough statistics from the FDA’s adverse event reporting system (AERS) regarding the erectile dysfunction (ED) drugs Viagra, Cialis, and Levitra show a total of just 93 cases of prolonged erection greater than four hours or painful erection greater than six hours (priapism) in all of 2007 — 74  for Viagra, three for Levitra and 16 for Cialis. According to the FDA, physicians are encouraged to report suspected adverse events, although the event may be related to an underlying disease, another drug, or simple chance.

With this being said, those taking medications to treat and prevent HIV have been shown to have a greater sensitivity to these medications and receive a more significant potential outcome of effects than those who are not.

Illegal drugs

There are a few drugs that are known to induce particularly ischemic priapism. Some are explicitly used for their ability to cause long-lasting erections; others have this as a by-product of their usage.

  • marijuana
  • cocaine
  • alcohol

Reports are being made regarding an increase in the rare practice of men injecting drugs directly into their penis. Some erectile dysfunction drugs, such as prostaglandin or papaverine (Caverject, Trimix), are administered this way. Still, individuals are known to have injected cocaine, methamphetamine, and heroin into their genitals, often through the urethra or dorsal vein.

Some people abuse erectile dysfunction drugs to improve their sexual performance. Stimulant drugs like cocaine and methamphetamine also increase arousal and sexual pleasure. The idea is that injecting drugs directly into the penis produces a quicker and more intense effect in the desired area.

The penis isn’t the safest place to stick a needle. But that’s not the only danger associated with genital drug injection.

 Bacterial Infections

Injection drug use causes bacterial infections because of dirty or shared syringes. Even if you don’t use someone else’s needle, you can get an infection from reusing a needle. 

Bacterial infections can cause gangrene (death of tissue in the affected area). Gangrene spreads quickly. Sometimes, a doctor must amputate a limb to stop the spread and save the rest of your body from decomposing. 

Unexpected Adverse Effects

It’s rare to find pure cocaine (or heroin or methamphetamine). Street drugs are usually cut with various substances to stretch the supply. You don’t know all the ingredients in these drugs, nor how the additives will affect you. You may have an allergic reaction or worse.

Penile injection of drugs may also have different effects from what you’re used to. 

Drugs that enter the urethra are absorbed by mucous membranes and may produce an effect similar to snorting (insufflation). Drugs injected into penile veins could have the same effect as injecting them into arm veins, but they might not.

Overdose

Overdose is always a risk with drug abuse. While any method of taking drugs can lead to overdose, injection drug use is hazardous because it puts a strong dose directly into the bloodstream. 

Addiction

Duh!

How is priapism diagnosed?

You will first need to stay calm and get yourself to the emergency room if you have an erection lasting more than four hours. The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism.

At this point, honesty is truly the best policy. Tell your doctor:

  • How long you have had the erection.
  • How long your erection usually lasts.
  • If you have used any medication or drugs, legal or illegal. Be honest with your doctor—drug use is especially of interest.
  • Whether or not the priapism happened after trauma to that area of the body.

Your doctor will review your medical history and perform a physical examination to help determine the cause of priapism.

After the physical exam, the doctor will take a blood gas measurement of the blood from the penis. During this test, a small needle is placed in the penis, blood is drawn, and then it is sent to a lab for analysis. This provides a clue to the type of priapism, how long the condition has been present, and how much damage has occurred.

You should see your doctor if you experience recurrent, persistent, painful erections that resolve independently. You might need treatment to prevent further episodes.

Treatment

The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may decrease blood flow to the penis, may be very helpful. Other treatment options include:

  • Ice packs: Ice applied to the penis and perineum may reduce swelling.
  • Surgical ligation: Used in cases where an artery has been ruptured, the doctor will ligate (tie off) the artery causing the priapism to restore normal blood flow.
  • Intracavernous injection: This treatment is used for low-flow priapism. Drugs known as alpha-agonists are injected into the penis, and they cause the arteries to narrow, reducing blood flow to the penis and causing the swelling to decrease.
  • Surgical shunt: Also used for low-flow priapism, a shunt is a passageway surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
  • Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you think that you are experiencing priapism, you should not attempt to treat it yourself. Instead, get emergency help as soon as possible.

Before you go…

Even though priapism is rare outside those suffering from injury or blood disorders, the proliferation of guys self-medicating with drugs designed for erectile dysfunction and street drugs to induce long-lasting erections makes this condition more common.

We must take care of our member, know the signs of priapism in ourselves and our sexual partners, and seek treatment as soon as possible if it develops.

As long as treatment is prompt, the outlook for most people is excellent. However, the longer medical attention is delayed, the greater the risk of permanent erectile dysfunction.