Erection lasting 4 hours

Unfortunately, in the small percentage of men suffering from priapism, the system goes haywire and they’re unable to get rid of their erection once it shows up. In a nutshell, blood can get in but it can’t get out, a condition that sounds a bit like one of those old Roach Motel commercials, but is actually quite serious.

“If an erection is left in place for more than 12 hours, damage to the tissue in the erection chambers can occur,” says Sharlip. “It can be a cause of serious erectile dysfunction. They may be able to get a partial erection in the future, but not a full erection.”

Worse yet, there have been reported cases of permanent penile injury thanks to untreated priapism. Dr. Christopher Steidle, author of “The Impotence Sourcebook,” details the case of “H.A.,” a medical professional who, after reading about the treatment of erectile dysfunction with penile injections, injected himself with an excessive dose.

Unfortunately, he then developed priapism, but was so embarrassed he went for seven days before seeking medical help. According to Steidle, “the resulting erection was unsalvageable, and the patient was left with a penis that was less than an inch long.”

If you should find yourself with a four-hour erection on your hands, the sooner you seek treatment (which usually involves either draining the blood from the area with a needle or doing the same thing with a surgical shunt), the better off your penis will be.

As for those who would make light of what doctors consider a serious medical emergency?

“I suppose it’s funny to talk about,” says Sharlip. “But it’s not funny when it happens to you.”

This information describes what to do if you develop priapism.

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About Priapism

Priapism is an erection that lasts too long. Priapism can develop without sexual stimulation and doesn’t go away after orgasm. There is a risk of having priapism after penile injection therapy.

When you have a full erection, no fresh blood flows into your penis. This means that your penis isn’t getting oxygen, which can damage the tissue and lead to permanent erectile dysfunction (ED).

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About Pseudoephedrine HCl (Sudafed®)

Figure 1. Pseudoephedrine HCl (Sudafed)

If you have priapism, taking pseudoephedrine HCl can help. You can buy pseudoephedrine HCl at your local pharmacy without a prescription, but the boxes are kept behind the pharmacy counter.

To buy pseudoephedrine HCL, take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 1). You will have to show a photo ID before the pharmacist gives you the box to purchase.

If you have problems with your heart, talk with your cardiologist about whether it’s safe for you to take pseudoephedrine HCl.

If you’re taking penile injections, make sure to have pseudoephredrine HCl with you as long as you’re using the injections.

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If You Develop Priapism

  • If you have an erection at penetration hardness (a 6 or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed). Don’t take extended-release or long-acting tablets, such as Sudafed 12 hour. Ask your pharmacist or APP if you have any questions. The pseudoephedrine HCl will be shipped by the compounding pharmacy along with the vial of medication and syringes, or you can buy it at your local pharmacy.
    • If your erection becomes less than penetration hardness within an hour of taking pseudoephedrine HCl, call your doctor’s office the next day to speak with your APP. You shouldn’t continue to inject with the same dose if you took pseudoephedrine HCl for a prolonged erection. Your APP will make changes to your penile injection therapy medication dose.
  • If you have an erection that lasts 4 hours and you haven’t talked to your APP, this is a medical emergency. You should treat it with the same urgency as a heart attack. Erections lasting longer than 4 hours can cause permanent damage to your erection tissue.
    • Go to MSK’s Urgent Care Center if you’re less than 30 minutes away. Ask the guard at the entrance to the hospital how to get there.
    • Go to your local emergency room if you’re more than 30 minutes away from Memorial Hospital.
    • Tell the staff at the Urgent Care Center or emergency room that you’ve had an erection for 4 hours. A doctor or nurse should see you immediately. If you aren’t treated quickly, it’s possible that you will end up with permanent ED.
    • Give the doctor or nurse the priapism card that was given to you to carry in your wallet. You can also have the doctor or nurse call us at the numbers listed above.

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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.

We don’t currently post comments online but are always keen to hear your feedback.

How Long Do “Normal” Erections Last?

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

How Long Erections Last

According to a 2005 Journal of Sexual Medicine study of 500 couples across Europe and the US, the average erection during sex lasts 5.4 minutes. But “normal” erections can last anywhere from a few minutes to hours or even longer. How long erections last depends on your:

  • Age
  • Health
  • Sexual activity
  • And what kind of erection you get (yes, there are different kinds)

Different Types of Erections

Nocturnal erections (including “morning wood”) can last up to 25 minutes. Erections also last for various amounts of time during masturbation vs intercourse. The J. Sex Med study also concluded that erections don’t last as long in older men. In the study, the men under 30 lasted over two minutes longer during sex than men over 50:

  • 18-30 year olds: 6.5 minutes avg.
  • 51+ year olds: 4.3 minutes avg.

But it’s important to point out that the study has some important flaws. The study didn’t include any gay couples. Also, the clock only started at the beginning of vaginal penetration, ending with (male) orgasm. The study ignores foreplay completely, so take the results with a grain of salt.

Is It Normal to Get Erections?

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Erections are a perfectly normal function of the male body, especially in guys who are going through puberty.

What Is an Erection?

An erection is a hardening of the penis that occurs when sponge-like tissue inside the penis fills up with blood. Usually, an erection causes the penis to enlarge and stand away from the body.

Erections can go away on their own or after ejaculation, the release of semen through the urethra, the small hole at the tip of the penis.

Sometimes guys ejaculate at night while sleeping (these are called nocturnal emissions or wet dreams). Guys may have several erections and arousal periods while in the REM (rapid eye movement) stage of sleep, the type of sleep in which most dreams occur.

What Causes Erections?

Although many erections are caused by sexual arousal, such as watching a sexy television show or fantasizing, many erections seem to happen for no particular reason.

So if you’ve had an erection in an odd or embarrassing situation — like right in the middle of a really boring history lesson — there’s no reason to worry that something is wrong with you. Your body is just acting naturally for a guy your age.

Am I Getting Too Many Erections?

Because each guy is different, it’s impossible to say what’s a “normal” number of erections. Some guys experience many erections each day, whereas others may not experience any.

Hormones fluctuate with age, sexual maturity, level of activity, and even the amount of sleep a guy gets. Unless your erections are causing you discomfort or pain, don’t worry about how many you get.

If you’re concerned, talk to your doctor, who can answer your questions and probably put your mind at ease.

What Can I Do to Avoid Getting Erections?

Because erections usually aren’t controllable, there’s not much you can do to avoid getting them. Unless the penis is stimulated enough to ejaculate, time is the only thing that will help them go away.

As your hormones settle down and you advance through puberty, the frequency of unexpected erections and wet dreams should decrease.

Reviewed by: Steven Dowshen, MD Date reviewed: November 2017

12 Surprising Facts About Erections

Whether you have one or not, you probably think you know everything there is to know about penises. But erectile dysfunction (ED) affects up to 30 million American men, many of whom don’t understand how or why it happens.

1. Most men with ED don’t actually have ED. Older men are more likely to suffer from erectile dissatisfaction than erectile dysfunction. This means that getting and keeping an erection has become more difficult and is more frustrating than it once was, but it’s not impossible.

2. Penises are fragile. Yes, you can break your penis. It’s not like a broken bone, though — instead, the blood vessels within the penis burst, causing painful swelling. According to the UK’s National Health Service, one-third of penile fracture cases are attributed to sexual intercourse where the partner is on top.

3. Erections happen early. Like in the womb, early. Male fetuses can experience erections in the womb.

4. Medications for ED don’t always work. Drugs designed to help men with ED regain a healthy sex life only work in about two-thirds of cases. Also, Psychology Today reports that some men need increasingly larger doses, which come with increasingly intense side effects.

Is erectile dysfunction inevitable? “

5. Shorter penises make bigger erections. Research shows that men with shorter penises experience erections that increase penis size by 86 percent. For longer penises, the growth is more like 47 percent.

6. The average erection is 5.6 inches long. A 2013 study attempted to settle penis size once and for all. The findings: The average erect penis is just shy of 5.6 inches. The data came directly from study participants, who self-measured, so there is the question of how many exaggerated.

7. The world’s largest erection is 13.5 inches. Jonah Falcon is said to have the world’s largest penis that, when erect, is well over 1 foot long. When flaccid, it measures 9.5 inches.

8. ED can signal a serious health problem. Sometimes, sexual problems are a sign of bigger issues. According to the Mayo Clinic, ED can be caused by heart disease, diabetes, Parkinson’s disease, multiple sclerosis, high cholesterol, and more.

9. Erections aren’t required for orgasm. Yes, men who can’t achieve erections may still have orgasms.

10. Lifestyle choices can make you more prone to ED. Alcoholism, drug use, being overweight, smoking, certain medications, and even “prolonged bicycling” can lead to ED, according to the Mayo Clinic.

5 natural treatments for erectile dysfunction “

11. Men have between three to five erections per night. Every night while you’re sleeping, your penis is hard at work. The average man experiences up to five erections while they sleep, each lasting about 30 minutes.

12. ED stress can make matters worse. ED can cause psychological stress, and psychological stress can cause ED. When men are frustrated by their inability to perform, it can make it even more difficult to overcome ED. Talking with a doctor or sex therapist may help.

Dealing with Erectile Dysfunction

  • Penile Injections. A penile injection is when you give yourself a shot of medicine in the base of your penis when you wish to have an erection. This medicine lets more blood flow to your penis. You will usually get an erection in about ten minutes which will last for 30 to 60 minutes. With this method, you do not need to be sexually stimulated in order to get an erection. If you use this method, you will be taught by your doctor or healthcare team how to give yourself a shot. It may take several tries before you are able to give yourself the shot the right way. If this medicine does not help, there are ways to help you have an erection with external medical devices (an object used outside of the body which is useful to treat a medical condition).
  • MUSE. MUSE® is a small pellet of medicine that is placed in your urethra with a disposable plastic applicator. The opening to your urethra is where the urine comes out of your penis. The medicine is smaller than a grain of rice. This medicine lets more blood flow to your penis. You will usually get an erection in five to ten minutes which will last for 30 to 60 minutes. With this method, you do not need to be sexually stimulated in order to get an erection. No needles are used with MUSE. If this medicine does not help, there are ways to help you have an erection with external medical devices.
  • Penile rings and vacuum pumps. These are external medical devices that help you with your erections. Penile rings are best for men who can get erections but can’t keep them. The rings are made of rubber and are placed around the base of the penis to make it rigid enough for sex. A vacuum pump is for men who can’t get or keep erections. The vacuum pump is made up of a clear plastic cylinder and a pump that may be hand or battery operated. The vacuum pump is placed over the penis. As air is taken out of the cylinder, blood is drawn into the penis. This makes your penis enlarge. A ring is then placed around the base of your penis to maintain the erection. It may take up to two weeks for a man to be comfortable with using a vacuum pump. It is important that you use these devices the right way and that they fit the right way. Your doctor or healthcare team should explain how to use them and how to buy them.
  • Penile implants. It is normal for your doctor to try and treat your erectile dysfunction with medicine or external medical devices first. If these options don’t help you get an erection, you may want to talk to your doctor about the chance of getting a penile implant. A penile implant is a medical device put in your penis during an operation. The implant will help you have a mechanical erection (the ability to have an erection using a medical device placed in your penis during an operation).
  • How May Erectile Dysfunction Affect My Sex Life?

    Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.

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    If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a “problem shared is a problem halved.” Not everyone wants a sexual relationship. Don’t try to guess or assume what your partner wants. Have an open and honest discussion with your partner.

    This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.

    When you’re ready to start having sex again, talk to your doctor or healthcare team. Other people you can talk to about your relationship include a counselor, your minister, a health professional, or other men in prostate cancer support groups. Your partner can be a valuable support if you’re feeling a little nervous about doing all the talking. Take them with you when you see your doctor. Please talk to your doctor or healthcare team about how you are doing with intimacy.

    Are There Things I Can Do To Help Myself If I Have Erectile Dysfunction?

    Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.

    Some changes you may want to consider are:

    • Try to exercise on a regular basis.
    • Try to eat a healthy diet.
    • Drink responsibly. Long-term, heavy drinking lowers your ability to have an erection.
    • Try to lower your stress and fatigue (extreme tiredness). Being diagnosed with prostate cancer and working in all the changes it brings to your life can be stressful. Stress and the tiredness caused by your prostate cancer treatment, can make it difficult for you to “get in the mood.” Many men going through prostate cancer treatment feel this way. Talking with your partner might help lower your stress. You may also speak to your doctor or healthcare team about how you are feeling. They are there to help you through this time.
    • Stop smoking. Research studies show that smoking can harm your ability to have sex. If you need help to stop smoking, speak with your doctor or healthcare team.
    • Practice your Kegel exercises. Kegel exercises help strengthen your pelvic floor muscles, which support your bladder and bowel. These muscles also help with erections. For more information, please see the IMPACT booklet, “Kegel Exercises for Men.”

    How May Erectile Dysfunction Affect My Sexual Relationships?

    Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a man’s self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance (your body image). All of these things may result in a lack of interest in sex.

    If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.

    If you have a partner, it is important that you involve them in any decisions you make about treatment for erectile dysfunction. The loss of sex in a relationship, changes in the way a couple have sex, or starting sex again after prostate cancer treatment can all affect a relationship. Your partner can go with you to your doctor appointments to learn more about your prostate cancer treatment and how to manage your side effects. Relationship therapy may also be available to you.

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    What Can I, As a Partner, Expect?

    One of the effects of prostate cancer treatment is erectile dysfunction or impotence. This means that your partner may not be able to have erections that are hard enough for him to have sex with you or that he may not be interested in sex because of the medicine he is taking to treat his prostate cancer. This affects not only the man, but you, too, as his intimate partner. If you are the partner of a man with erectile dysfunction, it can be difficult to cope with changes in your sexual relationship. Sometimes men struggle to come to terms with changes in their body image or their ability to perform sexually. This can sometimes result in him staying away from intimate (very private or close) situations where he may feel under pressure to make love. As a partner you may feel rejected by what seems like a lack of sexual interest or intimacy. This may not have anything to do with his feelings for you, but is a result of his cancer treatment. Erectile dysfunction can be difficult for both of you. You may want to reassure your partner that:

    • Sex is not as important as long as he is healthy and that he is no less of a man to you
    • You will work through it with him
    • You understand his feelings
    • He is important to you

    It may help if you explain to your partner how important nonsexual touching and intimacy such as kissing and cuddling is to you.

    However, it is important to understand that sex may be very important to both of you. This may be an opportunity for you to experiment sexually with each other and work on ways to remain intimate, even when an erection is not possible. There are many different ways to be sexual. Take this time to explore, together, the things you can do with each other that are sexually exciting. Explore a variety of options to maintain sexual and emotional intimacy and satisfaction. If you are used to your partner being the sexual initiator, this may be the time for a little role-reversal. It is OK for you to tell your partner that even though he has erectile dysfunction, you want to stay in touch physically and intimately. Talk to your partner about ways to do this. Instead of trying to “fix your sex life” take this as a time to “play.” Again, please don’t hesitate to talk to your partner’s doctor or healthcare team, if you are having difficulties with your partner’s erectile dysfunction.

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    What Have I Learned By Reading This?

    You learned about:

    • What erectile dysfunction is
    • Why prostate cancer treatment can cause erectile dysfunction
    • What can be done about erectile dysfunction
    • How erectile dysfunction may affect your sex life
    • What your partner can expect

    If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.

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    Key Words

    • Antidepressant: Medicine used to prevent or treat clinical depression .
    • Appearance : Your body image.
    • Applicator : A simple tool used to put on medicine.
    • Artificial : Man made.
    • Climax : Orgasm.
    • Clinical depression : a disorder marked by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of hopelessness, and thoughts of death.
    • Disposable : Made to be thrown away after you use it.
    • Dry orgasm: orgasm without the release of semen.
    • Doses : Amounts.
    • Ejaculate: The process of semen leaving the penis during sex.
    • Erectile dysfunction: When a man’s penis does not get hard enough for him to have sex.
    • Erection : When your penis is hard enough to have sex.
    • External medical device : An object used outside of the body which is useful to treat a medical condition
    • Fatigue : Extreme tiredness.
    • Hormone therapy : A cancer treatment that lowers the amount of testosterone in your body.
    • Impotence: When a man’s penis does not get hard enough for him to have sex.
    • Intimate Partner: Someone you have sex with.
    • Intimate : Very private or close.
    • Libido : Your sex drive.
    • Lifestyle : A way of life or style of living.
    • Mechanical erection : The ability to have an erection using a medical device placed in your penis during an operation
    • Orally : Taken by your mouth.
    • Orgasm : The highest point of sexual excitement. This is comes with strong feelings of pleasure and normally by ejaculation of semen by the male and by vaginal contractions within the female. Also called climax .
    • Prostate gland : A gland about the size of a walnut and located under the bladder surrounding the upper part of the urethra. This gland produces semen and is found only in men.
    • Radiation therapy : a cancer treatment that uses high energy beams, such as xrays, to kill cancer cells and to stop them from spreading.
    • Radical Prostatectomy (ra-di-cul pros-tatek-toe-me): A cancer treatment where a surgeon removes your prostate gland during an operation.
    • Semen: The fluid that carries sperm.
    • Sex drive : Your Libido.
    • Side effects: Unwanted changes that may occur in your body during or after prostate cancer treatment.
    • Sexual initiator : Partner who begins the act of sex.
    • Stimulated : Excited
    • Testosterone: Male hormone that is made in the testes and is needed for erection to happen and for a man to be interested in sex.
    • Urethra: The tube that takes urine from the bladder and semen from the prostate gland, through the penis to the outside of the body when a man urinates.

    Our Prostate Cancer Mission is You

    Patient Story >
    Barry Broughton is a successful marketing executive who has traveled the world and faced a lifetime of challenges. But few challenges would be as difficult as the diagnosis he received last year of prostate cancer.

    Meet Our Doctors >
    The Department of Urology at UCLA is one of the most progressive and comprehensive urology programs in the country. Our faculty members work side by side with research scientists for new cures and treatments for prostate cancer.

    Make An Appointment >
    Our goal is to provide you with fast, easy access to the physicians and services at UCLA. For assistance in determining which UCLA urologist(s) may have expertise to help you, please call the Urology Appointment phone number:

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    When a Good Thing Turns Bad

    An erection that lasts longer than a few hours can be very bad news.

    An erection that lasts too long? “No such thing!” you say.

    Sorry guys, but once again, you definitely can get too much of a good thing. Priapism—a prolonged erection unrelated to physical or mental stimulation—is no prize. Within an hour or so, your penis may begin to hurt, and within six hours permanent damage leading to impotence can begin. An inappropriate erection isn’t a cause for celebration, it’s an invitation to the emergency room.

    What in the world can cause good news to become so bad? Less commonly, an injury to the area between your scrotum and your anus (actually an extension of your penis inside your body) may rupture arterial vessels carrying blood into the penis, causing it to engorge. Arterial priapism usually isn’t immediately dangerous, and it can usually be corrected without too much difficulty. But it’s still reason to see your doctor ASAP.

    More often, an erection persists because veins that carry blood from the penis are squeezed shut, trapping blood inside. Tissue throughout the body, and especially in the penis, depends on a steady flow of fresh blood to supply it with nutrients and oxygen. As a result, priapism caused by vein shutdown can be very dangerous indeed.

    Only in about half the cases do we know what causes vein-induced priapism. Some drugs—such as sedatives, antidepressants, blood thinners, and high-blood pressure medications—have been implicated, and blood disorders such as sickle-cell anemia are known to increase the risk. Reports also link extended sexual activity to the disorder. Medical researchers have also noticed that priapism appears to run in families, although we’ve not found just what it might be that’s passed along in a father’s genes.

    As long as man with a prolonged erection gets help promptly, the prognosis is good. In the case of an arterially induced problem, clotting may be encouraged or a relatively simple surgical correction may be called for.

    When veins shut down, the situation is more urgent. There are drugs that open things up, and ice packs may help. In some cases, the old blood may need to be removed with a needle in order that fresh may flow in. Given soon enough, treatments are almost always effective.

    If you have an erection that lasts longer than a few hours, doesn’t go away in the absence of stimulation, and hurts, don’t worry about embarrassment. Worry about your future. The important thing is to get help quickly.

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