Painful erections, also known as priapism, is generally not normal and individuals with this condition must pay attention to the duration of the erection. There are many causes of erection pain, most of them include problems with blood flow and circulation of blood to the penis. Other causes may arise from medication side effects, trauma to the penis, or urethritis. Read below for more information on causes and treatments for painful erections.
Symptoms of painful erection
An erection is the stiffening and enlargement of the penis due to increased blood flow. Erections are the result of a complex interplay of psychological, vascular and neural processes that are most often associated with sexual arousal; however, it is important to note that erections can be stimulated by other causes as well.
What is priapism?
Erections become painful when they persist. A painful erection is not normal, and this condition is called priapism. In priapism, beyond the pain, the most important painful erection symptom is the duration of the erection. An erection that lasts for more than 4 hours is a medical emergency and needs prompt attention.
Are painful erections serious?
Pain often goes hand-in-hand with an erection that persists for longer than normal, but even if you do not experience pain, you must seek medical attention for symptoms of prolonged erection in order to prevent serious complications. Blood trapped in the penis quickly loses oxygen. This oxygen-deprived blood can begin to damage and destroy the tissues of the penis leading to critical conditions such as erectile dysfunction and infertility.
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6 painful erection causes
Painful erections (priapism) occur when there are problems with how blood flows, or circulates, to and from the penis.
Problems in circulation to the penis can be categorized as:
- Ischemic: Blood not able to leave the penis
- Non-ischemic: Blood flow to and from the penis is not regulated properly
Conditions that affect the blood vessels, smooth muscles and nerves of the penis can all affect the circulation to the penis and result in either ischemic or non-ischemic causes of priapism. As a result, the causes of painful erection symptoms are varied and broad. It is very important to see your doctor in order to diagnose the root cause of the issue.
Certain blood disorders will result in painful erections.
Functional: Medical conditions that affect the way different components of your blood function for example, sickle cell anemia, a medical condition that affects the shape of your red blood cells, often results in ischemic priapism.
Synthetic: Medical conditions that affect the processes that regulate the production of the different components of the blood can result in ischemic priapism. For example, in leukemia, a condition in which your body makes too many blood cells, ischemic priapism can often occur.
Certain medications may result in painful erections.
- Prescription medications: Priapism is a possible side effect of a number of medications that you may be prescribed for other conditions. For example, antidepressants, hypertension medications and medication used to treat erectile dysfunction can all cause painful erection symptoms.
- Non-prescription medications/drugs: Recreational drugs such as alcohol, marijuana, cocaine and other illicit substances can cause many types of ischemic priapism.
Trauma or injury to the penis or pelvic area often causes non-ischemic priapism. Traumatic events can range from serious incidents such as motor vehicle accidents to seemingly benign causes such as an insect bite or sting. Regardless of the cause, traumatic events that lead to painful erection symptoms and penis pain must also be followed up immediately as well.
This list does not constitute medical advice and may not accurately represent what you have.
Urethritis is an infection of the urethra, which drains urine out of the body from the bladder. The urethra may be involved alone or with other structures in an overall urinary tract infection.
Urethritis is not a sexually transmitted disease (STD) in itself, but the same bacteria and viruses that cause STDs can also infect the urethra. Another common cause is the E.coli bacteria, found in feces.
Most susceptible are sexually active women, but anything that allows bacteria (especially E. coli) to travel into the urinary tract can cause an infection.
The most common symptoms are burning on urination and a cloudy discharge.
Diagnosis is made through urine test and a swab taken from the urethra. A urethritis patient should be tested for sexually transmitted diseases as well.
Treatment involves antibiotics, if the urethritis is caused by bacteria. Taking cranberry supplements can also be helpful, as long as the patient is not also taking the blood thinner called warfarin.
Top Symptoms: painful urination, penis pain, fluid leaking, pink/blood-tinged urine, cloudy urine
Urgency: Primary care doctor
Late onset hypogonadism
Late onset hypogonadism is also called LOH, androgen deficiency, or testosterone deficiency syndrome (TDS.)
It is a reduction in testosterone production sometimes found in men over 50. A small amount of loss is natural due to aging, but LOH causes symptoms that may be severe and can interfere with quality of life.
Testosterone is needed to maintain the male reproductive system, but it also influences many other functions including metabolism, bone density, muscle strength and formation, and clear thinking.
LOH is most often caused by a direct loss of functioning in the testicles due to the combination of aging and other illnesses, especially those which interfere with circulation such as obesity, diabetes, or heart disease.
It may also be due to malfunction in the hypothalamus and/or pituitary glands in the brain, which control hormone levels.
Symptoms include erectile dysfunction as well as a decrease in libido, muscle strength, and energy. Osteoporosis is also a risk.
Diagnosis is made through patient history and blood tests. Treatment involves testosterone replacement therapy, which usually has very positive effects.
Top Symptoms: fatigue, difficulty concentrating, trouble sleeping, depressed mood, irritability
Urgency: Primary care doctor
Hemochromatosis is a condition where there is too much iron in the body. Most commonly, this occurs due to faulty genes (usually the HFE gene) in iron regulation. When the disease is due to genetic reasons, it is called Hereditary Hemochromatosis (HH). HH is a lifelong (chronic) disease, whi...
A prolactinoma is abnormal growth of the cells that produce the hormone prolactin in the pituitary gland, a small endocrine gland at the base of the brain. Prolactinoma leads to hyperprolactinemia or excess levels of prolactin in the bloodstream. Prolactinomas can occur in men or women but are more c..
A urinary tract infection is an infection of the urinary tract, which includes the kidneys, bladder, and urethra. Urinary tract infections are usually caused by infections by fecal bacteria.
Symptoms of urinary tract infections include pain with urination (dysuria), ...
A penile fracture, also known as broken penis, occurs when there is traumatic injury to the penis.
Rarity: Ultra rare
Top Symptoms: penis pain, penis injury, swollen penis, penis bruise
Symptoms that always occur with penis fracture: penis pain, penis injury
Urgency: Hospital emergency room
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Treatments for erection pain
When painful erections are an emergency
As soon as you notice symptoms of priapism, seek emergency medical care.
Medical treatments for painful erections
The doctor will determine whether your painful erection symptoms are related to ischemic or non-ischemic causes, and depending on the cause, perform one or more the following treatments:
- Ischemic priapism: Treatment for ischemic priapism involves draining the blood from the penis and using medications to facilitate blood flow out and away from the penis . Your doctor may do a small procedure using a needle and syringe to drain excess blood from the penis. The medication will constrict the blood vessels that carry blood to the penis (arteries) in order to open up the vessels that allow blood to flow out (veins).
- Non-ischemic priapism: Treatment for non-ischemic priapism often does not require direct intervention . The painful erection often goes away with measures such as pressure and ice packs on the affected area.
- Surgery: This is only performed when the above treatments are unsuccessful and not often necessary. Your surgeon will perform a procedure that reroutes blood flow and allows the blood to move normally through the penis.
When to see a doctor for self-resolving painful erections
If you experience recurrent painful erection symptoms that resolve on their own, see your doctor. You might need treatment to prevent further episodes.
FAQs about painful erection
Why do I get painful erections in my sleep?
Getting painful erections in your sleep is not a common symptom. To get an erection in the absence of sexual desire is called priapism. This condition is serious and requires evaluation by a physician. The most common reason you may get painful erections in your sleep is due to sickle cell disease, a disease in which your red blood cells are abnormally shaped and can block off blood vessels.
Why do I have long and painful erections?
Long and painful erections are called priapism. This condition is serious, and if it lasts longer than 4 hours it requires emergency treatment. Priapism may occur without clear cause, or may be due to conditions such as sickle cell disease, thalassemia, spinal cord trauma, or genetic disorders. Priapism may also be caused by some medications such as drugs for erectile dysfunction, blood pressure medications, antidepressants, antipsychotics, anticonvulsants, and recreational drugs.
Can a UTI cause a painful erection?
Urinary tract infections (UTIs) generally do not cause painful erections. UTIs are very uncommon in men, and when they occur, they are usually due to structural abnormalities in the urinary tract or placement of a catheter. UTI symptoms include painful urination, frequent and urgent urination, bladder pain, and change in urine color. Systemic signs of severe UTIs include fever, chills, lightheadiness and fatigue.
Do STDS cause painful erections?
Sexually transmitted diseases (STDs, also known as sexually transmitted infections or STIs) do not cause painful erections; however, they can cause pain or burning with ejaculation. You may also experience pain from open sores on the penis from STD infection. If you note sores on your penis or have burning or itching with ejaculation, you should seek medical attention.
Questions your doctor may ask about painful erection
- Are you sexually active?
- Do you feel pain when you urinate?
- Have you noticed a decrease in your libido or sex drive?
- Have you ever been diagnosed with diabetes?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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- Drugs Reported to Cause Priapism. UCSF Health. UCSF Health Link.
- Anele UA, Le BV, Burnett AL, et al. How I Treat Priapism. Blood. 2015;125(23):3551-3558. NCBI Link.
- Muneer A, Alnajjar M. Recent Advances in the Management of Priapism. F1000Research. 2018;7:37. NCBI Link.