ASK DR.K: ASK DR K Four Hours Later

Updated: Mar 11, 2021

Dear Dr. K, “What’s the deal about an erection lasting longer than four hours? A four-hour boner sounds pretty good to me!”

There are serious and even permanent detrimental consequences that are caused by a prolonged erection. Medically the condition is called “priapism.” This term is derived from Priapus, a Roman fertility god who was noted for his oversized and permanent erection and figured prominently in erotic art and literature. He was a popular theme in Roman graffiti.

What causes priapism?

All “the penis pills” list priapism as a possible risk to the medication, but only a few cases have been reported. Taking more than the recommended dose is usually the cause of a prolonged erection. Some other medications, such as risperidone, an antipsychotic, and trazadone, an antidepressant, are known to cause priapism. Marijuana, cocaine, and alcohol also have been known to cause priapism.

Some medical diseases, such as sickle cell disease which causes misshaped red blood cells which get clogged in the smaller blood vessels, can cause recurrent episodes of priapism. Leukemia has also been reported as a cause.

The venom from spider bites and scorpion stings can produce priapism.


Treatment is available and essential. You can take treatment in your own hands by masturbating to ejaculation. This releases adrenalin which directs bloodflow away from the penis. Exercising has a similar effect. Neosynephrine nasal spray and Sudafed tablets have adrenalin-like effects and may correct the problem. If these fail to deflate the problem, then it’s time to put your “big boy pants” on (for obvious reasons) and head to the emergency room.

An injection of phenylephrine directly into the penis, constricts the blood vessels and thus slows the bloodflow into the penis. This causes the spongy material in the penile shaft to contract, forcing the blood out.

Often the blood may be too thick to drain on its own, so the physician may need to use a needle and syringe to draw off the blood. (Just the thought of that may cause you to go limp.) Occasionally more aggressive procedures need to be done. These involve surgical procedures to shunt the bloodflow in the penis.

In extreme cases the damage is so severe that the penis becomes necrotic and must be amputated. Fortunately, this is a very rare consequence and early intervention will preclude this complication.

After treatment for priapism there can be a temporary period of ED. In rare cases the ED is permanent.

So, you can see priapism, despite the jokes, is no laughing matter and you should not hesitate or be embarrassed to seek treatment.