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.
10 most common cause(s)
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.
6 painful erection causes
Painful erections (priapism) occur when there are problems with how blood flows, or circulates, to and from the penis.
Ischemic/Non-ischemic
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.
Blood disorders
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.
Medications
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.
Traumatic causes
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.
Urinary tract infection
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), ...
Urethritis
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.
Rarity: Common
Top Symptoms: painful urination, penis pain, fluid leaking, pink/blood-tinged urine, cloudy urine
Urgency: Primary care doctor
Prolactinoma
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 common in women of childbearing age.
Common symptoms in women include amenorrhea (absence of a menstrual period), infertility and nipple discharge. Symptoms in men include decreased libido, erectile dysfunction, infertility, breast tissue enlargement, and rarely, nipple discharge. Additionally, because the prolactinoma occurs at the base of the brain, it can cause headaches or vision changes.
Prolactinomas can be treated with medications to lower the prolactin levels, with surgery to remove the tumor, or with radiation.
Penis fracture
A penile fracture, also known as a broken penis, occurs when there is a traumatic injury to the penis.
You should go to the emergency room as a penile fracture is a urologic emergency and often requires surgical treatment.
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
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 a 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.
Rarity: Common
Top Symptoms: fatigue, difficulty concentrating, trouble sleeping, depressed mood, irritability
Urgency: Primary care doctor
Hemochromatosis
Hemochromatosis is a condition where the body stores too much of the iron it receives from food. This iron builds up in the organs, especially the heart, liver, and pancreas, causing damage and eventually failure.
The condition is inherited. Most often it will first appear in men around the age of 30, and in women after menopause or hysterectomy.
Symptoms include ongoing fatigue; joint pain, especially in the first two fingers; abdominal pain; enlarged heart, liver, and spleen; mental confusion; reddish or ashen skin color; and irregular heartbeat.
It is important that any signs of hemochromatosis be seen by a medical provider so that treatment can begin before organ damage sets in. The condition can lead to many other illnesses including diabetes, cirrhosis of the liver, arthritis, some cancers, and some neurological disorders.
Diagnosis is made through blood tests, with confirmation through genetic testing.
Treatment involves regular blood donation; medication to help remove iron from the blood; and changing the diet to avoid foods high in iron, such as red meat and some fish.
Gonococcal urethritis
Gonorrhea is a sexually transmitted infection (STI) caused by a germ (bacterium) called gonococcus. This bacterium is spread by sexual contact, or through transmission during childbirth, and causes inflammation of the urethra, which is the tube that passes urine.
You should go to a retail clinic to be treated. They may likely refer you to be tested for sexually transmitted infections. If gonorrhea is confirmed, prescription antibiotics will be used for treatment. Please make sure you have protected intercourse until you have been tested.
Epididymitis
The epididymis is a coiled tube that stores sperm inside each testicle. Epididymitis is an inflammation of one or both of these tubes.
It is caused by a bacterial infection, most often from sexually transmitted diseases (STDs) such as chlamydia and gonorrhea. Epididymitis can also be caused by a urinary tract or prostate infection, or by trauma due to injury or heavy lifting.
Males of any age can be affected, though men engaging in unprotected sex are most susceptible.
Symptoms include redness, swelling, and pain in the testicle; pain on urination or ejaculation; discharge from the penis; and blood in the semen.
Any of these symptoms should be treated by a medical provider as soon as possible in order to prevent abscess or permanent damage.
Diagnosis is made through physical examination; penile swab for STD tests; urine and blood tests; and sometimes ultrasound of the testicles.
Treatment involves antibiotics as well as rest, cold packs to the testicles, wearing an athletic supporter, and refraining from lifting and sexual intercourse until the infection is gone.
Cushing syndrome
Cushing syndrome is a hormonal disorder that occurs when there is too much of the stress hormone cortisol in the body. It can be caused by taking steroid medications commonly prescribed for asthma or arthritis, or by problems with the glands in the body that are involved in creating cortisol. Symptoms can vary from person to person but often include easy bruising, a "hump" on the back, and stretch marks. Fatigue, a large stomach, red round face, and high blood sugar may also occur.
You should consider visiting a medical professional in the next week or two to discuss your symptoms. Cushing syndrome can be evaluated with a review of your symptoms and medical history, as well as blood tests. Treatment depends on the cause of your condition. If caused by steroid medication, you may be instructed to lower the dosage slowly over time. If caused by issues with your glands, surgery, radiation, or medication may be an option.
Chronic prostatitis
Chronic prostatitis is an ongoing inflammation or infection of the prostate gland, the small, walnut-shaped organ just below the bladder in men.
Prostatitis is most often due to common bacteria in the urine causing infection. It may also be caused by surgery or other trauma setting up an inflammation. In some cases, the cause remains unknown.
Men of all ages are susceptible. Risk factors include a past urinary tract infection; using a catheter for urination; or pelvic trauma from bike riding or horseback riding.
Symptoms include pain in the abdomen, low back, groin, and genitals; frequent need to urinate; pain, burning, and difficulty when urinating; urine that is cloudy or bloody; and painful ejaculation.
A medical provider should be seen for these symptoms since a bacterial infection can spread and lead to scarring, pain, and infertility.
Diagnosis is made through urine tests, blood tests, and ultrasound or CT scan.
Treatment involves antibiotics for bacterial prostatitis, though if all the bacteria are not destroyed the disease can become chronic. Nonsteroidal anti-inflammatory drugs are also helpful.
Acute prostatitis
Acute prostatitis is a sudden-onset bacterial infection of the prostate gland in men.
Bacteria can spread to the prostate through a urinary tract infection, or through a sexually transmitted disease such as gonorrhea or chlamydia. Infection can also start after a medical procedure such as a urinary catheter insertion.
Most susceptible are younger or middle-aged men with a urinary tract infection or STD (sexually transmitted disease;) a pelvic injury from trauma or from bicycling or other sport; an enlarged prostate; or a recent prostate biopsy.
Symptoms include pain and difficulty when trying to urinate; pain on ejaculation; pelvic and abdominal pain; fever; chills; and nausea and vomiting.
These symptoms should be evaluated by a medical provider because untreated prostatitis can lead to bacteremia of the blood ("blood poisoning,") prostatic abscess, and infertility.
Diagnosis is made through patient history, urinalysis, blood tests, and a physical examination which usually involves a digital rectal examination. Prostatitis does not cause prostate cancer.
Treatment is done with antibiotics, usually as an outpatient.
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 [4]. 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 [4]. 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.
Painful erection treatment quiz
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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 the placement of a catheter. UTI symptoms include painful urination, frequent and urgent urination, bladder pain, and a change in urine color. Systemic signs of severe UTIs include fever, chills, lightheadedness, 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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References
- Shigehara K, Namiki M. Clinical Management of Priapism: A Review. The World Journal of Men's Health. 2016;34(1):1-8. NCBI Link.
- Shah AP. Erection, Persistent. Merck Manual Consumer Version. Updated September 2017. Merck Manual Consumer Version Link.
- 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.