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Do you stay erect for a while after sex, or does your partner? You may think this is unusual, since you will have read that every man has a refractory period after ejaculation, during which he cannot achieve another orgasm for quite a while and his penis becomes flaccid. Any further sexual stimulation is unpleasant during this refractory period, which can last from minutes to more than a few hours, depending on the man's age and health.

Still, a remaining erection after orgasm isn't necessarily anything to worry about. Some men's erections immediately fade after ejaculation, leading their penises to become completely flacid. Other men's erections simply take a while to fully subside. 

Should you experience prolonged erections that continue for hours on end without sexual stimulation or being aroused, however, it is time to get in touch with your doctor. This condition is called priapism, and needs to be taken seriously enough to seek emergency medical care. 

What Causes Priapism (Prolonged Erections)?

Priapism comes in two types:

  • Ischemic priapism or low-flow priapism happens when blood is unable to leave the penis. This kind of priapism accounts for 95 percent of all cases. (It can, in some cases, be recurrent, in which case it is also called stuttering priapism.) This becomes more painful as time goes on, and your shaft will be completely erect, with the glans being soft. This kind of priapism can cause permanent damage and requires immediate medical attention.
  • Non-ischemic priapism or high-flow priapism is caused by dysfunctional blood flow. This is typically not painful, and though you are erect, your penis is not completely rigid. This isn't considered a medical emergency, but since you won't know for sure what is causing your prolonged erection, you still need to see a doctor. 

Prolonged erections can be caused by numerous different factors. The cause will never be identified in most cases, which remain idiopathic. Priapism can, however, result from:

  • Sickle cell disease (sickle cell anemia)
  • Alcohol and drug abuse
  • Prescription medications, especially hormones and injectable medications — note that Viagra is highly unlikely to cause priapism unless you are also taking prostaglandins
  • Injury of the perineum
  • Leukemia 
  • Other blood disorders
  • Penile cancer

How Do I Get Treated For Priapism?

You can expect a bunch of blood tests to figure out whether your blood has enough oxygen and whether you are suffering from sickle cell disease, as well as an ultrasound of the penile area and a drug screen. Once your healthcare team figures out whether your priapism is ischemic or non-ischemic, a few different treatment options are available. 

Non-surgical management of ischemic priapism includes:

  • Corporal aspiration, in which excess blood is removed from your penis. The success rate is around 30 percent.
  • The injection of medications that promote blood flow into the penis. The success rate is around 80 percent in this case.
  • Alternatives mentioned in scientific literature include gentle exercise, ejaculation, oxygen, applying an ice pack, and hydration. It is not currently clear just how effective these conservative management strategies are. 

Any identified underlying causes of your priapism, such as sickle cell disease, may need to be managed at the same time. You will also be offered pain relief.

Should these treatments not work, penile shunt surgery will be recommended, to facilitate normal blood flow within your penis. 

If you are diagnosed with non-ischemic priapism, your doctor will most likely adopt a wait-and-see approach. The issue will most probably resolve on its own.

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