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Highlights
- Priapism is any erection that’s persistent and painful.
- The most common form of priapism is when blood flow to the penis is somehow interrupted.
- Priapism from Viagra is rare and most commonly caused by drug interactions.
- Get familiar with possible risk factors such as blood or circulatory problems before taking Viagra.
Viagra (sildenafil) is one of the most popular treatments for erectile dysfunction (ED) on the market. And as long as it’s been around, there have been jokes about an erection lasting four or more hours. Yet priapism, as it’s called, isn’t a laughing matter; it can cause impotence or permanent damage to the penis. So how common is Viagra’s most alarming side effect? Spoiler alert: You’re at very low risk of it happening to you.
What Is Priapism?
At its most basic level, priapism is a persistent and painful erection. A typical erection usually lasts for up to half an hour, although that’s a flexible time limit that depends on factors like age and the presence of stimulation. Any erection lasting substantially longer than that may be a sign of priapism.
There are three possible types of priapism:
- Ischemic. The most common form, this is when blood flow out of the penis is restricted in some way. Generally, the shaft of the penis is hard, but the glans is not. It’s also notably painful and gets more painful over time.
- Nonischemic. Rarer than ischemic, nonischemic priapism is usually caused by medication such as blood thinners or by penis injury. This type of priapism usually has little risk of long-term damage and will resolve on its own.
- Recurrent. Most common in people with sickle cell disease and similar disorders, this condition is defined by ongoing episodes of ischemic priapism.
Regardless of the type, if you have an erection for a prolonged period of time, it’s a serious condition that calls for immediate medical attention.
Can Priapism Cause Impotence?
If priapism goes untreated, it can cause impotence. Blood that’s trapped in the penis will steadily lose oxygen, and the tissues of the penis are at increased risk of dying the longer they remain unoxygenated. There’s also a risk of clots in the penis that can further block blood flow, which will need to be removed.
Priapism can also cause scarring, leading to other problems such as Peyronie’s disease, which can also aggravate ED.
Bottom line: Untreated priapism can cause erectile dysfunction and even permanent damage to the penis.
Does Viagra Cause Priapism?
Viagra helps treat ED by preventing the action of a specific enzyme, phosphodiesterase 5, commonly called PDE5. PDE5’s action removes nitric oxide from the body. Viagra and other ED medications help the body to retain nitric oxide longer, causing the blood vessels to relax and more blood to flow into the penis.
Just taking Viagra is unlikely to cause priapism, in part because Viagra doesn’t cause erections independently. You need to have some form of stimulation to get the benefits. The FDA label for Viagra lists priapism as a possible Viagra side effect, but it has been reported “infrequently.”
How Common is Priapism with Viagra?
While it’s possible for ED drugs to trigger priapism on their own, over time it’s become clear that your chances of developing priapism from Viagra are very low.
A study conducted in 2020 analyzed all reports of priapism reported to the FDA, as well as clinical research into priapism in men without sickle cell disease. The study found the incidence of priapism with Viagra or any other ED drug was only 2.9% of reported cases (411 total). Antipsychotics are much more likely to cause the problem, accounting for one-third of reported cases in the data.
“Rare,” of course, does not mean never. However, at the time this study was conducted, Viagra had been on the market for over twenty years, and in 2020 alone, nearly three million Viagra prescriptions were filled — just in the U.S.
Priapism Risk Factors and Prevention
While priapism from ED drugs is rare, research has found some circumstances that can increase risk.
Here’s the list:
- Extreme overdoses. Case studies have found people who take doses well outside the prescribed amount are more likely to experience priapism.
- Drug or food interactions. A combination of drugs that includes a PDE5 inhibitor is often reported in case studies. Become familiar with Viagra’s potential drug interactions to avoid serious side effects.
- Blood diseases. Sickle cell anemia and most types of blood cancers are a possible risk factor for priapism, as they may cause blood clots and block blood flow.
- Circulatory disorders or damage. Injury to the circulatory system can create blockages or narrow points that make priapism more likely.
If you have any of these risk factors, talk to your doctor about your individual risk for priapism and other serious Viagra side effects.
Read The Comprehensive Guide to Viagra and Sildenafil Side Effects for detailed information about all the known side effects of Viagra.
Identifying Priapism: Symptoms to Watch For
The primary symptoms of priapism are:
- A persistent erection.
- Pain that gets progressively worse.
- A hard shaft but a soft glans (head) of the penis.
While none of these symptoms in isolation is necessarily a sign of priapism, if you’re experiencing two or more, seek medical attention right away.
What to Do if You Experience Priapism
If you think you’re experiencing priapism, the sooner you receive medical attention, the better. If your erection has lasted beyond any sexual activity you’ve engaged in and is beginning to be painful, err on the side of caution and go to an urgent care center or emergency department.
Treatment for Priapism
When you’re getting medical attention, there are a few steps doctors might take.
- Aspiration. This is a suction technique to pull blood out of the penis. It usually also involves rinsing with saline to remove any clots that might have formed.
- Medication. If aspiration doesn’t do the job, you may be given phenylephrine to lower your blood pressure.
- Surgical intervention. If neither of these work, shunts to remove the blood can be implanted surgically.
None of this sounds pleasant, but we can’t stress strongly enough that the earlier you seek help, the less intervention you’ll need.
Guidelines for Safe Use of Viagra
To prevent priapism after Viagra use, take the following steps:
- Review your medical history and prescriptions with your doctor to avoid any potential interactions.
- Take Viagra and any other ED drugs only as prescribed.
- If you have risk factors for priapism, talk to your healthcare provider before taking any ED medication.
- Be familiar with the signs of priapism and when to seek medical help.
Take these steps and you should be able to safely use Viagra with low risk of priapism.
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Dan is a long-time freelance writer focusing on technology, science, health, and medicine, with a lifelong interest in physics, biology, and medicine. His work has taken a particular focus on scientific studies “beyond the headlines,” reading the study to more closely examine the results.