--- title: "Priapism in children: an erection that won't go down" description: "A long-lasting, painful erection in a child or teenager: causes of priapism, the link with sickle cell disease, and when to go straight to the ER." lang: en url: https://kidsurologycare.com/conditions/priapism/ --- [Genitals](/conditions/#genitals) # Priapism in children: a painful erection that will not go down A long-lasting, painful erection in a child or teenager: causes of priapism, the link with sickle cell disease, and when to go straight to the ER. Written by: [Dr. Parviz Hajiyev](/doctor/), European Board-certified pediatric urologist (FEAPU). This is an emergency where hours matter. If these signs are present, do not wait for an appointment: call your local emergency number (103 in Azerbaijan, 112 in Europe, 911 in the US) or take your child to the nearest emergency department now. Call your local emergency number (112 in Europe, 911 in North America) Quick answers Is it urgent? If a painful, rigid erection does not go down, yes. This is an emergency. How long can we wait? If simple measures (peeing, walking, drinking water) have not helped within 2 hours, do not wait: go to the emergency department. Most common cause In children about 65% of cases are linked to sickle cell disease. Can it come back? Yes. Short, repeated episodes can be a warning of a severe episode, so tell the doctor about them. ## What is priapism? **Priapism** is an erection that is not related to sexual arousal, lasts for hours and does not go down by itself. It is rare in children, but its most common form is an emergency: without timely treatment it can cause permanent damage to the tissue of the penis. Morning erections and short erections are normal. They go away on their own and do not hurt. ## Types - **Ischemic priapism:** the most common form (about 95%). Blood gets trapped in the penis and oxygen levels fall. The erection is rigid and **painful**, while the head of the penis stays soft. This is an emergency. - **Stuttering priapism:** short, painful erections keep coming back and go away on their own. These episodes often come before a severe ischemic priapism, so always tell the doctor about them. - **Non-ischemic priapism:** usually develops 3 hours to 7 days after a blow to the penis, the perineum (the area between the legs) or the pelvis. The erection is not fully rigid. It is not an emergency, but a doctor needs to examine him. - **Priapism in a newborn:** very rare, and it usually settles on its own. ## Causes The most common cause of priapism in children is **sickle cell disease**: about 65% of cases. Other causes include leukemia, injury and some medicines. In about 1 in 10 children no cause is found. In boys with sickle cell disease the first episode happens at about 15 years of age on average, but 1 in 4 cases occurs before puberty. ## What can we do at home? If an erection will not go down, ask your child to pee, walk around and drink water. You can give pain relief suitable for his age. **If these measures have not helped within 2 hours, do not wait: go straight to the emergency department.** If the pain is very severe or he has sickle cell disease, go sooner. ## Diagnosis The doctor asks when the erection started and about pain, previous episodes, medicines, blood disorders and injuries. A **Doppler ultrasound** of the penis shows blood flow and helps identify the type of priapism. Blood tests are done, including a test for sickle cell disease. If needed, blood is taken from the penis to check its oxygen level. ## Treatment - **Ischemic priapism** is treated urgently. Treatment starts with the gentlest method and moves to the next step if needed. In children these procedures are usually done under anesthesia. - **In sickle cell disease** the pediatric urologist works together with a pediatric hematologist. The goal is both to stop the episode and to prevent new ones. - **Non-ischemic priapism and priapism in newborns** are first managed with observation and simple measures. The sooner the erection goes down, the better the outlook for the future function of the penis. So do not feel embarrassed and do not lose time. ## When to seek urgent care If any of the following is present, do not wait for an appointment or for a reply from the doctor: call your local emergency number or go to the nearest emergency department right away. - A painful, rigid erection that has not gone down within 2 hours despite simple measures - An erection that will not go down in a child with sickle cell disease or leukemia - The erection is not going down and the pain is getting worse Call your local emergency number (112 in Europe, 911 in North America) Note for pediatricians and family doctors Priapism is a full or partial erection lasting ≥4 hours and unrelated to sexual stimulation; it is rare in children. Causes: sickle cell disease (about 65%), leukemia (10%), trauma (10%), idiopathic (10%), drugs (5%). In sickle cell disease the mean age at first episode is about 15 years, and 25% present before puberty. Ischemic (low-flow) priapism is the most common form (95%): painful, with rigid corpora cavernosa and a soft glans and spongiosum; because of the risk of irreversible damage it is an emergency. Stuttering priapism (recurrent, self-limiting episodes) often precedes an ischemic episode. Non-ischemic (high-flow) priapism usually follows penile, perineal or pelvic trauma by 3 hours to 7 days and is not an emergency; neonatal priapism is very rare, is not associated with sickle cell disease, has polycythemia as the most common identifiable cause, and follows a benign course. EAU recommendations (all strong): Doppler ultrasound in all patients; full blood count and hemoglobinopathy screen in ischemic priapism; a multidisciplinary approach with pediatric hematology for sickle cell-associated priapism; a stepwise approach to ischemic priapism starting with the least invasive therapy; initial conservative management of neonatal and non-ischemic priapism. When ischemia is suspected, a corporal blood gas (pO2 < 30, pCO2 > 60, pH < 7.25) is informative. If conservative measures (walking, voiding, fluids, analgesia) fail for 2 hours or more, urgent care is needed. ## What happens at the visit? 1. A child with suspected priapism is seen without delay; we ask when the erection started, about previous episodes, medicines and any injury. 2. A Doppler ultrasound of the penis and blood tests are done, and if needed a blood sample is taken from the penis to check oxygen levels. 3. Ischemic priapism is treated step by step under anesthesia, starting with the gentlest method; in sickle cell disease decisions are made together with a pediatric hematologist. [Book on WhatsApp](https://wa.me/994504443035?text=Hello%2C%20I%20would%20like%20to%20book%20an%20appointment%20about%3A%20Priapism.)Pediatric Urology Center, Badam Medical Center, Baku ## Frequently asked questions My son has erections in the morning. Is that priapism? No. Morning erections and short erections are normal; they go away on their own and do not hurt. Priapism is an erection that lasts for hours, is often painful and does not go down by itself. My child has sickle cell disease. What should I do? If an erection is painful and does not go down, go straight to the emergency department and tell them your child has sickle cell disease. If short, repeated episodes happen, tell his hematologist and pediatric urologist: together they make a plan to prevent further episodes. An erection started a few days after a blow and will not go down. Is this urgent too? This may be non-ischemic priapism after an injury. It is not as urgent as the ischemic type, but have a pediatric urologist see him the same day: only an examination can tell the types apart. ## Related topics - [Paraphimosis Constricting foreskin Condition](/conditions/paraphimosis/) - [Testicular torsion Twisted testicle, acute testicular pain Condition](/conditions/testicular-torsion/) - [Penile curvature Chordee; penile torsion (a twist) is a separate finding Condition](/conditions/penile-curvature/) - [Genital injuries Scrotal injury, zipper injury, straddle injury Condition](/conditions/genital-injury/) Sources - [EAU Guidelines on Paediatric Urology, 2026: Emergencies in paediatric urology (Priapism).](https://uroweb.org/guidelines/paediatric-urology) - [Donaldson JF et al. Priapism in children: a comprehensive review and clinical guideline. J Pediatr Urol, 2014.](https://pubmed.ncbi.nlm.nih.gov/?term=Priapism%20in%20children%3A%20a%20comprehensive%20review%20and%20clinical%20guideline) This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination. Updated: October 31, 2026 --- Information for parents and colleagues; it does not replace an in-person examination. Emergencies: call 103 (Azerbaijan, Kazakhstan, Uzbekistan) or your local emergency number.