Priapism is an erection that lasts too long and happens without sexual arousal or does not go away after sex. The main symptoms of priapism are a firm penis that stays erect for 4 hours or more and often becomes painful. Priapism can affect boys and men of any age, but it is more likely in people with blood disorders such as sickle cell disease, after some medicines, or after injury. It is not usually fatal, but untreated priapism can damage tissue and lead to permanent trouble with erections. You do not need to wait for symptoms to worsen because early treatment often includes draining trapped blood, giving medicine, and treating the cause.
How many people live with Priapism?
There is no widely accepted count of how many people are living with priapism worldwide, and major medical references do not report a reliable global total. The same is true in the United States; experts usually track how often it happens instead, and describe priapism as rare, with about 0.3 to 1.5 cases per 100,000 males each year (European Association of Urology, 2024).
Overview
PriapismSymptoms
Priapism causes an erection that lasts too long, often more than 4 hours, and may happen without sexual arousal. Many with priapism have penis pain, firmness, and swelling. Early symptoms of priapism need urgent medical care.
Outlook and prognosis
With priapism, outlook depends on how long the erection lasts and how quickly treatment starts. Episodes treated within hours often resolve well, while longer episodes can injure penile tissue and raise the risk of ongoing erection problems.
Causes and risk factors
Priapism can be triggered by blood disorders such as sickle cell disease, certain medicines, alcohol or drug use, injury, and sometimes nerve or pelvic problems. Risk is higher in people with priapism linked to sickle cell disease, leukemia, or erection treatments.
Genetic influences
Genetics can matter in priapism, especially when it is linked to inherited conditions like sickle cell disease. In many cases, though, priapism is not mainly caused by genetic variations and can happen for other medical or medication-related reasons.
Diagnosis
Priapism is diagnosed based on how long the erection lasts, your symptoms, and a physical exam. Tests may include blood tests, a blood sample from the penis, and ultrasound to check blood flow.
Treatment and drugs
Priapism needs urgent treatment, especially if an erection lasts more than 4 hours. Care may include draining blood from the penis, medicines to reduce swelling, and treating the cause, such as sickle cell disease or certain drugs.
Symptoms
Priapism is when an erection lasts longer than it should, often 4 hours or more, and does not go away after sex ends or without sexual interest. The main thing people notice is a persistent erection that can become painful, especially in the more urgent form of priapism. Symptoms vary from person to person and can change over time.
One of the early symptoms of priapism is an erection that lasts 4 hours or more, continues after sex ends, or starts without sexual arousal. It usually does not go away with orgasm, rest, or time.
Pain often starts as pressure or aching and can become severe as time passes. For many, this can make sitting, walking, or even wearing clothing uncomfortable.
In the most urgent type of priapism, the shaft usually feels very firm or rigid. The tip of the penis may stay softer, which can be a clue that blood is trapped inside.
Some people have erections that come and go, often during sleep, with episodes lasting minutes to hours. These attacks can become more frequent and may lead to a longer-lasting episode.
How people usually first notice Priapism?
People usually first notice priapism when an erection lasts much longer than expected, often more than 4 hours, or happens without sexual arousal and does not go away after orgasm. For many, the first warning signs of priapism are a penis that stays firm or partly firm and may become increasingly painful, especially in the shaft, while the tip can sometimes feel softer. Because this can signal trapped blood and possible tissue damage, an erection lasting 4 hours or longer needs urgent medical care.
Types of Priapism
Priapism can affect daily life in very different ways, from a painful erection that will not go away to repeated shorter episodes that keep coming back. Doctors sometimes classify symptoms as low-flow versus high-flow priapism. These types of priapism differ mainly in how blood is moving, or not moving, through the penis, and that changes how urgent the situation is. In general, painful erections lasting 4 hours or more need prompt medical care.
Ischemic priapism
This is the most common type and happens when blood gets trapped in the penis and cannot drain out properly. It usually causes a rigid, often painful erection, while the tip may feel a little softer than the shaft. Many living with this type notice the pain builds over time, and it is a medical emergency.
Nonischemic priapism
This type happens when too much blood flows into the penis, often after an injury to the pelvis or genitals. The erection is usually less painful or not painful, and it may be partly firm rather than fully rigid. Although it is often less urgent than ischemic priapism, it still needs medical evaluation.
Stuttering priapism
This is a recurrent form of ischemic priapism, with repeated episodes that may stop on their own and then return. One type may be strong for a while, then fade as another emerges, but in this case the repeated attacks can become longer or more painful over time. Some may find the episodes happen during sleep or without clear warning, and any prolonged attack can turn into an emergency.
Can I slow down the onset of symptoms?
No, there is no good evidence that general lifestyle changes can reliably delay the onset of priapism, but for people at risk, managing known triggers may lower the chance of an episode. The clearest steps are reviewing medicines that can trigger it, avoiding heavy alcohol and recreational drugs, and working closely with a doctor to control conditions linked to priapism, especially sickle cell disease or other blood problems. If you have repeated episodes, a doctor can check for a treatable cause, and any erection lasting 4 hours or more needs emergency care; these steps may reduce risk for some people, but they cannot guarantee prevention.
What genetics can tell you about symptoms
For most people, genetics cannot precisely predict which symptoms of priapism will happen, how severe they will be, or exactly when they will start. What genes can sometimes show is whether someone has an inherited condition that raises the risk, especially sickle cell disease and some other blood disorders, where priapism may begin earlier in life and can come back repeatedly. Even then, genetics is only part of the picture, and symptoms can still vary a lot from one person to another.
Causes and risk factors
When an erection lasts too long and does not go away, the causes of priapism often include blood problems, certain medicines, or an injury. Priapism is more common in people living with sickle cell disease, leukemia, or injuries to the penis, pelvis, or spinal cord. Some risks are written in our DNA, passed down through families, and an inherited condition like sickle cell disease can raise the risk. Alcohol misuse and drugs such as cocaine can also trigger priapism. It’s rarely just one factor—it’s the mix that matters.
What are the most common causes or risk factors?
The most common risk factors for priapism are blood disorders that affect red blood cells, especially sickle cell disease and sometimes sickle cell trait, which are inherited conditions. It can also be triggered by medicines, especially drugs used for erections and some medicines for depression or mental health, and the risk can be higher with alcohol or drugs such as cocaine. Less often, priapism happens after an injury to the penis, pelvis, or spinal cord, or with certain blood cancers.
Environmental and biological risk factors
Priapism is an erection that lasts too long and does not go away on its own. Doctors often group risks into internal (biological) and external (environmental). In priapism, the main risks are things that affect blood cells, blood flow, nerves, or exposure to certain medicines and injuries.
Conditions that make blood cells clump, change shape, or move less freely can trap blood in the penis and raise the risk of priapism. Blood cancers and clotting problems can do this as well.
Pills and especially injected treatments for erection problems can sometimes keep blood trapped too long. The risk is higher when the dose is too strong or more than one erection medicine is used.
Some antidepressants and antipsychotic medicines can interfere with the signals that let an erection settle back down. This is an uncommon side effect, but it is a well-known cause of priapism.
Injury to the penis, pelvis, or the area between them can damage blood vessels and trigger priapism. In some cases, an injured artery keeps sending in extra blood after the trauma.
Genetic risk factors
Some cases of priapism are tied to inherited conditions, especially ones that affect red blood cells and blood flow. For many living with priapism, this can mean repeated painful episodes that begin in childhood, the teen years, or early adulthood. Some risk factors are inherited through our genes. Among the genetic causes of priapism, sickle cell disease is by far the best-established.
Sickle cell disease: This is the strongest inherited risk factor for priapism. Red blood cells can become stiff and sticky, slowing blood flow and trapping blood in the penis. In children and adults with sickle cell disease, early symptoms of priapism may be brief, repeated episodes before a longer emergency episode.
Sickle cell trait: The trait carries a much lower risk than sickle cell disease, but priapism can still happen in some people. This is uncommon, yet it matters when episodes seem unexplained or there is a family history of sickle cell conditions.
Thalassemia: Thalassemia and related inherited blood disorders have also been linked to priapism, though far less often than sickle cell disease. Changes in blood cells and blood flow may make it harder for blood to drain normally.
Family history: A family history of sickle cell disease, sickle cell trait, or thalassemia can point to a higher inherited risk for priapism. In some cases, genetic testing can give a clearer picture of your personal risk.
Lifestyle risk factors
Some episodes of priapism happen without any clear lifestyle trigger, but certain habits can raise the chance of an attack or make one more likely to last longer. When people ask about lifestyle risk factors for priapism, the strongest links are usually substance use and behaviors that increase dehydration or blood-flow problems. Lifestyle does not explain every case, but reducing these triggers may lower risk in some people.
Heavy drinking can contribute to dehydration and may disrupt normal blood flow in the penis. Alcohol is also linked with delayed response to symptoms, which can allow priapism to continue longer and increase the risk of tissue damage.
Cocaine, cannabis, amphetamines, and similar substances have all been associated with priapism in some cases. These drugs can affect blood vessels, nerve signaling, and circulation in ways that may trigger or prolong an episode.
Injecting non-prescribed substances into the penis to improve erections can directly cause trapped blood and severe priapism. This practice greatly increases the risk of a prolonged episode that needs urgent treatment.
Using erectile dysfunction medicines in higher doses than prescribed, combining them, or taking them with other sexual performance products can raise priapism risk. The chance may be higher when these drugs are used without medical supervision.
Risk prevention
Priapism is a long-lasting erection that is not related to sexual arousal, and it cannot always be fully prevented. For many living with priapism, prevention is mostly about lowering the chance of another episode by managing triggers, medicines, and underlying health problems. Prevention is about lowering risk, not eliminating it completely. Getting urgent care for early symptoms of priapism can also help prevent lasting damage.
Some episodes of priapism are linked to medicines, including certain erection drugs, antidepressants, ADHD treatments, and blood thinners. Do not stop a prescribed medicine on your own, but ask your doctor whether the dose or drug choice could be raising your risk.
Heavy alcohol use and recreational drugs, especially cocaine, can trigger priapism in some people. Cutting back or avoiding these substances may lower the chance of another episode.
Sickle cell disease is one of the best-known causes of recurrent priapism, and other blood problems can also play a role. Good day-to-day management, hydration, and condition-specific treatment can reduce attacks for some people with priapism.
Injury to the penis, pelvis, or perineum can lead to a form of priapism caused by abnormal blood flow. Using protective gear during sports and getting checked after trauma may help reduce risk or catch problems early.
Can you prevent Priapism?
Priapism cannot always be prevented, because it can happen suddenly and sometimes has no clear cause. But the risk may be lowered by treating health problems linked to it, such as sickle cell disease, and by avoiding or reviewing with your doctor any medicines, alcohol, or street drugs that may trigger a long-lasting erection. If someone has had priapism before, getting medical help quickly for new episodes and working with a doctor to find the cause may help lower the chance of it happening again.
Transmission
Priapism is not an infection, so it cannot be caught from someone else through sex, kissing, blood, the air, or everyday contact. If you are wondering whether priapism is contagious, the answer is no.
Instead, priapism usually happens because blood gets trapped in the penis or because of an underlying health problem, medication, or injury. In some people, inherited conditions such as sickle cell disease can raise the chance of priapism, but that means the risk factor can run in families, not that priapism itself is transferred from one person to another.
When to test your genes
Genetic testing is not routine for priapism. It may be worth discussing if episodes keep returning, especially if you or close relatives have sickle cell disease or trait, since inherited blood conditions can raise risk and sometimes shape prevention and long-term care.
Diagnosis
Priapism is diagnosed urgently because an erection that lasts too long can damage tissue in the penis and affect sexual function later on. In real life, this often means someone comes in after an erection has lasted 4 hours or more, or after repeated painful episodes that do not fully settle between them. Doctors usually begin with questions about when it started, how painful it is, whether the penis is fully rigid, and any medicines, blood disorders, or recent injury, since these details help guide the diagnosis of priapism.
A clinician checks how long the erection has lasted, whether it is painful, and whether the shaft is hard while the tip stays softer. This bedside exam helps tell apart low-flow priapism, which is usually painful and urgent, from high-flow priapism, which is often less painful and follows injury.
Doctors may take a small blood sample from the penis to measure oxygen and acid levels. Dark, low-oxygen blood strongly suggests low-flow priapism, while brighter, better-oxygenated blood points more toward high-flow priapism.
Blood tests may look for causes such as sickle cell disease, leukemia, infection, or problems with clotting. These tests also help check overall health before treatment and other lab tests may help rule out common conditions.
Doppler ultrasound uses sound waves to assess blood flow in the penis. It can help confirm whether blood is trapped with poor drainage or whether there is increased flow after an injury.
How is Priapism diagnosed?
Priapism is usually diagnosed when a person has an erection that lasts more than 4 hours or happens without sexual arousal and does not go away. A doctor will ask how long it has lasted, whether it is painful, what medicines or drugs were taken, and whether there are health problems such as sickle cell disease, then examine the penis and sometimes order blood or urine tests to look for a cause. To decide which type it is and how urgent treatment is, doctors may also use an ultrasound to check blood flow or take a small blood sample from the penis.
Stages of Priapism
Priapism does not have defined progression stages. That is because it is usually described as a sudden problem or a repeating pattern of prolonged erections, rather than a condition that moves through clear step-by-step phases over time. Doctors usually start with a conversation about when the erection began, whether it is painful, and whether blood disorders, medicines, or injury could be involved. To decide how priapism is diagnosed and treated, they may also do a physical exam, blood tests, and sometimes a test of blood flow or a small blood sample from the penis to see which type of priapism is present.
Outlook and prognosis
The outlook for priapism depends mainly on how quickly it is treated and whether it is ischemic or non-ischemic. Ischemic priapism is a urologic emergency, and erections lasting more than 4 to 6 hours can begin to damage penile tissue, with longer delays greatly increasing the risk of permanent erectile dysfunction, penile fibrosis, and shortening. When treated promptly, many people recover with preservation of sexual function, although recurrence can occur, especially in those with sickle cell disease or medication-related episodes. Non-ischemic priapism usually has a better prognosis because tissue oxygenation is preserved, and some cases resolve spontaneously or respond well to targeted treatment. Mortality from priapism itself is rare, but overall health risks may be higher when it is linked to serious underlying conditions such as hematologic disease, malignancy, or trauma. Long-term outcome is best when the cause is identified, emergency care is not delayed, and follow-up addresses recurrence prevention and erectile function.
Long-term effects
Priapism can have lasting effects when an erection lasts too long, especially with the ischemic type, which is the form caused by trapped, low-oxygen blood. Thinking about the long-term effects helps explain why fast care matters: the longer the episode lasts, the higher the chance of damage to penile tissue. Many living with priapism do well after prompt treatment, but prolonged or repeated episodes can affect sexual function and day-to-day well-being.
The main long-term effect of priapism is trouble getting or keeping erections later on. This becomes more likely when an ischemic episode lasts several hours, which is why early symptoms of priapism need urgent medical attention.
A prolonged episode can injure the erectile tissue and leave scar tissue behind. Over time, that scarring may make erections weaker, less flexible, or uncomfortable.
Some people develop penile shortening, curvature, or a change in firmness after severe or repeated priapism. These changes can become more noticeable during erections and may affect sexual activity.
In recurrent priapism, also called stuttering priapism, erections may keep coming back over months or years. Each episode can add to the risk of long-term tissue damage.
How is it to live with Priapism?
Living with priapism can be physically painful and emotionally draining, because an erection lasts far longer than it should and may happen without sexual arousal, sometimes creating sudden trips to urgent care and anxiety about when it might happen again. For many people, this can disrupt sleep, work, exercise, and intimacy, and the fear of permanent erectile problems if treatment is delayed can weigh heavily on daily life. Partners and loved ones may feel worried or unsure how to help, but clear communication and prompt medical care can make the condition more manageable and protect long-term sexual health.
Treatment and drugs
Priapism is treated as a medical emergency when an erection lasts more than 4 hours, because waiting can damage the tissue and affect future sexual function. In many cases, doctors first numb the area, drain trapped blood from the penis with a small needle, and may inject medicine that helps the blood vessels tighten so the erection goes down. If priapism is linked to a medicine, blood disorder such as sickle cell disease, or an injury, treatment also focuses on that cause to help prevent it from happening again. If first-line treatments don’t help, specialists may try second-line options, including a procedure to redirect blood flow. For people with repeated episodes, especially the stuttering type, doctors may suggest preventive treatment, which can include adjusting current medicines, using hormone-related treatment in selected cases, or other drugs based on the cause.
Can you cure Priapism?
Priapism can often be treated and stopped, but there is not one permanent cure that works for everyone because it depends on what is causing it. Treatment may include draining trapped blood, giving medicine, or treating an underlying problem such as a blood disorder or a medication side effect to lower the chance it happens again. Because an erection that lasts more than 4 hours can cause lasting damage, it needs emergency care right away.
Non-drug treatment
Priapism can quickly turn from uncomfortable to urgent, especially when an erection lasts for hours or becomes painful. Managing this condition often means getting help right away, because if you are wondering how to treat priapism at home, safe options are limited and a painful erection lasting 4 hours needs emergency care. Non-drug treatment focuses on getting trapped blood out of the penis, protecting tissue, and treating the cause. The exact approach depends on whether the priapism is the low-flow painful type or the high-flow type that is usually less painful.
Doctors first check how long the erection has lasted, how painful it is, and whether blood flow is low-flow or high-flow. This may include an exam, blood tests, and a small blood sample from the penis to guide the safest treatment.
In some mild cases, walking, gentle physical activity, cold packs, or trying to urinate may help while you arrange urgent medical advice. These steps are not reliable for erections lasting 4 hours or for painful priapism, so they should not delay emergency care.
For low-flow priapism, a specialist may use a needle to drain trapped blood from the penis. This can quickly lower pressure, improve blood flow, and reduce the risk of permanent erection problems.
After drainage, the penis may be gently flushed with sterile salt water to help clear thick, low-oxygen blood. This is often done together with aspiration to improve the chance that the erection goes down.
Your genes may have an impact on how drugs work for you
Right now, there is no widely used genetic test that helps doctors pick the usual medicines for priapism, and most treatment decisions are based on how long the erection has lasted, how severe it is, and what is causing it. In day-to-day care, people with priapism are usually treated the same way at first, even though inherited conditions such as sickle cell disease can raise the risk of priapism and may affect the bigger treatment plan. This means genes can matter more for the underlying cause than for predicting how well the standard priapism medicines will work.
Pharmacological treatments
Treatment depends on the type of priapism, because the medicines used for ischemic priapism are different from those used to prevent repeat episodes. For painful erections that last several hours, emergency treatment for ischemic priapism usually centers on medicines that quickly reduce blood flow into the penis and help trapped blood drain. Not everyone responds to the same medication in the same way. When priapism keeps coming back, doctors may also use daily or longer-term medicines to lower the chance of another episode.
Phenylephrine is the main drug used for ischemic priapism and is usually injected directly into the penis by a clinician. It tightens blood vessels, which can help the erection go down and limit tissue damage if treatment is given promptly.
Local numbing medicine such as lidocaine, and sometimes strong pain relievers, may be used during treatment because ischemic priapism can be very painful. These medicines do not fix the priapism itself, but they can make urgent procedures more tolerable.
Pseudoephedrine tablets are sometimes used when a prolonged erection happens after erectile dysfunction medicine injected into the penis. It may help in selected early cases, but it is not reliable for true ischemic priapism that has lasted for hours.
Terbutaline has been used in the past for some drug-related prolonged erections, especially very early on. Its benefit is uncertain, so it is not a standard first-choice treatment for most cases of priapism.
Genetic influences
Priapism sometimes has a genetic link, most often through inherited blood conditions that change how blood flows in and out of the penis. It’s natural to ask whether family history plays a role. The clearest example is sickle cell disease, a condition passed down from parents that can make priapism, including repeated short episodes, much more likely; sickle cell trait may also raise risk, but less strongly. Other inherited blood disorders can contribute in some people, but many cases of priapism are tied to medicines, injury, or other health problems rather than a direct gene change causing priapism itself. If priapism happens more than once, especially in childhood, the teen years, or alongside anemia, doctors may look for genetic causes of priapism and consider testing for conditions such as sickle cell disease.
Is Priapism genetic?
Genetics can matter in priapism, especially when it is linked to inherited conditions like sickle cell disease. In many cases, though, priapism is not mainly caused by genetic variations and can happen for other medical or medication-related reasons.
Having a genetic risk is not necessarily a diagnosis
Genetic variants are a normal and common part of human biology across the general population. Most of these variants do not directly affect health and are simply part of the natural differences seen among people. For many genes, having a variant connected with a condition points to a possible link, not a certain diagnosis, especially when several genes and environmental factors are involved. In some situations, though, one well-studied variant in a particular gene is enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
When priapism happens more than once, or appears alongside a blood condition such as sickle cell disease, inherited gene changes can help explain why it is happening and can shape treatment decisions. In those cases, doctors often treat both the erection itself and the underlying disorder, which may include fluids, oxygen, pain relief, and treatment of the sickle cell problem, along with urgent local care such as draining trapped blood or giving a medicine injection to bring the erection down. For many living with Priapism, this becomes especially important when episodes keep returning, because treatment for recurrent priapism may change once doctors identify sickle cell disease or another inherited blood disorder. Genetics is only one factor, and there is not yet a widely used pharmacogenetic test that can reliably predict which drug for priapism will work best or who will have side effects. How long the erection has lasted, whether an injury is involved, other medicines, and overall health usually matter more for immediate treatment than genetics alone.
Interactions with other conditions
Priapism can sometimes be a sign that another health problem is present, rather than an issue on its own. It is especially linked with blood disorders such as sickle cell disease and, less often, leukemia, because these conditions can slow or block blood flow in the penis and trigger prolonged erections. Doctors call it a comorbidity when two conditions occur together, and in some people priapism is part of a broader pattern that includes blood disease, nerve injury, or problems after pelvic trauma. Priapism can also happen alongside spinal cord injuries, pelvic cancers, or severe infections, and some medicines used for depression, mental health conditions, or erectile dysfunction can raise the risk as well. Someone might notice their symptoms flare when another condition is active, such as during a sickle cell pain crisis or after a medication change. Because early symptoms of priapism may overlap with other urgent problems, it is important to get medical care quickly and ask whether an underlying illness could be contributing.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Priapism?
The problems most often mistaken for priapism are a penile injury, especially a penile fracture, and painful swelling from an infection or inflammation of the penis or nearby tissues. In some cases, a long-lasting erection after sexual activity or after using erection medicines, alcohol, or recreational drugs can also seem similar at first, although this is often still a form of priapism.
History
Long before modern emergency care, doctors were already trying to make sense of prolonged, painful erections that did not go away on their own. Throughout history, people have described priapism in medical writings, although early explanations were often tied to myth, humor theory, or other ideas that medicine has since left behind. For many living with priapism, that history matters because it shows this is not a new or poorly imagined problem; it is a well-recognized condition that medicine has worked to understand for centuries.
The name comes from Priapus, a figure from ancient Greek and Roman mythology associated with a permanent erection. Over time, however, doctors moved away from myth and toward careful observation. By the 18th and 19th centuries, medical reports began separating short-lived erections from episodes that lasted for hours and could damage the penis if not treated. That shift was important because it turned priapism from a curiosity in old texts into a condition doctors knew could threaten future sexual function.
In the 20th century, understanding improved further. Physicians recognized that priapism does not always have the same cause and that some cases happen when blood becomes trapped in the penis, while others are linked to unusually high blood flow after injury. Researchers also noticed that priapism could occur alongside blood disorders, certain medicines, spinal cord problems, and other medical conditions. This helped explain why the early symptoms of priapism can look similar from one person to another even when the reason behind it is different.
Modern care has focused on speed and prevention. What once might have been watched for too long is now treated as a medical emergency when an erection lasts 4 hours or more. Better imaging, clearer definitions, and more effective procedures have made it easier for doctors to identify the type of priapism and choose the right treatment. Even so, the history of priapism is also a reminder that embarrassment can delay care. Many people first hope it will pass, but today there is much better awareness that prompt treatment gives the best chance of avoiding lasting problems.