What could cause a loss of erection after a prolonged period of being erect, followed by ejaculation while still in a flaccid state?

Loss of Erection After Prolonged Arousal with Subsequent Ejaculation While Flaccid

The loss of erection after prolonged arousal followed by ejaculation while flaccid is likely due to vascular fatigue and is not typically a sign of pathological priapism or serious erectile dysfunction.

Understanding What Happened

Normal Physiological Response

• Prolonged erections (>1 hour) can lead to vascular fatigue where the penile blood vessels that maintained the erection become exhausted, resulting in detumescence (loss of erection) despite continued sexual arousal 1
• This is different from ischemic priapism, which is a painful medical emergency lasting >4 hours requiring immediate intervention 1
• Your experience represents a non-pathological response where ejaculation occurred during the detumescence phase 1

Key Differences from Priapism

• Ischemic priapism is characterized by painful, rigid erections lasting >4 hours with abnormal blood gases (hypoxic, hypercarbic, acidotic) 1
• Your situation differs from priapism because:
  • The erection resolved naturally without intervention 1
  • You were able to ejaculate despite losing rigidity 1
  • There was no mention of pain, which is typically present in ischemic priapism 1

Why This Happens

Vascular Mechanisms

• Prolonged erections can lead to temporary vascular fatigue where:
  • Blood vessels that maintained the erection become temporarily exhausted 1
  • Normal detumescence pathways eventually activate despite continued arousal 1
  • The autonomic nervous system shifts from parasympathetic (erection) to sympathetic (detumescence) dominance 1

Ejaculation While Flaccid

• Ejaculation and erection are controlled by different neural pathways:
  • Ejaculation is primarily controlled by sympathetic nervous system 1
  • Erection is primarily controlled by parasympathetic nervous system 1
  • These systems can function independently, allowing ejaculation to occur without full rigidity 1

When to Be Concerned

Warning Signs Requiring Medical Attention

• Painful erections lasting >4 hours (true priapism) require emergency treatment 1
• Recurrent episodes of prolonged, unwanted erections (stuttering priapism) 1
• Consistent inability to maintain erections during sexual activity 1
• Ejaculation with little or no arousal 1

Normal vs. Abnormal

• A single episode of losing erection after prolonged arousal is generally not concerning 1
• The ability to reach ejaculation indicates functioning ejaculatory pathways 1
• Occasional episodes of detumescence before ejaculation are common and not typically pathological 1

Prevention Strategies

For Future Sexual Encounters

• Avoid maintaining full erection for extremely long periods (>1 hour) without ejaculation 1
• Take brief breaks during prolonged sexual activity to allow vascular recovery 1
• Stay hydrated and maintain good cardiovascular health, which supports erectile function 1
• If using erectogenic medications (e.g., PDE5 inhibitors), follow recommended dosing to avoid prolonged erections 1

When to Seek Medical Help

• If you experience painful erections lasting >4 hours 1
• If this pattern of losing erection before ejaculation becomes frequent or distressing 1
• If you notice other changes in sexual function or urinary symptoms 1

Remember that occasional variations in erectile function are normal and not necessarily indicative of a medical condition 1.