The phenomenon has been attributed to pressure on the cerebellum created by the noose.[3] Spinal cord injuries are known to be associated with priapism.[4] Injuries to the cerebellum or spinal cord are often associated with priapism in living patients.[2]
Death by hanging, whether an execution or a suicide, has been observed to affect the genitals of both men and women. In women, the labia and clitoris may become engorged and there may be a discharge of blood from the vagina.[5] In men, "a more or less complete state of erection of the penis, with discharge of urine, mucus or prostatic fluid is a frequent occurrence ... present in one case in three."[5] Other causes of death may also result in these effects, including fatal gunshots to the head, damage to major blood vessels, and violent death by poisoning. A postmortem priapism is an indicator that death was likely swift and violent.[5] In a case reported from Thailand, an excess of sildenafil (Viagra) was thought to be cause of a death erection in a 64-year-old man.