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The phenomenon has been attributed to pressure on the cerebellum created by the noose. Spinal cord injuries are known to be associated with priapism.

Injuries to the cerebellum or spinal cord are often associated with priapism in living patients.

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 will become engorged and there may be a discharge of blood from the vagina. In men, “a more or less complete state of erection of the penis, with discharge of urine, of mucus, or of the prostatic fluid, is a frequent occurrence … present in one case in three.”

Other causes of death may also result in these effects, including fatal gunshot wounds to the brain, damage to major blood vessels, or violent death by poisoning. Forensically, a postmortem priapism is an indicator that death was likely swift and violent.

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