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 and clitoris 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, mucus or prostatic fluid is a frequent occurrence ... present in one case in three." 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.
- In The Sexuality of Christ in Renaissance Art and in Modern Oblivion, art historian and critic Leo Steinberg notes that a number of Renaissance era artists depicted Jesus Christ after the crucifixion with a post-mortem erection. The artwork was suppressed by the Roman Catholic Church for several centuries.
- The 2003 Channel 4 documentary on the Jack Sheppard case, The Georgian Underworld, Part 4: Invitation to a Hanging noted that his hanging caused an erection.
- The "Cyclops" section of James Joyce's Ulysses makes multiple use of the terminal erection as a motif.
- In The Decline and Fall of the Roman Empire, Edward Gibbon relates an anecdote attributed to Abulfeda that Ali, on the death of Muhammad, exclaimed, O propheta, certe penis tuus cælum versus erectus est (O prophet, thy penis is erect unto the sky). This understanding of the anecdote, however, is based on a mistranslation of the Arabic source by John Gagnier, who translated Abulfeda's Life of Muhammad into Latin.
- Helen Singer Kaplan & Melvin Horwith (1983). The Evaluation of Sexual Disorders: Psychological and Medical Aspects. United Kingdom: Brunner Routledge. Retrieved 2007-01-26. "Men subjected to capital punishment by hanging and laboratory animals sacrificed with cervical dislocation have terminal erections. The implication is that either central inhibition of erection is released and erection created or that a sudden massive spinal cord stimulus generates an erectile response. There is ample experimental and clinical evidence to support the former supposition."
- Willis Webster Grube (1897). A Compendium of practical medicine for the use of students and practitioners of medicine. Hadley Co. Retrieved 2007-01-26. "Erection has long been observed to follow injuries to the cerebellum and spinal cord. Out of eleven cases of cerebellar hemorrhage, erection of the penis was noted six times by Serres. Death by hanging is often accompanied by partial erection."
- George M. Gould and Walter L. Pyle (1900). Anomalies and Curiosities of Medicine. Retrieved 2007-01-26. "Priapism is sometimes seen as a curious symptom of lesion of the spinal cord. In such cases it is totally unconnected with any voluptuous sensation, and is only found accompanied by motor paralysis. It may occur spontaneously immediately after accident involving the cord, and is then probably due to undue excitement of the portion of the cord below the lesion, which is deprived of the regulating influence of the brain... Pressure on the cerebellum is supposed to account for cases of priapism observed in executions and suicides by hanging. There is an instance recorded of an Italian castrata who said he provoked sexual pleasure by partially hanging himself."
- David Levy, DO. "Neck trauma". eMedicine.com. Retrieved 2007-01-26.
- William Augustus Guy (1861). Principles of Forensic Medicine. London: Henry Renshaw. Retrieved 2007-01-26.
- Steinberg, Leo (1997). The Sexuality of Christ in Renaissance Art and in Modern Oblivion (2nd ed.). ISBN 978-0226771878.
- Thomas Sutcliffe (2003-04-25). "Lock, Stock and Two Yards of Hemp". The Independent. Archived from the original on 2008-02-12. Retrieved 2007-01-26.
- Yann Tholoniat. "Joyce's Cyclops". Yann Tholoniat is a Professor at the University of Lorraine.
- Edward Gibbon (1776). The History of the Decline and Fall of the Roman Empire 9. Archived from the original on 2007-04-17. Retrieved 2007-01-26.
- Ismael Abu'l--Feda, De vita, et rebus gestis Mohammedis, Moslemicæ religionis auctoris, et Imperii Saracenici fundatoris. Ex codice MSto Pocockiano Bibliothecæ Bodleianæ textum Arabicum primus edidit, Latinè vertit, præfatione, & notis illustravit Joannes Gagnier, A.M.. Oxford, 1723, p. 140, note. c. Retrieved 25-06-2014. The English translation of the Arabic source should read: "In one account, ʿAlī, may God be best pleased with him, was called upon, while he was washing him [the Prophet], to raise his gaze to the sky."