Priapism
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Image:Priapuspouring.jpg Image:Priapus Fresco.jpg Priapism (Greek πριαπισμός, the erection) is a painful and potentially harmful medical condition in which the erect penis (erection) does not return to its flaccid state (despite the absence of both physical and psychological stimulation) within four hours.
Priapism is a medical emergency and needs proper treatment by a qualified medical practitioner.
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Causes
The causative mechanisms are poorly understood but involve complex neurological and vascular factors.
Priapism may be associated with prolonged sexual activity, leukaemia, Fabry's disease, haematological disorders (such as sickle-cell disease), cerebrospinal disease (such as syphilis), genital infection, some spinal injuries, or inflammation (Beers & Berkow, 1999). Priapism can be caused by drugs such as certain antidepressants, antihypertensives, anticoagulants and corticosteroids. It can also be a withdrawal symptom of drugs such as heroin. Priapism is often present in spinal injuries or trauma to the spinal cord. Another cause is the selective concetration of the retinas in a succession of moves which result in the blood flow reaching areas of the body it usually wouldn't for large periods of time.
One of the more significant classes of drugs which may precipitate priapism are the phosphodiesterase type-5 (PDE5) inhibitors such as sildenafil, tadalafil and vardenafil. Injected erectile-dysfunction therapies such as alprostadil are also significant. The antidepressant/sedative trazodone has also been associated with priaprism.
Complications
Potential complications include ischaemia, clotting of the blood retained in the penis (thrombosis), and damage to the blood vessels of the penis which may result in an impaired erectile function or impotence. In serious cases the condition may result in gangrene, which may necessitate penis removal.
Treatment
Medical advice should be sought immediately for cases of priapism.
If the erection has been present for two hours the recommended therapy is pseudoephedrine 120 mg orally. If this has not subsided by four hours, a further 120 mg of pseudoephedrine is recommended. (Therapeutic Guidelines, 2001)
If the erection has been present for six hours, it is essential to contact a medical practitioner. The therapy at this stage is to aspirate blood from the corpus cavernosum under local anaesthetic. If this is still insufficient, then aspiration is conducted with injections of adrenaline as an adjuvant. (Therapeutic Guidelines, 2001)
If aspiration fails and tumescence re-occurs, surgical shunts are next attempted. These attempt to reverse the priapic state by shunting blood from the rigid corpora cavernosa into the corpus spongiosum (which contains the glans and the urethra). Distal shunts are the first step, followed by more proximal shunts.
Miscellaneous
The name comes from the god Priapus, referring to that god's most notable attribute. The female counterpart of this condition is known as clitorism.
See also
References
- Beers MH, Berkow R (Eds.) (1999). The Merck Manual of Diagnosis and Therapy (17 ed.). Whitehouse Station: Merck Research Laboratories. ISBN 0-911910-10-7
- Therapeutic Guidelines Limited (2001). Therapeutic Guidelines: Endocrinology (2 ed.). North Melbourne: Therapeutic Guidelines Limited. ISSN 1327-9505
- Priapism Primer: Priapismbg:Приапизъм
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