Priapism

Priapism (Greek??????????, 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).

Priapism is a medical emergencyand needs proper treatment by a qualified medical practitioner.

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, haematologicaldisorders (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 drugssuch as certain antidepressants, antihypertensives, anticoagulantsand 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.

One of the more significant classes of drugs which may precipitate priapism are the phosphodiesterase type-5 (PDE5) inhibitors such as sildenafil, tadalafiland vardenafil. Injected erectile-dysfunction therapies such as alprostadilare also significant.

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 pseudoephedrine120 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 cavernosumunder local anaesthetic. If this is still insufficient, then aspiration is conducted with injections of adrenalineas 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.

Should all else fail, complete removal of the penis is necessary.

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

• paraphimosis

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:?????????

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It uses material from the http://en.wikipedia.org/wiki/Priapism Wikipedia article Priapism.