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Priapism 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). The causative mechanisms are poorly understood but involve complex neurological and vascular factors. 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 amputation.
Priapism is a medical emergency and needs proper treatment by a qualified medical practitioner.
Causes
Priapism may be associated with prolonged sexual activity, leukaemia, haematological disorders (such as sickle cell anaemia), cerebrospinal disease (such as syphilis), genital infection, or inflammation (Beers & Berkow, 1999).
Priapism can be caused by drugs such as certain antidepressants, antihypertensives, anticoagulants and corticosteroids.
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.
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 120mg orally. If this has not subsided by four hours, a further 120mg 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 & 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 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: Priapism
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