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Priapism – an erection that will not go down…

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Seek treatment immediately!

Over the last few weeks, we have been discussing the male genitalia and the male sexual response. During that time, I mentioned several conditions that I promised to discuss in detail in other articles. These conditions included priapism and the fractured penis.{{more}} To these, I will add Peyronie’s disease of the penis and sexually transmitted infections of the male genitalia. The latter is more appropriate to discuss now, as they will help us to better understand male infertility.

Priapism, as defined in a previous article, is the persistent, painful penile erection, not usually associated with passion. It is strange for people to imagine an erection that is not associated with sex and which is indeed painful! This is because social and personal conditioning has taught us that an erection is usually associated with eroticism and sexual intercourse.

In a normal erection, blood flows into the penis faster than it flows out and at peak rigidity the pressure in the penis is higher than the inflow pressure, so no new blood can flow in. However, the body only maintains this status of peak rigidity for a few minutes, until climax occurs, after which the blood then flows out faster than it flows in and the penis becomes flaccid. In priapism, this flaccid phase does not occur, either because the inflow of blood continues to occur faster than the efflux (rare) or the efflux of blood does not occur (common). The former, called high-flow priapism, is not dangerous or usually painful; but the latter, more common and dangerous type, is the painful low-flow priapism.

The penis usually becomes painful after 3-4 hours. This is because in the low-flow priapism, the old blood cannot get out of the penis and this prevents “new” oxygenated blood from getting into the penis. The penile tissues, now devoid of oxygenated blood, begin to break down and die, hence the pain.

In the black population, the most common causes of priaprism are sickle cell disease and its trait. Other blood diseases like leukemia and multiple myeloma can cause priapism, but these are not as common as the use of prescription and over-the-counter sexual enhancers like Viagra, Cialis, Enhance, Horny goat weed and “stud 500,” to name a few. This becomes worse if these sexual enhancers are combined or used too often in 24 hours. Other medications, like those used to treat high blood pressure (called vasodilators) and benign prostate problems (like hytrin and flomax), can cause priapism, especially if used with other stimulants or alcohol or cocaine. Rarely, diseases like renal failure, alcoholism, dehydration, acute prostate or urinary tract infections may cause priapism as do some psychiatric medications.

The treatment of priapism is a urological emergency. The young man is admitted to the hospital to have the old blood removed from the penis. This allows the influx of new blood. If treatment does not occur within 6 hours, the penile tissues begin to die and any attempts to salvage their function usually fail. Because of the embarrassment, most men present with priapism 1-2 days after the onset! At this time, the aim of treatment is to reduce pain and try to salvage the remains of the penis. The penis is numbed by either a local or a general anaesthetic and the old blood is first aspirated (sucked out), then irrigated (washed out), using special chemicals, using a large bore needle. New blood then enters the “space” left by the old blood. This is supposed to salvage the penis, but in real life, this rarely happens as planned and the man is left with a partially or totally dead penis, which cannot rise to the occasion (impotent). This is the type of impotence that Viagra and its brothers cannot help, so it is important that the man gets to the hospital before it is too late! If he arrives before 4 hours, then he can be helped and the penis salvaged. After then, especially 2-3 days after as is the norm, the only salvage is the use of prosthesis to help him achieve an erection.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: d[email protected]

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