Priapism

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Priapism

Priapism is a potentially harmful and painful medical condition in which the erect

Erection

An erection of the penis, clitoris or a nipple is its enlarged and firm state. It is the result of a complex interaction of psychological, neural, vascular and endocrine factors, and is usually, though not exclusively, associated with sexual arousal....
penis

Penis

The penis is an external sex organ of certain biologically male organisms, in both vertebrates and invertebrates.The penis is a reproductive organ, technically an intromittent organ, and for Eutheria, additionally serves as the external organ of urination....
does not return to its flaccid state, despite the absence of both physical and psychological stimulation, within four hours. Priapism is considered a medical emergency

Medical emergency

A medical emergency is an injury or illness that is Acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves....
, which should receive proper treatment by a qualified medical practitioner.

The name comes from the Greek god Priapus

Priapus

In Greek mythology, Priapus was a minor rustic fertility god, protector of livestock, fruit plants, gardens and male genitalia. His Roman mythology equivalent was Mutinus Mutunus....
, referring to the myth that he was punished by the other gods for attempting to rape a goddess, by being given a huge, but useless, set of wooden genitals.

pism may be associated with haematological

Hematology

Hematology, American_and_British_English_spelling_differences#Simplification_of_ae_.28.C3.A6.29_and_oe_.28.C5.93.29 haematology, is the branch of biology , pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases....
disorders, especially sickle-cell disease

Sickle-cell disease

Sickle-cell disease or sickle-cell anaemia is a life-long blood disorder characterized by red blood cells that assume an abnormal, rigid, sickle shape....
, and other conditions such as leukemia

Leukemia

Leukemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation of blood Cell , usually white blood cells ....
, thalassemia

Thalassemia

Thalassemia is an inherited autosomal recessive blood disease. In thalassemia, the genetic defect results in reduced rate of synthesis of one of the globin chains that make up hemoglobin....
, and Fabry's disease

Fabry's disease

Fabry disease is an X-linked recessive lysosomal storage disease. The disease is named for Johannes Fabry....
, and neurologic disorders

Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the Central nervous system, Peripheral nervous system, and autonomic nervous systems, including their coverings, blood vessels, and...
such as spinal cord

Spinal cord

The spinal cord is a long, thin, tubular bundle of neuron and glia that extends from the brain. The brain and spinal cord together make up the central nervous system....
lesions and spinal cord trauma (priapism has been reported in hanging victims; see death erection

Death erection

A death erection or terminal erection is a post-mortem erection, technically a priapism, observed in the corpses of human males who have been execution, particularly by hanging....
).

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Encyclopedia

Priapism is a potentially harmful and painful medical condition in which the erect

Erection

Penis

Medical emergency

Priapus

Causes

The causative mechanisms are poorly understood but involve complex neurological and vascular

Vascular

In zoology, "vascular" means "related to blood vessels", which are part of the Circulatory system. An organ or tissue that is vascularized is heavily endowed with blood vessels and thus richly supplied with blood....
factors. Priapism may be associated with haematological

Hematology

Sickle-cell disease

Leukemia

Leukemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation of blood Cell , usually white blood cells ....
, thalassemia

Thalassemia

Fabry's disease

Fabry disease is an X-linked recessive lysosomal storage disease. The disease is named for Johannes Fabry....
, and neurologic disorders

Neurology

Spinal cord

Death erection

A death erection or terminal erection is a post-mortem erection, technically a priapism, observed in the corpses of human males who have been execution, particularly by hanging....
). Recent breakthroughs in research of the disease have pointed to a raised level of the biochemical adenosine being the cause of the condition. This seems to cause blood vessels to dilate and has the potential to influence blood flow into the penis.

Priapism can be caused by medication

Medication

A pharmaceutical drug, also referred to as medicine or medicament, can be loosely defined as any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease....
s. The most common medications that cause priapism are intra-cavernous injections for treatment of erectile dysfunction

Erectile dysfunction

Erectile dysfunction is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance....
(papaverine

Papaverine

Papaverine is an opium alkaloid used primarily in the treatment of visceral spasm, vasospasm , and occasionally in the treatment of erectile dysfunction....
, alprostadil

Alprostadil

Alprostadil is the pharmaceutical name for prostaglandin E1. It is used as a drug in the treatment of erectile dysfunction and has vasodilatory properties....
). Other groups reported are antihypertensives, antipsychotic

Antipsychotic

Antipsychotics are a group of psychoactive drugs commonly but not exclusively used to treat psychosis, which is typified by schizophrenia. Over time a wide range of antipsychotics have been developed....
s (e.g., chlorpromazine

Chlorpromazine

Chlorpromazine is a phenothiazine antipsychotic, and the oldest in the antipsychotic family of drugs. It is a typical antipsychotic. It is principally used in the treatment of schizophrenia, though it has also been used to treat severe manic episodes in people with bipolar disorder....
, clozapine

Clozapine

Clozapine is an antipsychotic and benzodiazepine medication used in the treatment of schizophrenia. The first of the atypical antipsychotics to be developed, it was first introduced in Europe in 1971, but was voluntarily withdrawn by the manufacturer in 1975 after it was shown to cause agranulocytosis that led to death in some patients....
), antidepressant

Antidepressant

An antidepressant is a psychiatric medication used for alleviating major depressive disorder or dysthymia. Drug groups known as MAOIs, tricyclics, and second-generation antidepressants such as SSRIs, and serotonin-norepinephrine reuptake inhibitors are particularly associated with the term....
s (most notably trazodone

Trazodone

Trazodone is a psychoactive compound with sedative, anxiolytic, and antidepressant properties. The various manufacturers claim that the antidepressant becomes active in the first week of therapy....
), anticoagulants, cantharides (Spanish Fly) and recreational drugs (alcohol

Alcohol

In chemistry, an alcohol is any organic compound in which a hydroxyl Functional group is bound to a carbon atom of an alkyl or substituted alkyl group....
and cocaine

Cocaine

Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine....
). Phosphodiesterase type-5 (PDE5) inhibitors

PDE5 inhibitor

A phosphodiesterase type 5 inhibitor, often shortened to PDE5 inhibitor, is a medication used to block the degradative action of phosphodiesterase type 5 on cyclic GMP in the smooth muscle cells lining the blood vessels supplying the corpus cavernosum of the penis....
such as sildenafil

Sildenafil

Sildenafil citrate, sold as Viagra, Revatio and under various other trade names, is a Medication used to treat erectile dysfunction and pulmonary hypertension ....
("Viagra"), tadalafil

Tadalafil

Tadalafil is an orally administered medication for treating erectile dysfunction , that initially was developed by the biotechnology company ICOS, and then again developed and marketed world-wide as Cialis, by Lilly ICOS, LLC, the joint venture of ICOS Corporation and Eli Lilly and Company....
("Cialis"), and vardenafil

Vardenafil

Vardenafil is a PDE5 inhibitor used for treating impotence that is sold under the trade name Levitra , , ....
("Levitra"), have very rarely been implicated. PDE-5 inhibitors have even been evaluated as preventive treatment for recurrent priapism. Priapism has also been linked to achalasia

Achalasia

Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder: The smooth muscle cell layer of the esophagus loses normal peristalsis , and the lower esophageal sphincter fails to relax properly in response to swallowing....
. Priapism is also known to occur from bites of the Brazilian wandering spider

Brazilian wandering spider

The Brazilian wandering spiders , armed spiders or banana spiders are a genus of aggressive and highly spider bite found in tropical South America and Central America....
.

Complications

Potential complications include ischemia

Ischemia

In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue....
, clotting of the blood retained in the penis (thrombosis

Thrombosis

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood....
), and damage to the blood vessels of the penis which may result in an impaired erectile function or impotence

Erectile dysfunction

Erectile dysfunction is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis sufficient for satisfactory sexual performance....
. In serious cases, the ischemia may result in gangrene

Gangrene

For the American football team nicknamed "Gang Green," see New York Jets.Gangrene is a complication of necrosis characterized by the decay of biological tissues, which become black and malodorous....
, which could necessitate penis removal

Penectomy

Penectomy is the practice of surgery penis removal for medical or personal reasons.Cancer, for example, sometimes necessitates removal of all or part of the penis....
.

Treatment

Medical advice should be sought immediately for cases of erection beyond four hours. Generally, this is done at an emergency department

Emergency department

The emergency department , sometimes termed the emergency room , emergency ward , accident & emergency department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injury, some of which may be Medical emergency and requiri...
. The therapy at this stage is to aspirate blood from the corpus cavernosum

Corpus cavernosum penis

The corpus cavernosum penis is one of a pair of sponge-like regions of erectile tissue which contain most of the blood in the male penis during erection....
under local anaesthetic

Local anesthetic

A local anesthetic is a medication that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways , effects such as analgesia and paralysis can be achieved....
. If this is still insufficient, then intra-cavernosal injections of phenylephrine

Phenylephrine

Phenylephrine or Neo-Synephrine is an Alpha-1_adrenergic_receptor agonist used primarily as a decongestant, as an agent to dilate the pupil and to increase blood pressure....
are administered. This should only be performed by a trained urologist, with the patient under constant hemodynamic monitoring, as phenylephrine can cause severe hypertension

Hypertension

Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated....
, bradycardia

Bradycardia

Bradycardia , as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min....
, tachycardia

Tachycardia

The word tachycardia comes from the Greek words tachys and kardia .Tachycardia typically refers to a heartrate that exceeds the range of the normal resting heartrate, based upon age:...
, and arrhythmia.

If aspiration fails and tumescence

Tumescence

Tumescence is the quality or state of being tumescent or swollen. Tumescence usually refers to the normal engorgement with blood of the erectile tissues, marking sexual excitation and possible readiness for sexual activity....
recurs, surgical shunts

Shunt (medical)

In medicine, a shunt is a hole or passage which moves, or allows movement of bodily fluid from one part of the Human anatomy to another. The term may describe either congenital or acquired shunts; and acquired shunts may be either wikt:biologicial or wikt:mechanical....
are next attempted. These attempt to reverse the priapic state by shunting blood from the rigid corpora cavernosa into the corpus spongiosum

Corpus spongiosum

Corpus spongiosum is the mass of spongy biological tissue surrounding the male urethra within the penis....
(which contains the glans

Glans penis

The glans penis is the sensitive bulbous structure at the distal end of the penis. It is also commonly referred to as the "head" of the penis. Slang terms include "helmet", "nob" , and "bell end", and all refer to its distinctive shape....
and the urethra

Urethra

In anatomy, the urethra is a tube which connects the urinary bladder to the outside of the body. The urethra has an excretory function in both sexes to pass urine to the outside, and also a reproductive function in the male, as a passage for semen....
). Distal shunts are the first step, followed by more proximal shunts.

Distal shunts, such as the Winter's, involves puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside.

Proximal shunts, such as the Quackel's, are more involved and entail operative dissection in the perineum

Perineum

In human anatomy, the perineum is generally defined as the surface region in both males and females between the pubic symphysis and the coccyx. The perineum is the region of the body inferior to the pelvic diaphragm and between the legs....
to where the corpora meet the spongiosum, making an incision in both, and suturing both openings together.

Female Priapism

Female Priapism is better known as Clitorism

Clitorism

Clitorism , from the Latin Language "Clitorismus", in turn from the Greek language kleitoris + ismos, is a continued, painful condition in the female with recurring erection of the clitoris....
.