American Medical Association Family Medical Guide - American Medical Association [562]
WARNING!
Persistent Erection
Priapism is a medical emergency that requires immediate medical treatment. If you have an erection that persists for no reason, call your doctor right away, or go directly to the nearest hospital emergency department.
If priapism is not treated promptly, the spongy tissues of the penis can be permanently damaged, preventing future erections. The tissue can also die (gangrene; see page 601).
Diagnosis and Treatment
A diagnosis of priapism is based on the symptoms and a physical examination. The doctor will take a detailed health history to help find the possible underlying cause of the condition.
Emergency treatment of priapism involves draining excess blood from the penis with a needle and syringe and irrigating the spongy tissue of the penis with an antihistamine fluid to relax the erection and wash out old blood or blood clots. Priapism may be treated with surgery to bypass the blockage or drugs that relax the muscle in the penis, allowing blood to flow out of the penis. For people who have sickle cell disease (see page 613), blood transfusions to reduce the number of abnormal (sickled) blood cells can be effective. If priapism is treated promptly, the erection will subside and the person will eventually be able to have normal erections again.
Cancer of the Penis
Cancer of the penis is the growth of cancerous cells on the skin and in the tissues of the penis. Although the exact cause of penile cancer is not known, it seems to be associated with chronic irritation and inflammation of the head of the penis. There is a link between penile cancer and the human papillomavirus (HPV; see page 480), the virus that causes cervical cancer in women. Cancer of the penis occurs most frequently in men over age 55 and in blacks. Penile cancer rarely occurs in circumcised men, and is rare in the United States.
Although cancer can occur anywhere on the penis, it usually develops on the head (glans) or foreskin. Because this type of cancer is usually slow-growing, early detection and treatment will save the penis in most cases. If left untreated, cancer of the penis can spread to other parts of the body, usually through the lymphatic system (see page 908) or the bloodstream.
Symptoms
The main symptom of penile cancer is a sore or wartlike lump on the penis. Other possible symptoms include pain in the groin, a lump or swelling in the groin, a discharge from the penis, or bleeding during an erection.
Diagnosis
If you have symptoms of penile cancer, your doctor will examine your penis and may recommend a biopsy. For a biopsy, a small sample of tissue from the penis is removed for examination under a microscope for cancer cells. The biopsy will help the doctor distinguish cancer of the penis from syphilis (see page 483) or genital warts (see page 480), both of which can resemble a cancerous growth.
If cancer is detected, the doctor will order an imaging test such as ultrasound (see page 111), a CT scan (see page 112), or MRI (see page 113) of the pelvis to see if the cancer has spread. He or she also may perform an aspiration biopsy, in which a sample of cells is withdrawn through a hollow needle from a lymph node in the groin area. The cells are then examined under a microscope to determine if the cancer has spread to the lymph nodes. A test called lymph node dissection, in which lymph nodes in the groin area are removed and examined for the presence of cancer cells, may also be done.
Treatment
If you have cancer of the penis, your doctor probably will recommend surgery. Possible methods of surgery include wide local excision (in which the surgeon removes the cancer and some surrounding healthy tissue) or microsurgery (in which the surgeon removes the cancer and a very small amount of the surrounding healthy tissue while looking through a microscope). In laser surgery, the surgeon uses a concentrated beam of light to destroy the cancerous