Chapter Six: Penile Diseases: Causes and Treatment of Priapism

Chapter Six Penile Diseases

What is priapism?

Priapism refers to painful, persistent erections of the penis without sexual desire or stimulation. This condition is rare in China. If not treated promptly in its early stages, it can lead to penile necrosis, fibrosis, impotence, and psychological trauma. Therefore, this condition should be treated as an emergency at a reputable hospital as soon as possible.

Causes of priapism

In most cases, the cause is difficult to find clinically, and the precipitating factors can be divided into four categories:

(1) Mental and neurological factors: such as central nervous system diseases, central nervous system dysfunction (tumors or syphilis, etc.), and mental trauma caused by interruption of sexual intercourse due to strong fear.

(2) Blood-related causes: such as chronic myeloid leukemia, sickle cell anemia, diabetes or gout, which can cause increased blood viscosity and thrombophlebitis.

(3) Local organic lesions of the penis: penile trauma, direct stimulation of the dorsal nerve of the penis by metastatic tumors in the corpora cavernosa. Infiltration and continuous compression by pelvic tumors (such as bladder or prostate cancer).

(4) Drug-induced: For example, the use of antihypertensive tablets to treat hypertension, large doses of 6-aminocaproic acid for nosebleeds, or large doses of hemostatic agents for gastrointestinal bleeding have all been reported to cause priapism.

This condition commonly occurs in married middle-aged patients, often without sexual activity; in a few cases, it manifests as painful, rigid erections during intercourse, lasting for varying durations. Local examination reveals the penis is erect at a 50° angle to the abdominal wall; unlike normal penile erection, only the corpora cavernosa are erect, while the glans and corpus spongiosum remain erect. The glans turns bluish, and edema quickly develops on the foreskin. If the erection lasts longer than 48 hours, thrombosis can occur within the corpora cavernosa, causing the entire penis to harden. Continued erections transform from the initial reflex erection into a thrombosclerotic erection. After 10 days, the corpora cavernosa harden, resulting in permanent organic erectile dysfunction.

Traditional Chinese medicine believes that a person's excessive consumption of spicy, fatty, sweet, and alcoholic foods; a person's inherent yin deficiency; unclean sexual practices; excessive indulgence in sexual activity; falling, stumbling, or being struck by a hard object, which damages the blood vessels of the penis and obstructs the penile vessels; or prolonged use of tonifying tonics or excessive sexual activity that damages the yin essence, can lead to damp-heat in the liver meridian, yin deficiency with fire excess, and blood stasis, resulting in abnormal penile erection.

How to treat priapism (male erectile dysfunction)

The goal of treatment is to improve blood circulation and relax the erect penis, restoring normal sexual function. It is generally believed that any erection lasting 4-6 hours or longer should be addressed; erections exceeding 24 hours may lead to adverse consequences.

Western medicine treatment methods:

(1) First, try non-surgical treatment: including the use of sedatives, estrogen, local cold compresses and epidural anesthesia. In the early stage, the corpus cavernosum of the penis can be punctured with a large needle to release 20-70 ml of blood or the blood clot can be removed and then repeatedly rinsed with 1:1000 heparin saline solution.

(2) Surgical treatment: It is reasonable to use a shunt procedure that increases penile venous return as early as possible. The following methods can be selected: ① shunt between the corpus cavernosum and the corpus cavernosum; ② shunt between the corpus cavernosum and the corpus spongiosum; ③ anastomosis of the corpus cavernosum and the great saphenous vein on one or both sides; ④ shunt between the corpus cavernosum and the superficial or deep dorsal veins of the penis.

Treatment of secondary penile erection must first remove the underlying cause of the condition, and the aforementioned treatments can be used in conjunction with this approach.

Traditional Chinese Medicine treatment methods:

(1) Damp-heat in the liver meridian: Its main manifestations are persistent erection, swelling, heat and pain, irritability, insomnia and dreaminess, dizziness and swelling, bitter taste in the mouth and dry throat, short and dark urine, difficulty in urination, constipation, red tongue, yellow or yellow and greasy coating, and wiry and rapid or wiry and slippery pulse.

The treatment should focus on clearing heat and promoting diuresis, supplemented with methods to invigorate blood circulation.

For medicinal diet and food therapy, you can use Artemisia capillaris porridge (from "Porridge Recipes"): 30-50g Artemisia capillaris, 100g japonica rice, and appropriate amount of white sugar or salt.

Preparation and Usage: Wash the Artemisia capillaris and place it in an earthenware pot with 200ml of water. Simmer until reduced to 100ml, then remove the dregs. Add japonica rice and another 600ml of water, and cook until the porridge is done. Season to taste, either salty or sweet. Take twice daily, slightly warm. One course of treatment is 7-10 days.

Precautions for use: Artemisia capillaris should be harvested from the branches in March and April each year for optimal medicinal effect. When cooking porridge, only japonica rice should be used, and the porridge should be thin, not thick.

(2) Yin deficiency with fire excess: Its main manifestations are easy erection of the penis, or after the yin and yang are in harmony, it remains firm and does not fall down for several days, swelling and pain of the penis and testicles, soreness and weakness of the waist and knees, dizziness, dry throat, irritability and insomnia, tender red tongue with little coating, and thready and rapid pulse.

The treatment should focus on nourishing Yin and calming Yang, guiding the fire back to its source.

A medicinal diet and food therapy recipe is bitter melon stir-fried with pork kidney (from "A Guide to Nutritious and Delicious Meal Plans for Chronic Diseases: Sexual Dysfunction"): 150g bitter melon, 1 pair of pork kidneys, appropriate amount of salt, 15g olive oil.

Preparation and usage: Cut the fresh bitter melon in half, remove the seeds, wash and slice it. Remove the fat membrane from the fresh pork kidney, cut it open, wash it repeatedly with salt, and then slice it. Heat olive oil in a pan, stir-fry the kidney slices until half-cooked, then add the bitter melon slices and salt and stir-fry until cooked.

Massage techniques can be used, such as massaging the Qiaogong acupoint: first massage one side of the Qiaogong acupoint 20-30 times, then massage the other side of the Qiaogong acupoint.

Rub the Shenshu and Mingmen acupoints horizontally until a warm sensation is felt, then rub the Yongquan acupoints on both sides to draw the fire back to its source.

(3) Blood stasis: Its main manifestations are prolonged erection, swelling and pain, skin ecchymosis, and even dark purple color of the penis, swelling and hardness, purple spots or ecchymosis on the tongue, white coating, and slippery or deep and wiry pulse.

Treatment should focus on promoting blood circulation, removing blood stasis, and regulating the penis.

A medicinal diet and food therapy recipe is stir-fried chicken slices with black fungus (from "A Guide to Nutritious and Delicious Meal Strategies for Chronic Diseases: Sexual Dysfunction"): 6g black fungus, 250g chicken breast, 15g olive oil, appropriate amount of salt, 5g minced ginger, and 5g chopped green onion.

Preparation and usage: Soak black fungus in warm water until it expands, wash and slice chicken breast; heat olive oil in a pan, sauté ginger until fragrant, stir-fry chicken slices until half-cooked, then add black fungus and salt, stir-fry until cooked, and sprinkle with chopped green onions before serving.

Massage techniques can be used, such as pressing and kneading the Shenshu (BL23), Zhishi (BL52), Sanjiaoshu (BL22), Shuidao (ST28), and Sanyinjiao (SP6) acupoints. Each acupoint should be massaged for about one minute, until the swelling subsides.

Rub the lumbosacral region horizontally until it feels warm.