Erections a real problem
THE EDITOR, Sir:
Your headline in The Gleaner dated February 28, 2011 raises an important issue in sickle-cell disease.
Priapism is a painful involuntary erection not associated with sexual desire. It is common among post-pubertal males who, because of embarrassment or because they do not realise that it is a complication of the disease, often fail to mention this. The 42 per cent incidence, correctly quoted in your article, came from a questionnaire study published from the Jamaican Sickle Cell Unit in 1980, based on direct enquiry of patients. Under-reporting was so common that computer programmes designed for patient management do not allow doctors to progress until they have asked the question, 'Do you have painful erections not associated with sex?'.
Priapism in sickle-cell disease takes two forms - stuttering priapism and major attacks. Stuttering priapism occurs for two to four hours, usually at night, is relieved by simple measures such as exercise or bathing, and is associated with normal sexual function between attacks.
So why are we worried about stuttering attacks? First, the loss of sleep may cause daytime sleepiness at school or work but, more important, in a third of subjects these stuttering attacks may precede major attacks. In major attacks, there is a painful, distressing erection lasting at least 12 hours and often much longer, attacks which may result in impotence.
Treatment of short-lived stuttering attacks is, therefore, important, and these may respond to hormonal therapy or minor surgery, but these measures can only be given if priapism is reported to the doctor. Major attacks require hospital admission and prompt drainage, and if impotence does follow, the insertion of penile implants may allow sexual intercourse.
I am, etc.,
Sickle Cell Trust