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Vulva : Overview, Anatomy, structure and function - Sentelhealth

 Overview : The vulva is a part of the female reproductive system and is also part of the external genitalia. The vulva consists of labia minora, labia majora, mons pubis, clitoris, vestibular bulb, vulval vestibule, urinary meatus the vaginal opening, hymen, and Bartholin's glands. other parts of the vulva include sebaceous glands, urogenital triangle, and pudendal cleft. Pelvic floor muscles support the structures of the vulva and vulva including the entrance to the vagina. Vulva goes through changes during childhood, puberty, menopause, and post-menopause. Structure: A) Mons pubis: it is present in both sexes and act as a cushion during sexual intercourse and is more pronounced in female. the mons pubis is a soft fatty tissue at the front of the vulva in the pubic region covering the pubic bone. the lower part of the mons pubis is divided by a fissure called pudendal cleft. it separates mons pubis and labia majora, the mons pubis, and labia majora get covered by pubic hair at pu...
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Priapism - Overview | symptoms | causes | diagnosis | treatment -Sentelhealth

Priapism - Overview | Types | Symptoms | Causes | Diagnosis | Treatment -Sentelhealth

Overview

Priapism is a penile erection lasting longer than four hours which isn't related to sexual stimulation. Priapism is a rare condition and occurs most commonly in men in their 30s. Although, there are some cases of clitoral priapism that have been reported. Priapism
symptoms depend on the type of priapism the person has, there are three main types of priapism:

1)Ischemic priapism

ischemic priapism is the most common type of priapism. It is also called low flow priapism, it occurs as the blood is unable to leave the penis. symptoms of ischemic priapism include:
a)Penile erection lasting longer than four hours without sexual stimulation.
b)Ischemic priapism is painful and pain progresses with the duration of priapism.
c)Penile shaft is rigid but, the glans(tip) is soft.

2)Recurrent priapism

Recurrent priapism is a form of ischemic priapism characterized by recurrent episodes of a prolonged erection lasting longer than four hours. Recurrent priapism is a painful condition. Initially, the frequency and duration are short but, it progresses over time. A person with sickle cell anemia is more prone to have recurrent priapism.

3)Non-ischemic priapism

It is the least common variety of priapism also called high flow priapism. Non-ischemic priapism is characterized by normal or high blood flow to the penis.it is a painless condition symptom include:
a)Penile erection lasting longer than four hours without sexual stimulation.
b)Penis is erect but not fully rigid throughout its length.

When to see a doctor

1)A penile erection lasting longer than four hours unrelated to sexual stimulation needs urgent medical attention.
2)A person with recurrent episodes of penile erection unrelated to sexual stimulation which resolves on their own need to consult a doctor.

Causes of priapism :

The exact mechanism for causing priapism is not fully understood however, there are some factors that are thought to cause priapism

 1)Sickle cell anemia: This is the most common blood disorder that causes priapism. The sickle-shaped cells block the penis vessels preventing the blood from coming out of the penis. Other blood disorders like thalassemia, multiple myeloma, and leukemia also cause priapism.
2)Alcohol and drug abuse: incidence of priapism in alcoholics and cocaine and marijuana addicts is very high especially of ischemic priapism.

3)A trauma or injury to the penis is a common cause of non-ischemic priapism in which priapism occurs due to excessive blood flow to the penis.
4)Medications: Priapism particularly ischemic priapism is thought to be caused by certain medications which include -
a)Alpha blockers such as Tamsulosin,Prazosin,Terazocin
b)Blood thinners such as warfarin
c)Drugs used to treat erectile dysfunction especially the drugs which are directly injected into the penis, drugs like phentolamine.
5)Testosterone or GnRH(gonadotropin-releasing hormone)
6)Antidepressants like bupropion,prazocin,sertaline.

Diagnosis

Diagnosis of priapism is based mainly on history and clinical examination by a doctor. however, some investigations are used to confirm the diagnosis and to differentiate between the different types of priapism. The investigations include:

A)Blood gas analysis: in this test sample of the blood is taken from the corpora cavernosa of the penis and if  -
1)The blood has low PH it is classified as ischemic priapism.
2)The blood has normal PH then it is non-ischemic priapism.

 B)Ultrasonography: ultrasonography diagnoses the priapism and differentiates between various types of priapism based on the blood flow to the penis.
1)In ischemic priapism the blood flow to the penis is reduced or absent.
2)In non-ischemic priapism blood flow is normal or in excess.
Ultrasonography with the doppler is an investigation of choice for priapism. Ultrasonography is highly sensitive, it can also be used in the diagnosis of other penile diseases like erectile dysfunction, Peyronie's disease, retrograde ejaculation, premature ejaculation, and anejaculation.

Treatment

Priapism is medical and needs to be treated immediately and promptly but, very aggressive treatment methods are not recommended. Following are the treatment options for priapism:

A)Aspiration: in ischemic priapism aspiration is the initial treatment, aspiration is typically done from corpora cavernosa on either side. If this fails then cold normal saline is injected and removed. A penile ring block (nerve block) can be given to reduce pain.

B)Drugs and medications: if aspiration fails to give a response then a small dose of phenylephrine is injected into corpora cavernosa. patients on phenylephrine should be closely monitored for at least 60-90 minutes after the drug administration.For non-ischemic priapism diethylstillbesterol or terbutaline is used.
c)Surgery: Surgery mainly involves shunts the most commonly used shunt is Winter's shunt -which involves puncturing the glans at one of the cavernosal to remove the stagnant blood present in it. Winter's shunt is usually the first invasive technique used in the treatment of priapism.

Further reading :

A) Erectile dysfunction
B) Peyronie's disease


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