Priapism is a totally different affliction of the penis. It is the medical term for a usually painful erection lasting longer than three hours, with a complete absence of any sexual arousal.

In Graeco-Roman mythology Priapus is one of the lesser gods, of fertility, viticulture, gardening, beekeeping, etc. He is usually depicted with a gigantic phallus, and originated from Asia Minor. In the eyes of more educated Romans, Priapus was a figure of fun. He was imported from Greece in the first century by Roman practitioners of lighter verse.

Almost always he is pictured as a scarecrow and a deterrent to thieves keeping watch over a patch of land growing some vegetables and fruit and his coloured image is carved from a rough piece of wood. He is considered to be a connoisseur of the erotic, whose rough appear­ance is echoed in his forthright language, and who is immensely proud

of his phallus. The Carmina Priapea, a collection of nearly a hundred obscene erotic poems from ad ioo, are quite explicit about Priapus’ life and works.

The Priapus of the Priapea is a sexual glutton, a genuine Roman macho, who penetrates wherever he can. His sexuality is violent and unfeeling and some people have seen this as typical of the Roman male from the time of Nero:

Take heed: a boy behind, a girl in front I’ll take.

For bearded men who steal, remains a third ordeal.

Briefly summarized, that is the standard penalty for theft from Priapus’ garden or orchard. Depending on whether the offender is a woman, a man or a boy, they are threatened with vaginal, oral or anal rape. Priapus is also offered sacrifices in the poems, which are not only about crude sex. In one a dancer dedicates her tambourine and castanets to Priapus, expressing the hope that her audience will stay as enthusiastic as Priapus himself. Another promiscuous woman offers a generous number of wooden penises, one for every man she has ‘serviced’ the night before.

Priapism may occur as a side-effect of self-injection in the penis, but can also be the result of leukaemia, malignant tumours in the lower abdomen, the use of certain drugs and also sickle-cell anaemia, a here­ditary disease affecting mainly non-white populations living in or orig­inating historically from tropical or subtropical malarial regions. In this condition the red blood cells are more or less deformed, assuming a sickle shape, so that blood-clotting can quite easily occur, particularly when the flow speed is reduced. An instance of reduced flow is the state of erection, especially in sometimes 50-minute-long nocturnal erections. Young men with sickle-cell anaemia are prone to priapism. Treatment consists of the injection of a vascular constrictive medication directly into the penis. If that doesn’t help, an operation is necessary, in which a kind of bypass is constructed from the penis to an inguinal vein, allowing the accumulated blood to drain away uninterrupted. There are many variants: if an operation also fails to bring about flaccidity the erectile tissue compartments will fill up with connective tissue, giving them a wooden feel.

This happened to one of our patients not so long ago: after taking medication for depression a man, not yet 40, developed priapism. Unfortunately it emerged that that not all doctors are equally up to date on the treatment of priapism: it is necessary to act as soon as pos­sible after such an erection, which is often very painful, and preferably within six hours. He was dismissed by his doctor, who did not take the trouble to consult a specialist. Eventually the patient submitted a claim to his gp’s insurance company. However, damages had never been paid in the Netherlands in such a case, so that the patient’s lawyer sought advice from colleagues abroad. He found that in the United States about 200,000 euros would be paid out. The patient received less than a tenth of that. . .