A 21-year-old male presented to the hospital with a partially rigid penis of three months’ duration. At the time of his examination, the penis was half rigid with a tattoo on its dorsal (back) surface and a smaller tattoo on the tip. The patient stated that the tattoo was created just prior to the priapism and noted bleeding from the deep penile tissues for several days after the tattooing.
You may, of course, be curious as to what was tattooed. The tattoo on the dorsal surface of the penis reads in Persian borow be salaamat, which apparently means “good luck with your journeys.” The patient also had the English letter M tattooed on the tip of his penis, and he admitted that M was the first letter of his girlfriend’s first name.
The patient had no known causes that are normally associated with priapism, such as penile injury, sickle cell anemia, perineal injury (injury to the area between the anus and the genital organs), tumors, or drug injections.
One theory suggests that the priapism was secondary to the deep penetration of the needle by the tattoo artist. In Iran, tattoos are created manually using a handheld needle. This traditional Iranian technique allows no control of the depth of the needle penetration. After tattoo artists pierce the skin with the needle, coloring material (henna, ash, or other natural pigments) is then applied on the perforated skin surface.
The multiple piercings necessary to complete the tattoo apparently created a fistula (an abnormal passage) between the deep artery and the veins of the penis. As a result, more blood was entering the penile channel than could naturally be evacuated. The fistula formation caused a pooling of the blood outside of the vessel wall. This pooling and the stoppage of flow resulted in fibrosis of the penis tissue and created a permanent semierect penis. Under usual circumstances, the fibrotic damage caused by priapism results in the subsequent inability to get or maintain an erection adequate for penetration. But because this patient is 21 years old and the apparent damage was incomplete, he is able to get a partial erection and is capable of having intercourse. This case is the exception rather than the rule.
The takeaway message? Having someone repeatedly stick a needle into your penis for the purposes of tattooing is a bad idea that can result in grave consequences.
Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).
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