The authors present a case of a 24-year-old, poorly controlled insulin-dependent type 1 diabetic Caucasian man who presented to the emergency department, with a painful erection of 36 h duration that had failed to resolve with conservative management. This was the patient's seventh priapism, with his most recent attendance 1 week previously for which he underwent a distal cavernosal shunt. He admitted to taking several recreational drugs, including marijuana and cocaine, during the preceding few days, in addition to the long-term use of the oral anabolic steroid oxandrolone. He had no family history of sickle cell disease or trait. On examination, a tensely erect penis was noted. A diagnosis of stuttering priapism was made and 750 mL of blood subsequently drained via a distal corporoglandular shunt resulting in successful detumescence.
Back in New York, I joined the Midtown Y and fell in with a crew of hard-hat bruisers – vice cops and garbagemen in chalk-smudged Speedos and calf-high wrestling boots. I thought they were giants until the day in June when the real size kings walked in. Two of them, Tommy and Spiro, had chiseled trunks and the complicated, quasi-Cubist planes that give away hardcore juicers. But it was the third one, a mocha-skinned guy named Angel, that I couldn't pry my gaze off. When he doffed his Puma jacket and burned through upright rows, I saw the kind of vascular, strand-on-strand rhomboids you find in Da Vinci studies. There was art in what he did and art in what he made: muscle from a fourth dimension. I gathered my flimsy nerve and said hello.