Sleep Related Painful Erections due to Benzodiazepines

Abstract

Objective: To describe a case report of sleep related painful erection (SRPE) and review of the literature. Design and Method: We describe our case report and present a comprehensive review of the literature using Pubmed and Medline. Keywords used: sleep-related erection, painful erection, drugs. A 64 year old patient consulted our outpatient clinic with symptoms of erectile dysfunction, history of Peyronie’s disease and SRPE. The symptoms of SRPE started a year ago, at the same time he started taking benzodiazepines due to insomnia. After careful examination we advised to stop this medication. Re-evaluation after 10 days showed resolution of the symptoms with total disappearance of the SRPE. Results: SRPE is a rare sleeping disorder characterized by recurrent, painful penile erections occurring when awakening from REM sleep, while erections are painless during wakefulness. The repeated SRPE-related awakenings lead to REM sleep deprivation, and insomnia with accompanying daytime exhaustion, stress and irritability. Polysomnographic monitoring shows that the SPRE are associated with awakening in REM sleep, and demonstrates a disturbance of sleep stability, an increase in arousals, and instability in the erections which last beyond REM sleep. Unfortunately the pathophysiology of SRPE remains unknown. Previous association with obstructive sleep apnea syndrome therapy (OSAS) is described. It should be noted that the rarity of the published observations probably does not reflect the actual prevalence of the disorder. Conclusions: Patients with SPRE taking benzodiazepines should be counseled to stop this medication.