Sleep-related Painful Erection Research Articles

Sleep-related painful erections: a survey-based analysis of patient-reported experiences with diagnosis and management.

Sleep-related painful erection (SRPE) is a condition characterized by painful nocturnal erections and frequent nighttime awakenings; however, the pathophysiology is not well understood and existing literature consists mainly of case reports. We aimed to investigate the causes, treatments, and impact on quality of life among individuals affected by SRPE. An e-questionnaire comprising of 30 items was administered to a group of men with SRPE identified through social media in October of 2021. The survey collected information on demographics, clinical and social history, symptomatology, interventions and quality of life. 44 patients with SRPE completed surveys (70.9% response rate), with a mean age ± SD of 43.3 ± 12.8 years. Most respondents had no relevant medical history related to erectile function disorders. 43.2% of subjects reported sleep apnea, and 27.1% reported a mental health disorder or psychiatric medication use. Baclofen was the most common medication, but only 25% of patients found it beneficial. Sleep repositioning, oxygen device use and pelvic floor therapy were interventions that provided the most relief. Most patients did not require emergency department visits (93.2%); only a small number needed penile aspiration (n = 2). As reported by most respondents, SRPE significantly impacted patients' quality of life.

Improvement of associated symptoms using combined therapy in 44 patients with sleep-related painful erection during 1-year follow up.

The current study was aimed at analysing the clinical features and efficacy of combined treatments in patients with sleep-related painful erection (SRPE). Patients who presented with SRPE were continuously enrolled from the outpatient clinic of Peking Union Medical College Hospital from 2015 to 2021. Demographic data, medical history, diagnostics, treatment options and their effectiveness on SRPE in the short and long therapeutic term were recorded. Individually designed combined therapy aimed at controlling SRPE-related symptoms and comorbidities (general health, pain, psychological and sleeping disorders, late-onset hypogonadism, and lower urinary tract symptoms) was used, and the effectiveness was evaluated. In total, 44 patients with an average age of 44.66 ± 7.96 years were enrolled. The median length of the delay in diagnosis was 1.5 years (range, 1month to 27 years). Combined treatment aimed at controlling symptoms was used, the mean GAD-7, PHQ-9, PSQI and VAS scores were significantly decreased to 4.25 ± 3.44, 4.55 ± 2.86, 7.65 ± 3.06, and 2.90 ± 1.89 after treatment for 3months. Moreover, the VAS ratings were significantly decreased at 1year of follow-up (p < 0.001). SRPE mainly occurred in middle aged males, 79.55% (35/44) patients were more than 40 years old. The prevalence of anxiety, depression, poor sleep and nocturia is high in patients with SRPE. Combined treatments aimed at controlling these symptoms can be more effective.

REM sleep, REM parasomnias, REM sleep behaviour disorder

We review the literature on REM parasomnias, and their the underlying mechanisms. Several REM parasomnias are consistent with sleep dissociations, where certain elements of the REM sleep pattern emerge in an inadequate time (sleep paralysis, hypnagogic hallucinations and cataplexy) or are absent/partial in their normal REM sleep time (REM sleep without atonia, underlying REM sleep behavior disorder). The rest of REM parasomnias (sleep related painful erection, catathrenia) may have other still unclear mechanisms. REM parasomnias deserve attention, because in addition to disturbing sleep and causing injuries, they may shed light on REM sleep functions as well as the heterogeneous etiologies of parasomnias. One of them, REM sleep behavior disorder has special importance as a warning sign of evolving neurodegenerative conditions mainly synucleinopathies (some cases synucleinopathies themselves) and it is a model parasomnia revealing that parasomnias may have by autoimmune, iatrogenic and even psychosomatic etiologies.

Narrative review: pathogenesis, diagnosis, and treatment of sleep-related painful erection.

ObjectiveThrough critical analysis and comprehensive review of the limited literature, this paper can help clinicians better identify the pathophysiology of sleep-related painful erections (SRPE) and provide direction for future treatment research.BackgroundPatients with SRPE will be awakened by painful erections during sleep, which affects their sleep process and general health. At present, literatures of experimental and clinical research on SRPE disease are limited, as well as long-term reports on its pathogenesis and clinical management.MethodsWe use the PubMed database to obtain sleep-related peer erection literature. The search terms used include sleep, painful, penis and erection. After rigorous screening, the search returned 21 references published between 1987 and 2021.ConclusionsThe main cause of SRPE is obstructive sleep apnea (OSA) syndrome, psychological and spiritual factors, androgen elevation, neuroendocrine regulation and threshold of pain in the REM phase. The combination of multiple medications is the most effective approach to treat sleep-pain-related erections. The combination of CPAP, REM inhibitors and Baclofen has significant effect on SRPE caused by OSA syndrome. This article provides effective support and strategies for doctors to manage SRPE patients through a comprehensive analysis of the pathogenesis mechanism and clinical treatment strategies of SRPE.

A Case Report of Sleep-Related Painful Erection Successfully Treated with Paroxetine

Sleep-Related Painful Erection (SRPE) is a rare condition characterized by recurrent, painful penile erections occurring when awakening from the Rapid Eye Movement (REM) sleep stage. The cause of SRPE is still unknown, the therapeutic strategies still in an expert-based opinion phase and there is no consensus yet. We present a case of a 23-year-old patient suffering from SRPE for 1 year, the smart bracelet which has a sleep monitoring function showed his sleep was fragmented by awakenings at the end of all the REM period. Several treatments such as tamsulosin and highfrequency hyperthermia therapy and Chinese herbal medicine did not prompt any improvement of his condition, but after taking a single daily dose of paroxetine 20mg for twelves weeks, both the frequency and intensity of SRPE gradually decreased. Even though the antidepressants to which paroxetine belongs were included as one of the abandoned treatments in recent review, in our case, paroxetine showed a long-term and stable effect on patients with SRPE, it indicates that the therapeutic effect of paroxetine on SRPE deserves further study and observation.

Rare Disorders of Painful Erection: A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection

BackgroundA chief complaint of men with stuttering priapism (SP) and sleep-related painful erections (SRPE) is bothersome nocturnal erections that wake them up and result in poor sleep and daytime tiredness. SP and SRPE are rare entities that have similarities in their clinical features, but that require different treatment approaches. AimThe aim of this study was to describe the clinical features, investigations, and effective management options for men with SP and SRPE. MethodsRetrospective cohort study of 133 men with bothersome nocturnal painful erections that attended a tertiary andrology unit between 2004 and 2018. These men were divided into 3 groups. Group 1 (n = 62) contains men with sickle cell SP; group 2 (n = 40) has men with non-sickle cell SP and group 3 (n = 31) contains men with SRPE. OutcomeTo determine the effectiveness of medical and surgical treatments for men with SP and SRPE. ResultsHydroxyurea and automated exchange transfusion were the most effective treatment options in the sickle cell SP group. Hormonal manipulation and α-agonist therapies were effective in both SP cohorts (groups 1 and 2). Baclofen was the most effective therapy in men with SRPE. For men who failed medical management, implantation of a penile prosthesis resulted in complete resolution of the symptoms in men with SP (groups 1 and 2). Surgical management (penile prosthesis implantation and embolization) did not improve the patients’ symptoms in the SRPE group. Clinical ImplicationsThis study differentiates between sickle cell SP, non-sickle cell SP, and SRPE and describes effective treatment options for each group. Strengths & LimitationsThis is the largest cohort study for both SP and SRPE, respectively. Limitations include its retrospective nature and single-center experience. ConclusionManaging men in these 3 groups differently and in accordance with the proposed treatment pathway provides a more structured approach to the management of these rare conditions.Johnson M, McNeillis S, Chiriaco G, et al. Rare Disorders of Painful Erection: A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection. J Sex Med 2021;18:376–384.

Two Cases of Sleep-Related Painful Erection

Two Cases of Sleep-Related Painful Erection

Sleep Related Painful Erections due to Benzodiazepines

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.

Two cases of sleep-related painful erection in Korea

Two cases of sleep-related painful erection in Korea

Sleep-Related Painful Erections Associated with Obstructive Sleep Apnea Syndrome

Sleep-related painful erection is a rare syndrome recognized by reports of painful nocturnal erection, an association between REM sleep and pain, and the absence of pain during wakeful sexual activity. Approximately 30 cases have been reported in the literature. We add two more cases, each of which seemed to be associated with severe sleep apnea. Treatment of the apnea with Continuous Positive Airway Pressure device lessened the symptom in both men. Implications of this association are discussed.

Sleep-Related Painful Erection in a 50-Year-Old Man Successfully Treated with Cinitapride

The sleep-related painful erection (SRPE) is a well-established parasomnia characterized by episodes of penile pain during an erection and typically appears during REM sleep. It is associated with nocturnal awakenings, anxiety, and irritability. To report a case study that highlights the successful treatment of SRPE with cinitapride. We present a case report of a 50-year-old man suffering from SRPE that was studied by polysomnography. Severe fragmentation of rapid eye movement (REM) sleep was observed, and nine episodes of sleep-related erections were observed through the night; they were associated with REM sleep, and five of them were classified as SRPE. Cinitapride before the onset of sleep was started. Both the frequency and intensity of SRPE gradually decreased during a period of 6 months with the maintenance of normal sexual function. Cinitapride can play a role in reducing SRPE at night probably due to central modulation of neurotransmitters mediating erection.

First case report of sleep-related painful erection in Japan

Sleep-related painful erection is characterized by complaints of recurrent awakening with penile pain during erections, typically occurring during rapid eye movement sleep, followed by severe insomnia. Here, a case of sleep-related painful erection monitoring with nocturnal penile tumescence, the first case report in Japan, is presented. A 66-year-old man without obesity complained of nocturnal penile erections for 4 years. Overnight polysomnography and nocturnal penile tumescence monitoring showed an apnea-hypopnea index of 20 events/h, poor sleep efficiency of 73% and nocturnal awakenings after the second and third rapid eye movement sleep episodes with good rigidity and erection of penis.

Painful nocturnal erection.

Sleep related painful erection is a parasomnia occurring during rapid eye movement (REM) sleep. It is rarely dealt with in the literature, and is very often poorly understood. Because of repeated awakenings, it is interpreted as insomnia, and is attributed to anxiety. EEG recordings associated with nocturnal penile tumescence monitoring indicate the existence of disturbed sleep organization, with awakenings during REM sleep and frequent nocturnal erections, often unrelated to REM sleep. Though the pathophysiological mechanisms involved are not yet understood, an interpretation of sleep-related painful erections is proposed, based on the current understanding and physiology of diurnal and nocturnal erections.