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Sleep-related painful erections

Nature Clinical Practice Urology volume 2, pages 256–260 (2005)Cite this article

Abstract

Background A 45-year-old man presented with repeated awakenings at night caused by nocturnal painful erections, in sharp contrast with normal erections at other times, 2 years after surgical removal of a thoracic (Th6–7) ependymoma.

Investigations Physical examination, pharmaco-sensitized penile Doppler ultrasound, spinal and brain MRI, neurophysiological work-up (tibial and perineal somatosensory-evoked potential; hand, foot and perineal sympathetic skin response assessment), polysomnography with recording of nocturnal penile tumescence.

Diagnosis Sleep-related painful erections, characterized by penile pain during nocturnal erection, typically during rapid eye movement sleep, in the presence of a residual thoracic spinal cord syndrome.

Management Amitriptyline, an antidepressant that suppresses rapid eye movement sleep, was ineffective. Treatments with other antidepressants, clozapine and beta-blockers were suggested, but the patient declined because of potential severe side effects.

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Figure 1: MRI of spinal ependymoma.
Figure 2: Polysomnography (hypnogram) coupled with penile tumescence recordings demonstrate three episodes of rapid eye movement sleep-related erection with pain and awakening.

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Author information

Authors and Affiliations

  1. urologist at Salvator University Hospital, Marseille, France

    Gilles Karsenty

  2. Neurology Department,

    Esther Werth, Armin Curt & Brigitte Schurch

  3. Clinical Neurophysiology,

    Esther Werth, Armin Curt & Brigitte Schurch

  4. Neuro-Urology at the Swiss Paraplegic Centre, Balgrist University Hospital, Zürich

    Esther Werth, Armin Curt & Brigitte Schurch

  5. Vice-Chairman of the Neurology Department and Director of the Sleep Center at Zürich University Hospital, Zürich, Switzerland

    Claudio L Bassetti

  6. manager of ALEA Solutions GmbH, Zürich, Switzerland

    Peter A Knapp

Authors
  1. Gilles Karsenty
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  2. Esther Werth
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  3. Peter A Knapp
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  4. Armin Curt
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  5. Brigitte Schurch
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  6. Claudio L Bassetti
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Corresponding author

Correspondence to Gilles Karsenty.

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Competing interests

The authors declare no competing financial interests.

Glossary

PRIAPISM

Persistent, abnormal penile erection, usually without sexual desire

EPENDYMOMA

A brain tumor (WHO grade I/II) derived from the ependymal cells that line the ventricles of the brain and the central canal of the spinal cord

BABINSKI'S SIGN

Dorsiflexion of the big toe and fanning of the other toes on sensory stimulation of the lateral foot sole, indicating a dysfunction of the pyramidal tract

PHIMOSIS

Constriction of the preputial orifice preventing retraction of the prepuce over the glans

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Karsenty, G., Werth, E., Knapp, P. et al. Sleep-related painful erections. Nat Rev Urol 2, 256–260 (2005). https://doi.org/10.1038/ncpuro0184

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  • DOI: https://doi.org/10.1038/ncpuro0184

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