Case Study | Published:

Sleep-related painful erections

Nature Clinical Practice Urology volume 2, pages 256260 (2005) | Download Citation

Subjects

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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Author information

Affiliations

  1. G Karsenty is a urologist at Salvator University Hospital, Marseille, France.

    • Gilles Karsenty
  2. E Werth is Co-Director of the Sleep Center of the Neurology Department. A Curt is a consultant in Clinical Neurophysiology and B Schurch is head of the department of Neuro-Urology at the Swiss Paraplegic Centre, Balgrist University Hospital, Zürich.

    • Esther Werth
    • , Armin Curt
    •  & Brigitte Schurch
  3. CL Bassetti is Vice-Chairman of the Neurology Department and Director of the Sleep Center at Zürich University Hospital, Zürich, Switzerland.

    • Claudio L Bassetti
  4. PA Knapp is manager of ALEA Solutions GmbH, Zürich, Switzerland.

    • Peter A Knapp

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Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Gilles Karsenty.

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

About this article

Publication history

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DOI

https://doi.org/10.1038/ncpuro0184

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