Sleep-related painful erections


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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

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.


  1. 1

    Holland TM (2003) Is gonorrhoea presenting with painful spontaneous erections more often than we think? Int J STD AIDS 14: 140

  2. 2

    Thorpy MJ (1990) Classification of sleep disorders. J Clin Neurophysiol 7: 67–81

  3. 3

    Karacan I (1971) Painful nocturnal penile erections. JAMA 215: 1831

  4. 4

    Steiger A and Benkert O (1989) Examination and treatment of sleep-related painful erections—a case report. Arch Sex Behav 18: 263–267

  5. 5

    Matthews BJ and Crutchfield MB (1987) Painful nocturnal penile erections associated with rapid eye movement sleep. Sleep 10: 184–187

  6. 6

    Szucs A et al. (2002) Sleep-related painful erection is associated with neurovascular compression of basal forebrain. J Neurol 249: 486–487

  7. 7

    Yamaguchi Y and Ohki K (2004) First case report of sleep-related painful erection in Japan. Sleep Biol Rhythms 2: 159–161

  8. 8

    Calvet U (1999) Painful nocturnal erection. Sleep Med Rev 3: 47–57

  9. 9

    Ferini-Strambi L et al. (1996) Sleep-related painful erections: clinical and polysomnographic features. J Sleep Res 5: 195–197

  10. 10

    Schmidt MH and Schmidt HS (2004) Sleep-related erections: neural mechanisms and clinical significance. Curr Neurol Neurosci Rep 4: 170–178

  11. 11

    Ferini-Strambi L et al. (1996) Cardiac autonomic nervous activity in sleep-related painful erections. Sleep 19: 136–138

  12. 12

    Suh DD et al. (2003) Nocturnal penile tumescence and effects of complete spinal cord injury: possible physiologic mechanisms. Urology 61: 184–189

  13. 13

    Young T et al. (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217–1239

  14. 14

    Margel D et al. (2004) Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 63: 545–549

  15. 15

    Weiss JP and Blaivas JG (2002) Nocturnal polyuria versus overactive bladder in nocturia. Urology 60 (Suppl 1): S28–S32

Download references

Author information

Correspondence to Gilles Karsenty.

Ethics declarations

Competing interests

The authors declare no competing financial interests.



Persistent, abnormal penile erection, usually without sexual desire


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


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


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

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Karsenty, G., Werth, E., Knapp, P. et al. Sleep-related painful erections. Nat Rev Urol 2, 256–260 (2005).

Download citation

Further reading