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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The authors declare no competing financial interests.
Persistent, abnormal penile erection, usually without sexual desire
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- 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
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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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