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Sleep-related painful erections

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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Correspondence to Gilles Karsenty.

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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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