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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Holland TM (2003) Is gonorrhoea presenting with painful spontaneous erections more often than we think? Int J STD AIDS 14: 140
Thorpy MJ (1990) Classification of sleep disorders. J Clin Neurophysiol 7: 67–81
Karacan I (1971) Painful nocturnal penile erections. JAMA 215: 1831
Steiger A and Benkert O (1989) Examination and treatment of sleep-related painful erections—a case report. Arch Sex Behav 18: 263–267
Matthews BJ and Crutchfield MB (1987) Painful nocturnal penile erections associated with rapid eye movement sleep. Sleep 10: 184–187
Szucs A et al. (2002) Sleep-related painful erection is associated with neurovascular compression of basal forebrain. J Neurol 249: 486–487
Yamaguchi Y and Ohki K (2004) First case report of sleep-related painful erection in Japan. Sleep Biol Rhythms 2: 159–161
Calvet U (1999) Painful nocturnal erection. Sleep Med Rev 3: 47–57
Ferini-Strambi L et al. (1996) Sleep-related painful erections: clinical and polysomnographic features. J Sleep Res 5: 195–197
Schmidt MH and Schmidt HS (2004) Sleep-related erections: neural mechanisms and clinical significance. Curr Neurol Neurosci Rep 4: 170–178
Ferini-Strambi L et al. (1996) Cardiac autonomic nervous activity in sleep-related painful erections. Sleep 19: 136–138
Suh DD et al. (2003) Nocturnal penile tumescence and effects of complete spinal cord injury: possible physiologic mechanisms. Urology 61: 184–189
Young T et al. (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217–1239
Margel D et al. (2004) Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology 63: 545–549
Weiss JP and Blaivas JG (2002) Nocturnal polyuria versus overactive bladder in nocturia. Urology 60 (Suppl 1): S28–S32
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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
Rights 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). https://doi.org/10.1038/ncpuro0184
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncpuro0184
This article is cited by
-
A clinical guide to rare male sexual disorders
Nature Reviews Urology (2024)
-
Sleep-related painful erections: a survey-based analysis of patient-reported experiences with diagnosis and management
International Journal of Impotence Research (2024)
-
Sleep related painful erection: an algorithm for evaluation and management
Basic and Clinical Andrology (2019)
-
Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome
Archives of Sexual Behavior (2016)
-
Sleep-Related Painful Erections Associated with Obstructive Sleep Apnea Syndrome
Archives of Sexual Behavior (2012)