The Treatment of Sleep-Related Painful Erections

Abstract

Introduction As specialists in male genital problems, urologists and sexologists will most likely to be involved in the treatment of males presenting with sleep-related painful erections (SRPEs). This means that this phenomenon needs to be recognized by urologists and sexologists, and that they should have knowledge of the current diagnostic and therapeutic approaches. Aim To review the literature on SRPE and to find the best pharmacological treatment. Methods Four personal clinical observations from two clinics and 29 other cases with SRPE found in PubMed were analyzed, especially regarding the results of pharmacological treatment. Main Outcome Measures The results of pharmacological treatment. Results Many of the various treatments proved to be ineffective and only a few showed efficacy for a few weeks or months. The only effective drugs in the long term were baclofen, clonazepam, and clozapine. Conclusions Until now, the phenomenon of SRPE is not well understood. The rarity of the published cases undoubtedly does not reflect the actual occurrence of SRPE. Controlled double-blind pharmacological trials are needed, and long-term follow-up including polysomnography coupled with nocturnal penile tumescence and rigidity monitoring may provide further information about SRPE.

A Case of Painful Erections After Pelvic Surgery

“…Treatment options for sleep related painful erections include blockage of erection, suppression of REM sleep, suppression of pain or relaxation of pelvic floor muscles (van Driel et al, 2008). In this case, blockage of erection was not an option because this patient had painful erections in all circumstances, so blocking painful erections would mean blocking all erections.…”

“…Penile erections accompanied by pain are usually due to priapism, sleep related painful erections (SRPE) (Muneer, Minhas, Arya, & Ralph, 2008;van Driel, Beck, Elzevier, van der Hoeven, & Nijman, 2008) or penile surgery (DeCastro, Costabile, McMann, & Peterson, 2008). The most frequent cause of painful erections is priapism, which is classified into low flow and high flow; the former is usually due to sickle cell anemia (Adeyoju et al, 2002) and the latter posttraumatic (Montgomery, Waller, & Robinson, 2003;Muneer et al, 2008).…”

A 35-Year-Old Man Presenting Sleep-Related Painful Erections (Erpes): A Case Report and Review of Literature

“…It can maintain stable serum levels all night long, preventing recurrence of the painful erections. Rourke (2006) [16] and van Driel (2008) [13] reported patients who have had good sustainable responses with oral baclofen at bedtime, in a 40mg oral dose. Traditionally prescribed to treat spasticity, the theoretical benefit consists in relaxation of pelvic muscles, specially bulbocavernous and ischiocavernous, acting in pain source.…”

“…As purposed by van Driel et al [13], there are at least three pharmacologic approaches to treat SRPEs:…”

“…Clozapine is an atypical anti-psychotic drug with noradrenergic, anticholinergic, antihistaminergic, and weak antidopaminergic properties, and may act by marked sedation and improvement of sleep architecture, with few adverse effects. [15] The benzodiazepines (diazepan, bromazepan, clonazepan), with their REM sleep-suppressing properties, have been tested for treating SRPE by some authors [13] with success.…”