Sleep-related painful erection (SRPE) is a rare condition where people get painful erections while they’re in deep sleep with rapid eye movement (REM). This pain can disrupt their sleep.

What is SRPE

According to the International Classification of Sleep Disorders of the American Academy of Sleep Medicine, sleep-related painful erections (SRPEs) are defined as experiencing penile pain during erections, often happening during episodes of rapid eye movement (REM) sleep.

 Individuals with SRPEs often wake up frequently due to this intense penile pain.

Frequent awakenings and disruption of REM sleep can lead to feelings of anxiety, tension, irritability, and daytime fatigue. Normally, patients don’t experience pain during erections related to sexual activity.

Sleep-related erections (SREs) have been noticed in boys and men of all age groups and have even been documented in an unborn fetus.

SRPEs fall under the category of parasomnias, which are unwanted physical occurrences, events (like movements or behaviors), or experiences (such as emotions, perceptions, or dreams) that happen while falling asleep, during sleep, or upon waking up.

The methods for diagnosing and managing SRPEs are not clearly established.

Related: Painful Erections: All You Need To Know

Cause Of Sleep-Related Painful Erection

Possible mechanisms of SRPE include:

Increased Testosterone Levels

Androgens (male sex hormones) affect both the brain and specific organs in the body. In the brain, they mainly impact sex drive and sexual behavior. In the corpus cavernosum (a part of the penis), androgens are crucial for keeping the production of nitric oxide, which helps with erections, running smoothly.

Testosterone supplementation in men with low testosterone levels (hypogonadism) has been observed to boost both the frequency and rigidity of sleep-related erections (SREs). Moreover, there’s a rise in testosterone levels in the bloodstream as individuals transition from non-REM to REM sleep, corresponding with the occurrence of SREs.

Altered Autonomic Function

Ferini-Strambi and colleagues suggested that problems with the autonomic nervous system, which controls things like heart rate and digestion, could be causing painful erections during sleep.

SRPEs and Obstructive Sleep Apnea Syndrome

Researchers believe that intermittent changes in the autonomic system and fluctuations in blood gas levels associated with obstructive sleep apnea syndrome (OSAS) disrupt the neural network that regulates sleep-related erections (SREs). This disruption may cause an imbalance between the parasympathetic and sympathetic nervous systems, triggering sleep-related painful erections (SRPEs)

Psychosomatics

Calvet presumed that anxiety and stress could be the cause of painful erections, rather than just a result of the sleep deficit associated with the condition.

Related: Sexual Performance Anxiety

Reduced Pain Threshold In The REM Phase

The relationship between pain and sleep works both ways. Pain can disturb sleep, while poor sleep quality can make pain feel worse.

Shortening sleep or experiencing a lack of REM sleep can lead to increased sensitivity to pain the next day, a condition known as hyperalgesia.

Compartment Syndrome

When the urinary bladder becomes overly full during the night, it can stimulate the erectile center, leading to a persistent erection. The inflammation resulting from the bladder being overly full obstructs the normal return of blood through the veins, resulting in a continuous erection and pain.

Treatment

Management of Underlying Conditions

If SRPE is linked to conditions like Obstructive Sleep Apnea or hormonal abnormalities, treatment focuses on addressing these issues. This may include using continuous positive airway pressure (CPAP) therapy for OSA or hormone replacement therapy for hormonal imbalances.

Medications

In some cases, medications may be prescribed to help manage SRPE symptoms. This could include medications to improve sleep quality or to alleviate pain associated with erections.

Behavioral Therapies

Cognitive-behavioral therapy (CBT) or relaxation techniques may be beneficial in managing anxiety or stress-related factors that could exacerbate SRPE.

Lifestyle Modifications

Making lifestyle changes such as maintaining a healthy weight, avoiding alcohol and caffeine before bedtime, and practicing good sleep hygiene can also help improve sleep quality and potentially reduce SRPE episodes.

Consultation with Specialists

Depending on the underlying cause and severity of SRPE, consultation with specialists such as urologists, sleep medicine specialists, or endocrinologists may be necessary for comprehensive management.

Treatment approaches for SRPE may vary depending on individual factors, and it’s essential to consult with a healthcare provider for personalized recommendations.

Summary

Sleep-related painful erections (SRPE) are rare and involve experiencing painful erections during REM sleep. They are possibly linked to hormonal changes and autonomic nervous system alterations. Anxiety and bladder overfilling at night can also contribute. Treatment focuses on managing underlying issues like sleep apnea, hormonal imbalances, and pain, often involving medication, therapy, and lifestyle adjustments.

References

1. Vreugdenhil, S., Weidenaar, A. C., de Jong, I. J., & van Driel, M. F. (2017). Sleep-related painful erections: A meta-analysis on the pathophysiology and risks and benefits of medical treatments. The Journal of Sexual Medicine, 15(1), 5–19. https://doi.org/10.1016/j.jsxm.2017.11.006 
2. Wang, Y., Zhang, J., & Li, H. (2021, December 21). Narrative review: Pathogenesis, diagnosis, and treatment of sleep-related painful erection. Translational Andrology and Urology. https://doi.org/10.21037%2Ftau-21-1045