Narrative Review

Pathogenesis, Diagnosis, and Treatment of Sleep-Related Painful Erection

Yutao Wang; Jianzhong Zhang; Hongjun Li


Transl Androl Urol. 2021;10(12):4422-4430. 

In This Article

Abstract and Introduction


Objective: Through critical analysis and comprehensive review of the limited literature, this paper can help clinicians better identify the pathophysiology of sleep-related painful erections (SRPE) and provide direction for future treatment research.

Background: Patients with SRPE will be awakened by painful erections during sleep, which affects their sleep process and general health. At present, literatures of experimental and clinical research on SRPE disease are limited, as well as long-term reports on its pathogenesis and clinical management.

Methods: We use the PubMed database to obtain sleep-related peer erection literature. The search terms used include sleep, painful, penis and erection. After rigorous screening, the search returned 21 references published between 1987 and 2021.

Conclusions: The main cause of SRPE is obstructive sleep apnea (OSA) syndrome, psychological and spiritual factors, androgen elevation, neuroendocrine regulation and threshold of pain in the REM phase. The combination of multiple medications is the most effective approach to treat sleep-pain-related erections. The combination of CPAP, REM inhibitors and Baclofen has significant effect on SRPE caused by OSA syndrome. This article provides effective support and strategies for doctors to manage SRPE patients through a comprehensive analysis of the pathogenesis mechanism and clinical treatment strategies of SRPE.


Sleep-related painful erection (SRPE) is a rare condition which sees patients experiencing frequent erections during rapid eye movement (REM) sleep causing deep penile pain and interrupted sleep. Nocturnal spontaneous erections can be classified into physiological and pathological erections. Nocturnal physiological erections are considered to occur 3–5 times during REM without pain. SRPE is a pathological sleep erection that differs from physiological nocturnal penile tumescence (NPT), which is characterized by penile pain during REM period and relief after urination,[1] and classified as an REM parasomnia by the International Classification of Sleep Disorders by the American Academy of Sleep Medicine.[2] As this condition harms the patient's sleep state and physical and mental health, it is critical to explore SRPE and reduce the burden of disease and improve the quality of life of patients. As presently there is no systematic guidance for this condition, this article reviews the mechanisms, diagnosis, and treatment of SRPE to help gain a better understanding for both physicians and patients. We present the following article in accordance with the Narrative Review reporting checklist (available at