For people suffering from a condition that affects their sexual function, an accurate diagnosis is an important first step in the process of continuing treatment. This may seem simple, but unfortunately, many sexual disorders have overlapping symptoms and manifest in similar ways, making it sometimes difficult to pinpoint the root of the problem. Stuttering priapism (SP) and sleep-related painful erection (SRPE) are two rare disorders that have similar symptoms and can cause painful erections at night, but they are separate conditions that need to be treated and treated in different ways.
A team of researchers including David Ralph, MS, FRCS, explored the similarities and differences between SP and SRPE with the goal of determining the most effective medical and surgical treatments for men with either condition. Dr. Ralph, an accomplished urologist and microsurgeon who has done extensive research on a variety of sexual medicine topics, including Peyronie’s disease and erectile dysfunction (ED), said:[This study] it is important because it differentiates between different types of painful nocturnal erections. The mechanisms [of these disorders] it can be different and the treatment is also different.”
Priapism is a prolonged, often painful erection unrelated to sexual arousal that can last for hours. It’s an uncommon condition, but it occurs more often in people with sickle cell anemia (SCD), an inherited disorder in which red blood cells become hard and sticky and take the shape of a C-shaped “sickle.” SP is a type of ischemic priapism low flow (IP), caused by blood not being able to flow properly out of the penis. Men with SP experience recurrent, painful, prolonged erections with occasional episodes of IP (erections lasting more than four hours). While SP erections can happen at any time, they usually happen at night when men are sleeping. Like other forms of priapism, SP can cause fibrosis and can lead to erectile dysfunction.
SRPE is a condition in which men experience painful erections during REM sleep but have normal, painless erections when awake. The cause of SRPE is not clear, but some early research suggests that it may be related to stress and anxiety. Unlike patients with SP, men with SRPE do not have episodes of IP, and the disorder does not affect sexual function or lead to ED.
Given the similar presentation of the two disorders, it can be difficult to determine which condition a man has, which is problematic because the conditions require different treatment approaches. “SRPE is often treated as SP,” explained Dr. Ralph, “but it could be a sleep disorder or a penile non-pathological condition. The etiology of both conditions is unknown, but in SRPE the penile structures may not be the source of the symptoms.”
This study of 133 men with bothersome nocturnal erections (62 with sickle cell SP, 40 with non-sickle cell SP, and 31 with SRPE), revealed that autotransfusion of red blood cell exchange and hydroxyurea (a drug that can help maintain of abnormal red blood cells from forming) were the most effective treatment options for men with sickle cell SP. Hormonal manipulation and a drug called etilefrine were effective for both groups of SP patients. Baclofen, a drug used to treat muscle spasms, was the most effective treatment option for patients with SRPE. Finally, surgery in the form of penile prosthesis implantation was effective for men in the SP groups, but not effective for men in the SRPE group.
The results of this study highlight the importance of knowing a patient’s medical history and establishing a correct diagnosis when treating a sexual disorder. Further research on both SP and SRPE would be helpful in determining the causes and unique characteristics of each condition.
Contribution to his article David RalphMS, FRCS.
Resources:
Centers for Disease Control and Prevention (CDC). (2020, December 14). Sickle cell disease (SCD).
Johnson, MJ, McNeillis, V., Chiriaco, G., & Ralph, DJ (2021). Rare painful erectile disorders: Cohort study of the investigation and management of priapism stuttering and sleep-related painful erection. The Journal of Sexual Medicine, 18(2), 376-384.
Mayo Clinic. (2019, June 15). Priapism – symptoms and causes.
