CLINICAL CASE REPORT SERIES Sleep-Related Painful Erections Associated with Obstructive Sleep Apnea Syndrome Alex Ferre ´ • Josepa Vila • M. Jose ´ Jurado • Nuria Arcalis • Juaquim Camps • Roser Cambrodi • Odile Romero Received: 28 September 2010 / Revised: 14 July 2011 / Accepted: 5 November 2011 / Published online: 14 February 2012 Ó Springer Science+Business Media, LLC 2012 Abstract Sleep-related painful erection is a rare syndrome recognized by reports of painful nocturnal erection, an associa- tion between REM sleep and pain, and the absence of pain dur- ing wakeful sexual activity. Approximately 30 cases have been reported in the literature. We add two more cases, each of which seemed to be associated with severe sleep apnea. Treatment of the apnea with Continuous Positive Airway Pressure device less- ened the symptom in both men. Implications of this association are discussed. Keywords Sleep-related painful erections Á Priapism Á REM parasomnia Á Sleep apnea-hipopnea syndrome Introduction The disorder known as sleep-related painful erection (SRPE) is characterized by painful penile erections occurring during sleep and mainly in the REM phase whereas, during wakefulness, erections are normal and there is no associated pain or interfer- ence with sexual relations, including intercourse and masturba- tion. To date, it has not been related to urological problems or to other sleep disorders (American Academy of Sleep Medicine, 1990; Schenck & Mahowald, 1996). The aim of this article was to describe two new cases of SRPEs with obstructive sleep apnea syndrome (OSAS), an association that has not been reported to date. Case 1 The patient was a 63-year-old man with a 20-year history of hypertension and poor blood pressure control, treated with enal- april. Ten years ago, he began to suffer episodes of SRPEs, cou- pled with awakenings during the night—2 to 4 times per night, particularly during the second half, for 28days a month, and poor sleep quality. The painful erections had a fast remission upon awakening. Erections occurring during the day and sex- ual relations were painless and presented normal function. The patient underwent a complete urological workup. Phys- ical examination and laboratory analyses, including a hemo- gram, a biochemical profile, a hormone profile, and an ultra- sound study of the kidneys, bladder, and prostate, were normal. Magnetic resonance imaging (MRI) of the brain disclosed signs of demyelinization in the frontal regions and brainstem, sug- gestive of hypoxic-ischemic lesions, as well as lacunar infarcts in the basal ganglia and right pons. Study of nocturnal penile tumes- cence yielded normal findings, with five erections, lasting 30– 45 min, and normal rigidity of the base and tip. Treatment with finasteride 5 mg was established, with no clinical response. Despite treatment, the patient reported persis- tent nocturnal erections, poor quality of sleep owing to frequent awakenings, and morning headache. Moreover, blood pressure control was irregular, with episodes of decompensated hyper- tension. He was hospitalized three times to investigate uncon- trolled hypertension. During hospitalizations, SRPE persisted. A. Ferre ´(&) Á M. J. Jurado Á R. Cambrodi Á O. Romero Sleep Unit and Clinical Neurophysiology Department, Vall d 0 Hebro ´ n University Hospital, Passeig Vall d 0 Hebron 129, 08035 Barcelona, Spain e-mail: aferre@vhebron.net J. Vila Á J. Camps Nephrology Department, Vall d 0 Hebro ´ n University Hospital, Barcelona, Spain N. Arcalis Radiology Department, Hospital de Granollers, Granollers, Spain 123 Arch Sex Behav (2012) 41:1059–1063 DOI 10.1007/s10508-011-9894-2