Sleep-Related Painful Erections: Causes and Solutions

by Martin Reed Patient Advocate

Sleep-related painful erection (SRPE) is a rare disorder characterized by penile pain during nighttime erections. Someone suffering from SRPE will not normally experience pain from erections that occur during the day or during sexual activity. Instead, pain occurs primarily during REM sleep and will often lead to nighttime awakenings, resulting in fragmented sleep and the potential development of chronic insomnia. Other symptoms associated with SRPE include daytime anxiety, tension, irritability, and excessive daytime sleepiness.

One study found the average age of SRPE onset was 40 years but since SRPE is poorly understood, there is an average delay of five years between onset of the condition and diagnosis — and there are usually a number of unsuccessful consultations with urologists and neurologists prior to diagnosis.

What causes sleep-related painful erections?

We still don’t know for sure what causes SRPE. Experiencing erections is completely normal during REM sleep, and for most men will typically occur three to five times per night — however, they should not be painful.

A 2005 study published in the journal Nature Clinical Practice Urology suggested that SRPE may be caused by:

  • Disturbances in the nervous system that lead to hyperactivity and the release of beta-adrenergic substances such as adrenaline

  • Neurotransmission disturbances

  • Damage or stimulation to the hypothalamus

A 2017 study published in the journal Sexual Medicine identified abnormal tightening of the pelvic floor muscles during REM sleep as a potential cause of painful nighttime erections.

How to treat sleep-related painful erections

A painful erection will typically subside soon after awakening. Urinating and the application of cold water can also help.

One study that reported on the case of a 57-year-old man with SRPE found that applying an ice pack to the penis during sleep prevented erections but, perhaps unsurprisingly, also led to sleep disruption and occasional swelling due to excessive cold exposure.

Researchers did find that a combination of gabapentin and clonazepam, taken roughly one hour before bed, minimized the severity of SRPE symptoms, reduced the frequency of nighttime erections, and improved sleep duration.

A separate clinical case report found that paroxetine, a selective serotonin reuptake inhibitor (SSRI), helped reduce the awakenings associated with SRPE. The authors of the case report pointed out that paroxetine may be effective because it can suppress REM sleep and has sedative properties.

Another study found clomipramine prevented nighttime pain and awakenings for one 66-year-old man who had been suffering from SRPE for four years.

The Nature Clinical Practice Urology study mentioned earlier in this article found that clozapine reduced painful erections and normalized sleep structure without preventing the occurrence of nighttime erections.

Finally, the study published in Sexual Medicine found that pelvic floor physiotherapy helped relieve symptoms of SRPE.

What to do next

If you think you are suffering from SRPE, speak with your doctor. You may need to undergo a sleep study as part of the diagnostic process. A sleep study will also evaluate whether you are suffering from other sleep issues such as obstructive sleep apnea — a sleep disorder which has been associated with SRPE. If that proves to be the case, CPAP therapy may help.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.