Sleep-related painful erection, erectile dysfunction and psychological distress

Sleep-related painful erections (SRPE) are a rare parasomnia characterized by recurrent nocturnal penile pain occurring predominantly during rapid eye movement (REM) sleep, while erections during wakefulness remain painless. SRPE may lead to sleep disturbance, sexual avoidance, and psychological distress. Although its pathophysiology remains unclear, psychoneuroendocrine mechanisms have been proposed.

In this exploratory case-control study, fourteen men with SRPE were compared with fourteen men diagnosed with psychogenic erectile dysfunction without a history of SRPE. All participants underwent polysomnography, clinical and urological examination, hormonal assessment, and psychometric evaluation using the International Index of Erectile Function-5 (IIEF-5) and the Trauma Symptom Checklist-40 (TSC-40). Hormonal parameters were obtained from fasting morning blood samples. Non-parametric statistical methods were applied.

Men with SRPE showed significantly lower erectile function and greater psychological distress compared with controls (p < 0.05). Mean prolactin levels were higher in the SRPE group but did not differ significantly at the group level (p = 0.089). Within the SRPE group, prolactin levels were negatively correlated with erectile function and positively correlated with psychological distress (nominal p < 0.05), whereas no such associations were observed in the control group.

SRPE may be associated with a specific psychoneuroendocrine profile in which psychological distress and prolactin dynamics are linked to secondary erectile dysfunction. These exploratory findings support a multidimensional clinical perspective integrating sleep-related, psychological, and neuroendocrine factors and warrant further investigation in longitudinal studies.