Sleep-Related Painful Erection (SRPE), Erectile Dysfunction and Stress

Objective:Erectile dysfunction (ED) is one of the most prevalent male sexual disorders, but in some cases, it may develop secondary to rare conditions such as Sleep-Related Painful Erections (SRPE). SRPE is characterized by painful penile rigidity that occurs during nocturnal erections, typically in REM sleep, without pain during erections while awake. This study explores the association between SRPE, stress-related factors, and subsequent erectile dysfunction. Methods: We evaluated 14 men diagnosed with SRPE and compared them with 14 men who had erectile dysfunction but no history of SRPE. All participants underwent clinical, urological, and hormonal assessments, including nocturnal penile tumescence testing and polysomnography. Psychological stress and trau-ma-related symptoms were measured using standardized questionnaires (IIEF-5 and TSC-40). Blood samples were analyzed for key hormones, including prolactin, free and total testosterone, TSH, LH, DHEA-S, SHBG, and PSA. Results: Significant correlations were found between prolactin levels and erectile function scores (R = 0.50, p < 0.05), as well as between prolactin and psychosocial stress scores (R = 0.55, p < 0.05). A moderate correlation was also observed between free testosterone and erectile function (R = 0.31, p < 0.05). These associations were not present in the control group. No major structural or organic abnormalities were detected in either group. Conclusions: Our findings suggest that SRPE may be linked to psychogenic factors and neuroendocrine imbalance, particularly in-volving prolactin and stress responses. SRPE appears to contribute to the development of secondary erectile dysfunction by creating fear and anxiety around sexual activity. Early recognition and a multi-disciplinary therapeutic approach, including psychological interventions, are essential for effective management.