Efficacy of multimodal treatment involving Baclofen, pelvic floor physiotherapy and polysomnography for sleep related painful erections (SRPE): a single centre observational cohort study

Ameer Alarayedh; Mohamed Gad; Kenji Tomita; Celina J Pook; Muza Rexford; Paula Igualada-Martinez; Colette Pollard; Joerg Steier; Tet Yap

doi:10.1038/s41443-024-01005-2

Efficacy of multimodal treatment involving Baclofen, pelvic floor physiotherapy and polysomnography for sleep related painful erections (SRPE): a single centre observational cohort study

Int J Impot Res. 2024 Dec 23. doi: 10.1038/s41443-024-01005-2. Online ahead of print.

Authors

Ameer Alarayedh¹, Mohamed Gad², Kenji Tomita^{2

3}, Celina J Pook^{2

3}, Muza Rexford², Paula Igualada-Martinez², Colette Pollard², Joerg Steier^{2

4}, Tet Yap²

Affiliations

¹ Guy's and St Thomas' NHS Foundation Trust, London, UK. ameer.alarayedh@gstt.nhs.uk.
² Guy's and St Thomas' NHS Foundation Trust, London, UK.
³ GKT School of Medical Education, King's College, London, UK.
⁴ Faculty of Life Sciences and Medicine, King's College London, London, UK.

PMID: 39715868
DOI: 10.1038/s41443-024-01005-2

Abstract

Sleep Related Painful Erections (SRPE) are parasomnias exclusive to Rapid Eye Movement (REM) sleep, causing sleep disturbances, daytime fatigue, and impaired quality of life. Due to a lack of standardized management, we developed a diagnostic and treatment pathway for this rare condition at our institution. Patients diagnosed with SRPE from 2017-2024 by strict criteria were recruited into our novel pathway. This included a comprehensive diagnostic panel to exclude potential confounding causes of penile pain through history, clinical examination, laboratory tests and imaging studies. Once SRPE is diagnosed a stepwise approach of initiating Baclofen (10 mg daily at night), followed by polysomnography (PSG) (to explore sleep architecture and implement sleep medication and/or treat obstructive sleep apnoea accordingly) and pelvic floor physiotherapy (PFP) (to target pelvic floor hypertonicity). Symptoms were evaluated using a dedicated questionnaire during clinic follow-up. Patients achieving a symptom-free period of >6 months were discharged. Twenty patients with SRPE (mean age 46.2 ± 11.6 years) were included. The mean delay to referral was 3.5 ± 3.1 years, with a mean of 3.3 ± 2.1 SRPE episodes per night (range 1-7) lasting 33 ± 23.7 minutes. 85% of patients completed most of the pathway. Baclofen was administered to 17 patients (10-80 mg at night), 17 underwent PSG, and 9 had PFP assessment. Baclofen benefited 70.6% of patients: 35.3% managed with Baclofen alone, 52.9% required additional sleep medication, and Baclofen was replaced by Etilefrine (5-15 mg at night) in 11.8%. PSG findings included fragmented sleep (76.5%), REM sleep abnormality (47.1%), and mild sleep apnoea (41.2%). Among those assessed for PFP, 66.6% had abnormal pelvic floor muscle tone and initiated PFP. After 3.5 ± 1.9 years of follow-up, 45% were successfully discharged and 55% are still on follow-up and experienced symptom improvement. This multimodal pathway offers a promising framework for managing SRPE.