A narrative review on sleep-related painful erections - is this stuttering priapism?

Sleep-related painful erections (SRPE) and stuttering priapism (SP) are two rare disorders of penile erection. The aim of this article is to highlight the key similarities and differences between each condition and their management. We performed a literature review on the PubMed and Medline databases with a particular focus on the pathophysiology, risk factors, investigations and management of SRPE and SP. The main presenting feature in both SRPE and SP is sleep disruption due to brief episodes of painful erections that are typically self-limiting. SP is considered a subtype of ischaemic priapism and sickle cell disease is an important risk factor. These patients can develop major priapic episodes which require emergency management. The pathophysiology in SRPE is less well-defined and episodes only occur during sleep, detumesce quicker than in SP and do not progress to ischaemic priapism. Treatment aims are to prevent recurrence, but no established guidelines exist and the limited data is mainly from case studies. Management options in SP include hormonal analogues and α-agonists but in SRPE, baclofen has demonstrated the most consistent results. Our review suggests that SRPE and SP are two distinct conditions and further research is required to develop optimal management strategies for each disease process.