Sleep-related painful erections (SRPE) and erections lasting for more than four hours (priapism) are two unknown and rare erectile disorders. Each has a major impact on the quality of marital life of the men who suffer from them. A muscle relaxant drug can reduce the pain caused by SRPE, while a new surgical technique involving opening the erectile tissue structures in the penis could be used to treat priapism if other treatment options are no longer effective. These are the conclusions of PhD research conducted by UMCG physician and researcher Sanne Vreugdenhil, who will defend her thesis at the University of Groningen on 25 September 2019.
Erections are essential phenomena in procreation and in people’s sex lives. Sanne Vreugdenhil researched two unknown and rare erectile disorders: sleep-related painful erections (SRPE) and erections lasting for more than four hours (priapism). Patients suffering from these conditions are often too ashamed to consult their GPs early on. In addition, many doctors do not recognize these conditions at all or only at a late stage, which sometimes hinders effective treatment. Little research has been conducted into these disorders so far.
Some men wake up a few times every night due to a painful erection. The pain is substantial and severely disrupts their sleeping pattern. The resulting stress, anxiety and feelings of despair strongly reduce the quality of life for many of these men. Although their sex-related erections do not cause problems, their sex life is often impaired by this condition. A quarter of them state that they had to take sick leave due to their symptoms.
Vreugdenhil’s research shows that elevated tension of the pelvic floor muscles may cause SRPE. Baclofen, a muscle relaxant drug, has proven to be highly effective as a treatment. Nearly all patients experienced complete or partial alleviation of their symptoms. Unfortunately, most of them experienced a relapse after they had stopped taking the drug.
Priapism is an erectile disorder in which an erection lasts for more than 4 hours. There have even been cases in which an erection has lasted for over 36 hours. The condition is named after a minor Roman fertility god who is always depicted with a huge erection. Priapism can have several causes, varying from spinal cord lesion and the use of psychiatric medication to a brain tumour and leukaemia. It may ultimately lead to decay of the erectile tissue structures in the penis, resulting in the patient never being able to achieve an erection again without the help of a penile prosthesis.
Priapism lasting for more than 36 hours is extremely difficult to treat. According to the current guidelines, these patients are eligible for early implantation of a penile prosthesis. This procedure carries a high risk and is sometimes difficult to perform. It also has a high risk of complications such as infection. Moreover, any remaining erectile tissue will be destroyed by the implantation procedure.
As an alternative treatment, Vreugdenhil advocates a surgical procedure that was first performed in 1824 and has since fallen into disuse. It involves opening the erectile tissue structures of the penis to prevent tissue decay. In the past, this surgery often led to infection, but Vreugdenhil believes that this can be prevented with the right antibiotics that are now available.
Sanne Vreugdenhil (1991, Dronten) studied Medicine at the University of Groningen. She completed her PhD project at the Department of Urology and the Behavioural and Cognitive Neuroscience research school of the UMCG. The title of her thesis is ‘Pathologic Erections’. She is currently completing her urology specialist training.
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