Sleep-related painful erection: the first case in a child

: Sleep-related painful erections (SRPE) is a rare sleep disorder characterized by recurrent nocturnal painful penile erections, typically occurring during rapid eye movement (REM) sleep, without associated pain during daytime erections. Although approximately 100 cases have been described in adult males, there are no reports of SRPE in childhood. We present the case of a male infant born at 36 weeks' gestation, who began experiencing SRPE and nocturnal awakenings in his first year of life. Despite a family history of autoimmune diseases and restless leg syndrome, initial medical evaluations-including cystoscopy, ultrasound, and somatosensory evoked potentials-showed no abnormalities. Treatments with niaprazine and diazepam were ineffective, prompting a referral to our sleep center. A video-polysomnography (PSG) revealed sleep fragmentation associated with erections, primarily during REM sleep. Biochemical tests and a brain MRI ruled out hormonal and neurological abnormalities. Treatment with L-5-hydroxytryptophan, initiated due to the presence of arousal disorders, appeared to provide clinical benefit, suggesting that SRPE, at least in this case, could be considered a peculiar form of parasomnia. At a four-month follow-up, the child demonstrated overall improvement. While sleep terrors and somniloquy persisted at a reduced frequency, the painful erections decreased in both frequency and intensity, indicating a potential, though unconfirmed, benefit from the treatment. It is also possible that reassurance played a key role in the overall improvement, as has been noted in adult populations.