SRPE Treatment Ideas - SRPE condition

We have gathered here some SRPE treatment ideas. These are attempts at treatment that SRPE sufferers have pursued, with mixed results. As of yet, there is no broad cure for SRPE.

CPAP Machine

At least a few SRPE sufferers have seen a reduction in the number of nightly erections as a result of starting to use a CPAP machine.

The addition of a CPAP (or BIPAP) machine to at least one person’s nightly routine has been a silver bullet for his SRPEs.

If you suspect you have sleep apnea but no CPAP machine, it’s worthy of investigation.

Muscle Activation Techniques (MAT)

At least one SRPE sufferer has reported MAT being of great benefit to him. He said that after a session, he gets 1 or 2 great nights of sleep.
muscleactivation.com

Medications

Please consult a doctor before taking any new medications. Also, some people in this group are actually here as a result of the side effects caused by pharmaceutical drugs. Please, before starting a medication, consult with your doctor, as well as online patient discussion forums dedicated to the specific medication, in order to properly understand the potential risks and benefits.

Antidepressants / SSRIs

If you listen to the Dr. Drew clip on the Resources page of this website, he discusses SRPE-type issues in some of his patients, and he’s had good luck with a small dose of SSRIs to resolve the issue.

In particular, he mentions Zoloft and Prozac as remedies, along with Cognitive Behavioral Therapy as another helpful tool. If you are hesitant to take SSRIs or are concerned about side effects, there is now a gene testing service called GeneSight that can help identify which of these drugs you are likely to respond best to, with fewest side effects. SSRIs can cause changes in mood.
(see also Cymbalta below)

Antihistamines

Please consult a doctor before taking any antihistamine pills as they can have side-effects.

If SRPEs are thought to be a result of nerve inflammation, a strong antihistamine like hydroxyzine may be prescribed in an attempt to calm the inflammation.

Interestingly, a number of SRPE sufferers have also reported an increase in nasal congestion that began around the same time as their SRPEs, and they report becoming congested after ejaculating.

Here is an interesting article that talks about the relationship between sex and nasal congestion, and the ‘erectile tissue’ in the nose:
https://www.human.com.sg/stuffy-nose-while-having-sex

Baclofen

Baclofen is of the more common medications prescribed to help with SRPE and it has improved the situation of quite a few SRPE-sufferers. Many people in the reddit and facebook forums will have tried Baclofen and will have opinions to share on it.

It should be mentioned that Baclofen is a GABA receptor agonist similar to benzodiazepines, so there is a risk of developing dependency on it. There is also likelihood of developing a tolerance to it, so it may become less effective over time and require a greater dose to deliver the same effect.

Here’s a study on the possible effectiveness of Baclofen for treating SRPE:
Sleep-Related Painful Erections—A Case Series of 24 Patients Regarding Diagnostics and Treatment Options | Sexual Medicine | Oxford Academic

Cymbalta (generic: Duloxetine)

At least one SRPE sufferer in this community has seen his severe SRPE brought under control with the help of Duloxetine.

It is normally used as an antidepressant, but more and more commonly it is also used for issues related to nerve pain and inflammation.

It may take up to 3 or 4 weeks to set in and impact your SRPEs.

Consult with your physician and/or psychiatrist to see if they think it may be a good fit for you.

Ketoconazole
Typically used as an anti-fungal, ketoconazole in a large enough dose can inhibit testosterone production over the course of the night, impacting the cycles of tumescence that occur along with REM sleep.

It can be rough on the kidneys, so you’ll have to get your blood tested every few months to make sure it’s not damaging kidney function.

Dr. Larry Levine pioneered this approach and would be good to contact before trying it.

Here’s some research Levine did with Ketoconazole:
Prevention of recurrent ischemic priapism with ketoconazole: evolution of a treatment protocol and patient outcomes

Pelvic Floor Physical Therapy

If you haven’t yet seen a pelvic floor physical therapist about your situation, it may be very helpful for you to do so.

These people have a comprehensive understanding of the functioning of the pelvis and all its component parts.

They can tailor a therapy routine to your specific body and needs.

Depending on what may be causing your SPREs, certain exercises can worsen your symptoms (for example, in the case of pudendal neuralgia, squats and abdominal exercises can make things worse), so it is best to develop a program with the help of a knowledgeable professional.

See the Resources section of this document for sample Physical Therapy exercises.

Steroids (injections and pill form)

Prior to pursuing steroids as a possible treatment for SRPE, please talk to your doctor and do some research online about the side effects of steroids on the body as steroids can cause very serious side effects.

Steroids can be helpful in diagnosing the source of your problem, and they may offer some weeks of relief from SRPEs. It’s not a long-term solution.

Steroids will often be administered by a pain management specialist, and there are a variety of injections that can be given.

A common injection for problems involving the genitals is a pudendal nerve block, where they inject steroids into both of your butt cheeks near the two branches of the pudendal nerve.

In theory, it’s possible that just one or two injections could settle down a dysfunctional nerve and rid someone of the problem entirely.

With steroids also come some mood and sleep changes, especially in the first few days.

For one SRPE-sufferer, it usually took about 4 or 5 days after the injection for the steroid to set in, and then the SRPEs would go away for 4-5 weeks.

A doctor will only allow you to take so much steroid in a year, and it likely won’t be enough to stay in a state of no-SRPEs.

With the passage of time, steroids can have all sorts of effects on all sorts of bodily processes, and they can stop being effective in calming SRPEs.

Another thing to keep in mind with steroids if you take a full course of them or get an injection is that they are likely to impact aches and pains all over your body, so if you have any chronic pain, it’s possible that it may also go away or be lessened for a period of time.

Sounds dreamy, but inflammatory pain can serve as an alarm system that lets you know when you are doing harm to yourself, and the steroids can turn the alarm’s volume way down, but only temporarily.

Those old aches and pains suddenly feeling not-so-bad can inspire one to take a run on that problematic knee or do some squats in spite of the bulging disc, but those problems still remain, and if you’re careless, they can be worse after the steroid wears off.

If you pursue this path, it’s not a bad idea to do a sort of journal entry a few days before your injection, to jot down how you’re feeling emotionally, and the common aches and pains you experience on a daily basis, just so you have a baseline to compare against once the steroid is in you.

Surgeries

Lumbar spine surgery (Dr. Goldstein’s procedure)

The surgery is done at the level of the lumbar spine to free the spine of compression that can cause SPREs.

An example of a specific procedure that might be performed would be a “foraminotomy and diskectomy with annuloplasty,” but the specific procedure would vary based on each individual spine and its maladies.

Be aware that It can take up to a year or more after the surgery for the SRPEs to possibly be improved. Recovery from the procedure itself at the site of the surgery in the spine should only take about 1-2 months.

Of the 3 people who have reported having had this surgery for SRPE reasons, 0 of the 3 have reported long-term success from it.

Penile Implant

This is generally considered the “nuclear option” for erectile dysfunctions like priapism.
It aims to disable the body’s natural erectile function by putting the device in there, and from then on, erection is achieved manually by pumping a rubber ball that resides in the scrotum and pumps fluid into two plastic pieces that run the length of the penis shaft in order to cause rigidity.

An example of one such device is the AMS-700.

At least one SRPE sufferer has gone to these lengths to cure his SRPEs, and it was not successful as a solution, although his situation was more complex than just isolated SRPEs; there were multiple urological issues at play.

There is some evidence to suggest that penile implants are not effective for SRPEs, so proceed with caution.

The following study showed that, while effective for priapism, SRPE sufferers weren’t always helped by a penile implant. In fact, in this particular study, none of the participants with SRPEs saw positive results from the procedure:
pubmed.ncbi.nlm.nih.gov/33390335/

Hopefully, these SRPE treatment ideas will give you a bit of understanding of what you can do if you have this condition.