'Staying Hot': Investigating the influence of overnight conditions on the penile skin temperature during male sexual arousal-A novel methodology for nocturnal erection detection.

Objective: The objective of this study is to assess the impact of overnight environmental conditions on erectile penile temperature within a controlled setting, with the aim of investigating the feasibility of using temperature measurements for nocturnal erection detection in erectile dysfunction diagnostics. Subjects/patients and methods: We conducted a proof-of-concept study involving 10 healthy male participants aged 20 to 25. The study was carried out at the Department of Urology, St. Antonius Ziekenhuis, the Netherlands. Penile temperature thermistor measurements were taken during visually aroused erections of participants in naked state and in simulated overnight condition (underwear and blankets). Main outcome variables were peak and baseline temperature during erectile periods. To minimize the impact of differences in erectile strength and duration between consecutive measurements, we applied randomization to the order of the environmental conditions. Results: We observed a significant increase in penile temperature during erection in both the naked (p < 0.01) and simulated overnight condition (p < 0.01). The mean temperature increase was 1.70 and 0.67°C, respectively. While penile temperature returned to baseline immediately after naked erections, the 'Staying Hot effect' was noted in the simulated overnight condition measurements, where the temperature remained elevated at peak temperature for the entire 30-min period following the erection. Conclusions: The findings from this study indicate that the penile temperature not only significantly increases during naked sexual arousal but is also detectable under simulated overnight conditions. This underscores the potential of using temperature measurements for nocturnal erection detection, representing a crucial initial step in developing a modernized, non-invasive sensor system for ambulatory erectile dysfunction diagnostics. Further research, including an overnight study, is needed to gain insights into the feasibility of utilizing penile temperature measurements for nocturnal erection detection and to assess the impact of the 'Staying Hot effect' on subsequent erection detection.

Improvement in the ability to have sex in patients with Peyronie's disease treated with Collagenase Clostridium histolyticum.

Objective: To describe the results of intralesional Collagenase Clostridium histolyticum (CCH) treatment in patients with Peyronie's disease (PD) in real-world setting. PD is characterized by curvature of the erect penis caused by fibrotic tissue in the tunica albuginea. Patients and methods: Patients with stable PD and curvature of 30° to 90° were prospectively enrolled. CCH injections were initially given using a scheme of four cycles of two injections within 48-72 h every 6 weeks. Later using a modified scheme of three injections every 4 weeks, combined with a vacuum erection device (VED) twice daily. All patients were requested to take pictures of the erect penis prior to and following treatment, from above and laterally. Curvature was measured by three independent researchers based on the provided pictures using a goniometer. Furthermore, patients filled in the Peyronie Disease Questionnaire-NL (PDQ-NL) and Patient Reported Outcome Measurement (PROM).The primary outcome was reduction in curvature and the ability to have penetrating sex again. Secondary outcomes include pain scores during injections, changes in PDQ-NL, PROM and complications of CCH treatment. Results: Sixty-three patients were included, mean age was 56.0 years (range 39-70) and mean reduction in curvature 20.6° (SD 10.2, range 5-49); 74.5% of the patients were able to have penetrating sex again following treatment, compared with 41.2% prior to treatment. According to the PROM questions, sexual improvement was seen in 66.7% of patients. The satisfaction rate was 6.8 (SD 1.8). All patients save two recommend treatment. Conclusions: Intralesional treatment with CCH in men with PD leads to a mean curvature improvement of 20.6°. Following treatment, 74.5% of men were able to have sexual intercourse and 54.9% of the couples were satisfied with their sex life. No major complications occurred in the patients treated with CCH. CCH is not available in Europe anymore despite good results.

New methods for the monitoring of nocturnal erections.

The golden standard for measuring nocturnal erections is the RigiScan Plus. It is a relatively big and uncomfortable device dating from the previous century. The aim of this perspective is to conceptualize a user-friendly sensor that can be used at home for monitoring nocturnal erections. A literary search is carried out to explore the physiological changes during nocturnal tumescence and detumescence that can be measured non-invasively. Five sensor concepts are considered: plethysmography for penile arterial pulse, displacement sensor for axial length, strain gauges for radial rigidity and circumference, temperature sensors for measuring skin and cavernosal temperature, and a saturation sensor to measure hypoxia in cavernosal tissue during maximal rigidity. We think that due to practical issues, measuring penile length during sleep is impossible. Further research is recommended to investigate the remaining sensor concepts. Whether a combination of these techniques is favorable or only one of them should be studied more thoroughly.

Surgical outcomes after collagenase Clostridium histolyticum failure in patients with Peyronie's disease in a multicenter clinical study.

In the present study we aimed to investigate the surgical outcomes of patients with persistent penile curvature (PC) after Collagenase Clostridium histolyticum (CCH) intraplaque injections. Data from 90 patients with persistent PC after CCH in a multicentre study from 6 andrological centres were retrospectively reviewed. Three standardized surgical techniques were performed. Group 1: plaque incision grafting (PIG) with penile prosthesis implant (PPI); Group 2: PIG without PPI; Group 3: Nesbit technique. Hospital stay, operative time, postoperative complications and PC persistency/recurrence (> 20°) were evaluated. Overall satisfaction and functional outcomes were assessed through International Index of Erectile Function-Erectile Function (IIEF-EF), Peyronie's Disease Questionnaire (PDQ), Female Sexual Function Index (FSFI) administered pre and 3 months postoperatively. Of all, 25 (27.8%) patients received grafting procedure + PPI (Group 1), 18 (20.0%) patients belonged to Group 2, and 47 (52.2%) to Group 3. Bovine pericardium graft and collagen fleece have been used in in 22 (51.2%) and 21 (48.8%) patients, respectively. Median penile length after surgery was 13.0 cm (IQR 12.0-15.0). After surgery, Group 1 showed higher increase in penile length after surgery and better improvements in terms of PDQ-PS. In contrast, both IIEF-EF and FSFI scores did not differ among groups. Overall, 86 (95.6%) did not report any complication. 4 (4.4%) patients had PC recurrence; of those, 2 (8.0%), 1 (5.6%) and 1 (2.1%) cases were observed in Group 1, Group 2 and Group 3, respectively. In case of persistent PC after CCH, surgical correction by grafting with or without concomitant PPI or Nesbit technique emerged as a technically feasible, effective and safe procedure, with no significant postoperative complications.

Discrepancy between Expectations and Experiences after Prostate Cancer Treatment: A Dutch Multicenter Study.

OBJECTIVES: To evaluate possible discrepancies between patients' expectations concerning sexual side effects related to prostate cancer treatment, based on the obtained information prior to treatment. Moreover, to determine if demographic or clinical factors may have an effect on the accuracy of patients' expectations concerning sexual side effects after treatment. METHODS: A multicenter, cross-sectional survey was performed among men treated with prostatectomy, brachytherapy, external-beam radiotherapy and/or hormonal therapy. RESULTS: In total, 412 questionnaires were analyzed. Of men with sexual side effects after treatment, 1 in 3 (32.5%, n = 109) reported their complaints as worse than expected; significantly more often reported by men treated surgically (P = .001), men with a local stage tumor (P = .005) and by men with a lower prostate-specific antigen level at diagnosis (P = .046). It was significantly less often reported by men treated with radiotherapy combined with hormonal therapy (P = .031). Men who used brochures as an information source reported their sexual side effects significantly less often as worse than expected (P < .001). CONCLUSION: One in three men with sexual side effects after prostate cancer treatment, experienced their complaints as worse than expected based on the obtained information prior to treatment. Men treated with radiotherapy combined with hormonal therapy indicated less discrepancy between expectations and developed sexual side effects, whereas prostatectomy, low stage tumor and low prostate-specific antigen level were associated with more discrepancy. Brochures should be administered additionally to verbal information to improve patients' understanding of possible sexual side effects and to enhance the accuracy of patients' expectations.

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals.

AIMS AND OBJECTIVES: To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. BACKGROUND: Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and training are two of the most often reported barriers. Provision of additional training could improve knowledge, competence and general practice of healthcare professionals. DESIGN: Two questionnaires were used in this pre-post study to determine knowledge, competence and general practice at the time of the symposium and six months afterwards. METHODS: In order to perform repeated measures to analyse alterations among participating healthcare professionals (n = 55), the McNemar's test was used. A STROBE checklist was completed. RESULTS: Seventy-three per cent (n = 40) stated that not enough attention was paid to prostate cancer-related sexual dysfunction during their education. Nurses felt significantly less competent in discussing sexual function, advising on sexual dysfunction and actively inquiring sexual complaints compared to other healthcare professionals. After the symposium, sexual dysfunction was significantly more often discussed. No significant effects were found on knowledge on sexual dysfunction, knowledge on treatment of sexual dysfunction, competence in discussing sexual function, advising on sexual dysfunction, actively inquiring sexual complaints and rate of referral. Tools needed to address sexual dysfunction concerned written information materials (75.5%) and a website containing adequate information (56.6%). CONCLUSIONS: The symposium had no significant influence on knowledge, competence and rate of referral in men with sexual dysfunction after prostate cancer treatment. However, sexual dysfunction was more frequently discussed after the symposium, so increase of awareness of consequences of prostate cancer treatment was achieved. RELEVANCE TO CLINICAL PRACTICE: Consequences of prostate cancer treatment to sexual function should be taken in consideration in daily practice; written information materials and a website containing adequate information were indicated as valuable resources to address sexual dysfunction in routine consultations.

Dealing with patients facing a history of sexual abuse: A cross-sectional survey among Dutch general practitioners.

BACKGROUND: Sexual abuse (SA) is a common problem. As the primary confidant, the general practitioner (GP) has a valuable role in identifying a history of abuse, specifically with regard to the commonly performed pelvic examination for cervical cancer screening. OBJECTIVES: This study focused on GPs' practice patterns, knowledge, training need and barriers concerning asking patients about SA. Furthermore, it was investigated who performs the cervical smear within the practice and if SA is taken into consideration. METHODS: The authors constructed a 31-item questionnaire, which was sent to a group of 730 Dutch GPs in September 2012. RESULTS: The response rate was 49.3%. Half of the 357 responding GPs asked their patients about SA sometimes. The majority (76.2%) stated they had some knowledge of SA. The most important barriers for not asking were 'no angle or motive for asking' (81.6%), 'presence of third parties' (73.1%), and 'not enough training' (54.1%). In most practices (84.3%), the nurse practitioner (NP) was assigned to perform the cervical smears, of which 34.8% presumably never ask about SA in advance. Additional training was in need according to 68.6%. GPs desired a clinical practice guideline regarding the counselling of SA (83.5%). CONCLUSION: This study showed SA is an under-evaluated problem in general practice, yet GPs are motivated to improve knowledge and counselling skills. NPs perform most of the cervical smears, but the majority never or rarely asked about SA in advance. Educational training and a clinical guideline regarding SA would be appreciated and hence recommended.

Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide.

Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.

Internalized homophobia and reduced HIV testing among men who have sex with men in China.

Although previous research has examined barriers and facilitators of HIV testing among men who have sex with men (MSM) in China, few studies have focused on social factors, including homophobia and internalized homophobia. This study utilized data from a global online survey to determine correlates of HIV testing as part of a subanalysis focused on Chinese MSM. Controlling for age, HIV knowledge, number of sexual partners, and other covariates, ever having tested for HIV was significantly correlated with lower internalized homophobia. This study suggests that stigma associated with sexual orientation may serve as a barrier to participation in HIV testing and other health-promoting behaviors.

Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men.

OBJECTIVE: We evaluated the relationship among syndemic conditions (defined as a cluster of interconnected psychosocial health conditions), sexual behaviours and self-reported HIV infection in a global sample of men who have sex with men (MSM). METHODS: We used generalised estimating equations logistic regression models with robust SEs to assess the relationships among cumulative number of syndemic conditions--including depression, substance use, violence, sexual stigma and homelessness--and unprotected anal intercourse (UAI) and HIV infection, while accounting for clustering within-country in a global cross-sectional survey of 3934 MSM across 151 countries. RESULTS: We observed parallel, significant dose-response associations between the number of syndemic conditions and UAI, as well as number of syndemic conditions and HIV infection. Compared with participants without syndemics, the adjusted OR (aOR) for UAI among those with 1, 2 and 3 or more syndemic conditions were 1.44 (Bonferroni-adjusted 95% CI 1.23 to 1.68), 1.89 (1.51 to 2.36) and 2.03 (1.43 to 2.89), respectively. Compared with participants without syndemics, the aOR for HIV infection among those with 1, 2 and 3 or more syndemic conditions were 1.67 (1.24 to 2.26), 2.02 (1.44 to 2.85) and 2.35 (1.31 to 4.21), respectively. CONCLUSIONS: This analysis provides evidence of intertwining syndemics that may operate synergistically to increase HIV risk among MSM globally. To curb HIV effectively and advance the health of MSM, multiple conditions must be addressed concurrently using multi-level approaches that target both individual and structural risk factors.

Trends in HIV prevalence among men who have sex with men in China 2003-09: a systematic review and meta-analysis.

BACKGROUND: The year-by-year trend of HIV prevalence among men who have sex with men (MSM) in China is not well documented. METHODS: Published studies on HIV prevalence among MSM in China were reviewed and grouped by year, region and age group. Meta-analysis was used to summarise the estimates of national and regional HIV prevalence rates and trends among MSM from 2003 to 2009. HIV prevalence among MSM in different age groups (<25 years old v. ≥25 years old) was also calculated. RESULTS: Eighty-three publications were included in the meta-analysis. The pooled HIV prevalence among MSM in China increased from 0.6% (95% confidence interval (CI): 0.0-2.1%) in 2003 to 7.4% (95% CI: 5.7-9.2%) in 2009. A yearly increase of 1.1% (95% CI: 0.5-1.5%, P<0.001) in HIV prevalence was detected. The pooled regional HIV prevalence among MSM ranged from 2.3% (95% CI: 1.7-2.9%) in east China to 11.4% (95% CI: 9.2-13.6%) in south-west China. No difference was detected (χ(2)=0.5160, P=0.4726) between HIV prevalence in the <25-year-old age group (3.1%, 95% CI: 1.6-4.6%) and that in the ≥25-year-old age group (4.0%, 95% CI: 1.8-6.3%). CONCLUSION: The HIV prevalence among MSM in China is high and climbing. Effective strategies are required to prevent the epidemic from continuing to spread.

Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention.

Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.

HIV testing among men who have sex with men in China: a systematic review and meta-analysis.

HIV testing among men who have sex with men (MSM) in China has not been well studied. We systematically reviewed studies addressing HIV testing among MSM in China and conducted a meta-analysis on testing indicators before and after the adoption of China's National Plan for HIV/AIDS Prevention and Control among MSM in 2007. Rate of lifetime HIV testing (24 % [period 1-before adoption] vs. 47 % [period 2-after adoption]) and testing in the past 12 months (21 vs. 38 %) were both significantly higher in period 2. Rate of lifetime pre-test counseling showed a significant increase from period 1 to period 2 (72 vs. 90 %), while the figure for the past 12 months pre-test counseling did not change (51 vs. 50 %). More efforts are needed to promote frequent HIV testing among MSM.

Sexual abuse history in GI illness, how do gastroenterologists deal with it?

INTRODUCTION: Data support an increased prevalence of sexual abuse (SA) among patients with gastrointestinal (GI) complaints. Sexual abuse causes multiple symptoms related to pelvic floor and stress mediated brain-gut dysfunctions. Treating these patients asks for a holistic approach, using centrally targeted interventions. However, gastroenterologists have never been surveyed regarding their practice patterns and constraints about inquiring into SA. AIM: To evaluate whether gastroenterologists address SA in their daily practice and to evaluate their knowledge regarding the implications of SA in GI illness. METHODS: A 42-item anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and fellows in training). The questionnaire addressed SA and pelvic-floor-related complaints. MAIN OUTCOME MEASURES: The results of this survey. RESULTS: One hundred eighty-three of the 402 (45.2%) questionnaires were returned. Overall, 4.7% of the respondents asked their female patients regularly about SA; in males, this percentage was 0.6%. Before performing a colonoscopy, these percentages were even smaller (2.4% and 0.6%, respectively). When patients presented with specific complaints, such as chronic abdominal pain or fecal incontinence, 68% of the gastroenterologists asked females about SA and 29% of the males (P < 0.01). The majority of respondents stated it as rather important to receive more training on how to inquire about SA and its implications for treatment. CONCLUSION: Gastroenterologists do not routinely inquire about a history of SA and they rarely ask about it before performing colonoscopy. There is a need for training to acquire the skills and knowledge to deal with SA.

Prevalence of sexual abuse among patients seeking general urological care.

INTRODUCTION: Sexual abuse (SA) history can be found in the backgrounds of an important fraction of men (8-10%) and women (12-25%). Until now there are no data about this prevalence within a urological patient population. AIM: To establish the prevalence of SA among men and women visiting a urological outpatient clinic and to assess their opinion on screening for SA by urologists. METHODS: A questionnaire to identify SA was translated into Dutch, English, and Turkish, and was adjusted for use in men. These questionnaires were anonymously distributed among 1,016 adult patients attending the urological outpatient clinic. MAIN OUTCOME MEASURE: The self-reported prevalence of SA. Secondary outcome measures were data about the assailant, victim's age at the time of the abuse, if the abuse was disclosed to the urologist, if the urologist had asked for SA, and patient opinions on standard screening for SA in urological care. RESULTS: A total of 878 questionnaires were returned, giving a total response rate of 86.4% (878/1,016). Thirty-three patients refused to participate. This resulted in 845 filled-out questionnaires suited for analysis (845/1,016 = 83.2%). There were more male (75.7%) than female respondents (21.8%); 2.1% (13/624) and 13.0% (21/161) of the male and female respondents reported a history of SA, respectively. Almost 42% reported a stranger as assailant. In nearly 90%, the SA took place before adulthood: 56.2% in childhood and 31.2% in adolescence. Fifteen percent of the respondents with SA had it disclosed to their urologist. More than 70% of the abused respondents considered the idea to screen for SA in urological practice to be a good one. CONCLUSIONS: The prevalence of SA in patients seeking urological care in the Netherlands is 2.1% for men and 13.0% for women.

Female sexual abuse evaluation in the urological practice: results of a Dutch survey.

INTRODUCTION: There is a strong association between urological complaints and a history of sexual abuse, especially in females. It is not known whether urologists integrate these facts in their daily practice. AIM: To evaluate whether Dutch urologists address the issues of sexual abuse in their female patients and to evaluate their perception of sexual abuse prevalences. METHODS: A five-item anonymous questionnaire was mailed to all 405 registered members of the Dutch Urology Association (urologists and residents). MAIN OUTCOME MEASURES: The results of the survey. RESULTS: One hundred eighty-six surveys of eligible respondents were returned (45.9% response rate). A total of 68.8% stated that they always ask their female patients about sexual abuse before doing the physical examination. Overall, 79.3% said to do so when a patient has certain urological complaints: 77.6% in case of lower abdominal pain, 62.1% in urgency or frequency, 41.4% in incontinence, 29.3% in urinary tract infections, and 3.4% in hematuria. The majority of the respondents (74.3%) estimated the frequency of sexual abuse in their urological clinic to be equal or less than 10%. CONCLUSION: Nearly 70% of the responding Dutch urologists and residents ask their female patients about possible sexual abuse. They estimate the frequency of sexual abuse in their female patients to be equal or less than 10%.

Multiple pelvic floor complaints are correlated with sexual abuse history.

INTRODUCTION: The relationship between sexual abuse and urinary tract symptoms, sexual abuse and gastrointestinal symptoms, or sexual abuse and sexual dysfunction has been described before. A correlation between all these symptoms and sexual abuse has not yet been reported. AIMS: The first aim of this study was to document the prevalence rates of reported sexual abuse in a large sample of female patients with complaints of the pelvic floor. The second aim was to evaluate the frequency of complaints in the different domains of the pelvic floor, such as complaints of micturition, defecation, and sexual function, in female patients reporting sexual abuse, and comparing these data with female patients without a history of sexual abuse. METHODS: Female patients with pelvic floor complaints were evaluated in a tertiary referral center. History taking was assessed by a pelvic-floor clinician. The number of domains with complaints of patients with a history of sexual abuse was compared with the number of domains with complaints of patients without sexual abuse. MAIN OUTCOME MEASURES: The number of patients who reported sexual abuse and the frequency of complaints in the different domains of the pelvic floor. The number of domains of patients with a history of sexual abuse was compared with patients without a history of sexual abuse. RESULTS: Twenty-three percent (42/185) of the patients reported a history of sexual abuse. The female patients with a history of sexual abuse had significantly more complaints in three domains of the pelvic floor (35/42) compared with the nonabused (69/143) (83% vs. 48%, P < 0.001). CONCLUSIONS: Twenty-three percent of the female patients in a pelvic floor center evaluated by a pelvic-floor clinician reported a history of sexual abuse. This is comparable with the percentage of sexual abuse observed in the population at large. In our sample, the patients with multiple pelvic floor complaints (micturition, defecation, and sexual function) related to pelvic floor dysfunction were more likely to have a history of sexual abuse than the patients with isolated complaints.

Macroscopic hematuria in patient with myelofibrosis caused by extramedullary hematopoiesis of bladder.

Extramedullary hematopoiesis (EMH) is a physiologic process in fetal life. However, after birth, its occurrence is abnormal, and it develops when hematopoiesis in the bone marrow is disturbed, such as occurs in many hematologic disorders. EMH can become symptomatic, depending on its extent and location. We describe the case of a 67-year-old man with postpolycythemic myelofibrosis who presented clinically with macroscopic hematuria due to EMH in the bladder. EMH in the bladder is extremely rare but illustrates the importance of an adequate pathologic assessment of transurethral resection chips, especially in patients with underlying disease.

The treatment of sleep-related painful erections.

INTRODUCTION: As specialists in male genital problems, urologists and sexologists will most likely to be involved in the treatment of males presenting with sleep-related painful erections (SRPEs). This means that this phenomenon needs to be recognized by urologists and sexologists, and that they should have knowledge of the current diagnostic and therapeutic approaches. Aim. To review the literature on SRPE and to find the best pharmacological treatment. Methods. Four personal clinical observations from two clinics and 29 other cases with SRPE found in PubMed were analyzed, especially regarding the results of pharmacological treatment. MAIN OUTCOME MEASURES: The results of pharmacological treatment. RESULTS: Many of the various treatments proved to be ineffective and only a few showed efficacy for a few weeks or months. The only effective drugs in the long term were baclofen, clonazepam, and clozapine. CONCLUSIONS: Until now, the phenomenon of SRPE is not well understood. The rarity of the published cases undoubtedly does not reflect the actual occurrence of SRPE. Controlled double-blind pharmacological trials are needed, and long-term follow-up including polysomnography coupled with nocturnal penile tumescence and rigidity monitoring may provide further information about SRPE.