Montorsi Francesco, Oettel Michael
Istituto Scientifico H. San Rafaele, Milan, Italy.
J Sex Med. 2005 Nov;2(6):771-84. doi: 10.1111/j.1743-6109.2005.00095.x.
Sleep-related erections have been reported to occur from the intrauterine life to senescence. It has been speculated that the main function of nocturnal erections is to provide adequate engorgement of the corpora cavernosa, which then leads to increased tissue oxygenation. This is in turn to prevent cavernous fibrosis, the histopathological basis for corporeal venoocclusive dysfunction, which probably is the most common cause of organic erectile dysfunction. It has been suggested that sleep-related erections are triggered by the release of nitric oxide by the nitrergic nerve fibers within the cavernous nerves. Androgens regulate this mechanism as well as some other non-nitrergic processes within the corpora cavernosa and within the central nervous system. By contrast, the erectile response to tactile or visual erotic stimuli in wakefulness predominantly involves an androgen-independent system, although it may, at least to a certain degree, also be influenced by androgen-sensitive mechanisms. No doubt, androgens are key players in the physiology of nocturnal erections, and the availability of new, user-friendly testosterone preparations such as transdermal gel and intramuscularly administered testosterone undecanoate stimulates further investigations on this field. The prospect that the quality of sleep may also be improved by an androgen therapy administered to improve sleep-related erections in hypogonadal men needs further basic research and appropriate clinical studies.
据报道，与睡眠相关的勃起从子宫内生活到衰老阶段都会出现。据推测，夜间勃起的主要功能是使海绵体充分充血，进而增加组织氧合。这反过来又能预防海绵体纤维化，而海绵体纤维化是海绵体静脉闭塞功能障碍的组织病理学基础，可能是器质性勃起功能障碍最常见的原因。有人提出，与睡眠相关的勃起是由海绵体内的含氮神经纤维释放一氧化氮触发的。雄激素调节这一机制以及海绵体和中枢神经系统内的一些其他非含氮过程。相比之下，清醒状态下对触觉或视觉性刺激的勃起反应主要涉及一个不依赖雄激素的系统，尽管它至少在一定程度上也可能受到雄激素敏感机制的影响。毫无疑问，雄激素是夜间勃起生理学中的关键因素，新型、使用方便的睾酮制剂（如透皮凝胶和肌肉注射十一酸睾酮）的出现刺激了该领域的进一步研究。通过雄激素治疗改善性腺功能减退男性与睡眠相关的勃起，进而改善睡眠质量这一前景需要进一步的基础研究和适当的临床研究。
