Must all men wake up with Morning Erection???

A 27 year old male painter comes to the consulting room to complain about the size of his penis and makes mention of the fact that he barely experiences erections when he wakes up from his sleep. Something all his male friends are experiencing. He also says that he suffers badly with premature ejaculation. Most times he can barely last a minute and desperately needs help.

ANSWER:
His complaint is pregnant with three ‘kids’, however his chief complaint was the lack of morning penile erection as compared to what his friends tell him. As well as the premature ejaculation. I will attend to the former through this write-up and attend to the latter in another write-up.

Morning glories, or nocturnal penile tumescence (NPT), as they are correctly called, are spontaneous erections that occur during sleep or while waking up. All guys without erectile dysfunction are graced with them and they normally occur around three to five times during sleep. Nocturnal penile tumescence” (as it is medically known) is not only an interesting physiological phenomenon, it also tells us a lot about a patient’s sexual function. Morning penile erection is no respecter of persons since it affects all males, including males in the womb. It also has a female counterpart which is less popular and less frequently discussed (nocturnal clitoral erection). The origin of the two organs is the same, the clitoris is formed from blood vessels as the penis does, therefore, the clitoris can become erect like it does during sex.

First, let’s identify the causes of erections?

Penile erections occur in response to complex effects of the nervous system and endocrine system (the glands that secrete hormones into our system) on the blood vessels of the penis. When sexually aroused, a message starts in the brain, sending chemical messages to the nerves that supply the blood vessels of the penis, allowing blood to flow into the penis. The blood is trapped in the muscles of the penis, which makes the penis expand, resulting in an erection. Several hormones are involved in influencing the brain’s response, such as testosterone (the main male hormone).This same mechanism can occur without the involvement of the brain, in an uncontrolled reflex action that is in the spinal cord. This explains why people with spinal cord damage can still get erections and why you can get erections when not sexually aroused or when you wake up from your sleep.

So why do men get erections while they sleep?

First we must know that Sleep is made up of several cycles of REM (Rapid Eye Movement) and non-REM (deep) sleep. During REM sleep, there is a shift in the dominant system that’s activated. We move from sympathetic (fight and flight) stimulation to parasympathetic (rest and digest) stimulation. Nocturnal penile erections occur during (REM) sleep (the phase of sleep during which we dream). They occur when certain areas of the brain are activated. This includes areas in the brain responsible for stimulating the parasympathetic nerves (“rest and digest” nerves), suppressing the sympathetic nerves (“flight and fight” nerves) and dampening areas producing serotonin (the mood hormone). This shift in balance drives the parasympathetic nerve response that results in the erection. This is spontaneous and does not require being awake. Some men may experience nocturnal penile tumescence during non-REM sleep as well. But this is more common particularly in older men. The reason for this is unclear. The reason men wake up with an erection may be related to the fact we often wake up coming out of REM sleep. The hormones that can cause erections during the day are kept at the lowest level in the body. At the end of the day, when you go to sleep and rest, the suppressed hormones are released by the body. The hormone secretion is greatly increased and naturally, the penis becomes erect, especially after REM sleep. The male hormone testosterone, which increases in the blood, reaches its highest level the moment you wake up. It has been shown to enhance the frequency of nocturnal erections. Since the testosterone is so high, the penis can be erect even though there is no sexual stimulation. In other words, most cases of morning erection are not caused by dreams and sexual thoughts. Also, during sleep, the nitric oxide secretion increases in the body, and the erection is caused by the fact that this compound expands the blood vessels. But let me also say: Even if your brain is asleep, it continues to receive signals from around your body. If your penis has any contact with your partner, you can have an erection. It is useful to note that an erection happens when there is an expansion of the blood vessels in the penis, followed by an increase in blood flow. Since there are several sleep cycles per night, men can have as many as five erections per night and these can last up to 20 or 30 minutes. But this is very dependent on sleep quality and so they may not occur daily. The number and quality of erections declines gradually with age but they are often present well beyond “retirement age” - attesting to the sexual well-being of older men. In women, Pulses of blood flow in the vagina during REM sleep causes the clitoris to engorge and vaginal sensitivity increases along with vaginal fluidity.

Is there any purpose for morning erections?
It has been suggested as a signal for alerting men of their full overnight bladder, since it often disappears after emptying the bladder in the morning. It’s more likely the reason for the morning erection since the unconscious sensation of the full bladder stimulates nerves that go to the spine and these respond directly by generating an erection (a spinal reflex). This may explain why the erection goes away after emptying one’s bladder. However, scientific studies are undecided as to whether morning erections contribute to penile health.

So does it mean anything if you don’t get erections after waking up?

Loss or lack of nocturnal erection can be a useful indicator of common diseases affecting erectile function. Diabetes is a typical example where the lack of morning erections may be associated with erectile dysfunction due to poor nerve or blood supply to the penis. In this case, there’s a poor response to the messages sent from the brain during sleep which generate nocturnal erections. It is thought nocturnal erections can be used as a marker of an anatomical ability to get an erection (a sign that the essential body bits are working), as it was thought to be independent of psychological factors that affect erections while awake. Studies have suggested, however, that mental health disorders such as severe depression can affect nocturnal erections. Thus its absence is not necessarily a marker of disease or low testosterone levels. The frequency of morning erections and erection quality has also been shown to increase slightly in men taking medications for erectile dysfunction. Someone with a long history of masturbation can suffer from a desensitized sexual stimuli hence suffer lack of morning erection. Lack of morning erection may also be a sign of declining testosterone or poor cardiovascular health.

So what is the good and bad news for this man?

While some men will put their nocturnal erections to good use, many men are not aroused when they have them and might find them a nuisance. Since good heart health is associated with an ability to have erections, the presence of nocturnal erections is generally accepted to be good news. Since this man is not taking medications for hypertension, diabetes or Hyperlipidemia, Maintaining a healthy lifestyle is therefore important in avoiding erectile dysfunction associated with lack of morning erections. It’s important for him to eat healthily, maintain a healthy weight, exercise and avoid smoking and alcohol. It’s an amusing, albeit often highly inconvenient phenomenon that half of the world’s population has to deal with on a regular basis. Also, due to the nature of his job, he might be missing out on REM sleep, hence missing out on the repair process, which causes morning erections. A good sleep is therefore advised. The bad news is that his past addiction to pornography has resulted in certain levels of desensitization. There is a mismatch between the brain and the penis. So medication is not the answer to this problem because the issue isn’t the penis but the mind and its lack of sensitivity to dopamine and other brain chemicals.

In conclusion: Many men make the mistake of attempting to use aphrodisiacs to treat morning erection loss, but it’s almost impossible until the root cause is addressed. A complete loss of morning erection can signal depression, chronic stress, heart diseases and other underlying health conditions. It is also the first sign of low testosterone. Treatment is based on the underlying condition.

By Dr Ernest Aggrey (HMD), 0543999776/[email protected]