Morning erections: Why men get them and when changes could signal a health issue
Commonly called “morning wood”, these are a normal part of male biology. But sudden changes in their frequency may sometimes point to erectile dysfunction or other health issues.
(Photo: iStock/Pepe Laguarda)
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Waking up with an erection is a common occurrence if you’re a grown man. In fact, you may also experience three to five erections while asleep – and not be aware of them, said Dr Chia Jun Yang, a consultant with Department of Urology, National University Hospital. Urologists call these 10-to-30-minute episodes nocturnal penile tumescence – and they are a part of a man’s physical and sexual health.
But as with everything else that deflates with age, that tentage under the sheets may be poking up less frequently, or not as tall and proud as it used to. What factors can contribute to morning erections in the first place, and should you be concerned if they don’t show up?
HOW DO ERECTIONS OCCUR IN THE FIRST PLACE?
Four main conditions need to be present for an erection to occur, said Parkway East Hospital’s urologist Dr Jay Lim Kheng Sit: pipes, wires, hormone and mood.
First, the “pipes” or blood vessels in the penis. “Erection occurs when inward blood flow is higher than outward flow,” he said, so the vessels must be in good working order – no leakage or blockage. “Smoking and diabetes are examples of conditions that can damage or block the pipes.”
Second, the “wires” or nerves that supply the penis. “This is similar to the wiring of your light switch,” compared Dr Lim. “If the wires are broken (either by surgery, injury or neurological conditions), you cannot switch on the light even if the bulb is working.”
Third, testosterone is the main driver of libido. “Low testosterone is like a faulty on-off switch that fails to be triggered by sexual stimulation,” said Dr Lim. “Erections do not occur even when there are good pipes or normal wiring.”
Finally, mood. This is a multi-facet component that is directly affected by stress, fatigue, emotions or surroundings, said Dr Lim. “Simply put, a non-conducive environment prevents erection and is also the hardest component to treat in patients with erectile dysfunction.”
As for the erection’s average duration, it is difficult to quantify “as there are sexual and non-sexual erections”, said Dr Lim. However, an “erection time of more than two hours is considered abnormal and require treatment as penile tissue require fresh oxygenated blood.”
WHAT CAUSES MORNING ERECTIONS AND WHY MEN HAVE THEM?
Every night, the body floods the spongy tissues in the penis with blood to bring it fresh oxygen and vital nutrients. This nightly rush of blood keeps the tissue elastic, prevents scarring or structural damage, and acts as a check for your blood vessels and nerves.
As for the cause, it is your testosterone at work. But to better answer the question, said Dr Lim, it is about how this erection-causing sex hormone is released by the body at night, independent of sexual thoughts.
Testosterone is released in pulses during sleep, said Dr Lim. “It is released during REM (rapid eye movement) sleep and starts to rise from 3am to 8am.” And since there are about four to six periods of REM in a typical sleep, you may experience a similar number of nocturnal penile tumescence – though for most men, they get up to three to five nightly erections, according to Dr Lim.
Another good reason to get enough sleep: “These non-sexual nocturnal erections are diminished in men who lack adequate sleep or suffer from chronic sleep disorders.”
Testosterone peaks again between 6am and 10am, and gradually drops during the day to reach a low in the evenings, explained Dr Lim. “As a result of the high level of testosterone in the bloodstream, males experience morning erections commonly termed ‘morning wood’.” This is also why doctors schedule testosterone checks early in the morning to avoid false alarms.
What about prepubescent boys? “Contrary to popular belief, morning erections can occur before puberty due to neurological reflexes,” said Dr Chia. These reflexes refer to the involuntary functions that the body performs, such as breathing, heart pumping, digesting and inducing those nightly checks on the penis – including the awkward morning surprise.
As for male babies and toddlers who spring down-there salutes at their parents, they are exposed to more testosterone than you think. For one, babies are bathed in the erection-causing hormone in the womb. Then, one to three months after birth, both genders naturally experience a temporary hormonal spike – a phase commonly referred to as mini-puberty to help their reproductive organs mature. By the time the baby is six months old, the levels would have dropped to prepubertal levels.
“It’s very common for friends of mine who are parents to call and ask if it’s a problem that their three-year-old has an erection,” wrote Dr Ryan Berglund, a urologist on Cleveland Clinic. “The answer I always give them is that it’s totally normal.”
IS IT NORMAL TO MISS A MORNING ERECTION OR TWO?
Since these morning episodes are associated with REM, not catching enough zzzs at night can naturally affect their occurrence. The occasional absence of morning erections is not a cause for alarm, said Dr Chia. “A gradual decline with age is normal and expected.”
Morning erections are also linked to testosterone levels, which peak around 17 to 18 years of age, said Dr Lim. “Men begin to experience a testosterone decline of about 0.5 per cent to 1 per cent annually in their 50s. The corresponding decrease reduces the frequency of morning erections.”
However, “persistent absence over several weeks, combined with difficulty attaining or maintaining an erection that is sufficient for satisfactory sexual performance can suggest erectile dysfunction, and warrant a visit to the doctor for further evaluation”, said Dr Chia.
CAN LESS FREQUENT MORNING ERECTIONS BE LINKED TO ERECTILE DYSFUNCTION?
Erectile dysfunction (ED) – the inability to get or keep an erection firm enough for sex – affects about 51 per cent of respondents to some degree in a Singapore study on 729 men aged 30 and above.
But can morning erections and ED be linked? Researchers are undecided. For example, a five-year Finnish analysis of 989 men suggests that the frequency of morning erections predicted the development of complete ED.
More specifically, there is an approximate 2.5-fold risk of ED among those with fewer than one morning erection per week, compared with men who experience two or three morning erections weekly. However, the same study also found that regular intercourse plays a more important role in staving off ED than morning erections.
In Singapore, Dr Chia has seen both scenarios being played out. “Men with ED can have reduced morning erections, especially if it is due to an organic cause” that “result in reduced blood flow to the penis”. Similarly, there are also many men with ED who have not noticed diminishing morning erections.
CAN MORNING ERECTIONS BE AN INDICATION OF HEALTH?
Since blood flow is a key factor, having regular morning wood is a sign that your blood circulation and blood vessels are in good health. “Cardiovascular risk factors such as hypertension, high cholesterol levels and diabetes result in decreased blood flow to the penis and hence, reduce the frequency of morning erections,” said Dr Chia.
In fact, before ordering blood tests, Dr Lim often asks patients about their morning situations as an “indirect way of assessing testosterone levels”. “Coupled with conditions that affect bloods vessels like diabetes, hypertension and smoking that accumulates in its detrimental effect, all these have a direct impact on erectile function.”
Sometimes, missing morning actions can be caused by certain medicines. “These include certain classes of anti-hypertensives and anti-depressants,” said Dr Chia. However, “it is important not to stop these medications without consulting your doctor as that can lead to adverse outcomes.”
What about the use of sauna, cold plunges or wearing tight underpants? “There is no good evidence to show that they can affect morning erections,” said Dr Chia.
Source: CNA/bk
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