I don’t have a MORNING ERECTION anymore: WHY? WHAT should I do? HOW can this be avoided?

I don’t have a morning erection anymore: WHY, WHAT  should I do, and HOW can this be avoided?

Paradoxical erections can be described as both morning and night erections. These are genital reflex phenomena that occur during the REM phase, which reflects good vascular function and hormonal functioning.

My patients often report morning erections disappearing. This is a common reason for sexology consultations.

« It’s not normal! »

 « I’m too young! » (what does that mean? )

« I used have good erections when i went to urinate, but they are gone now! »

It is essential to diagnose erectile dysfunction accurately, gather all elements, and plan care. Let me tell you why starting with a story.

« I don’t get an erection in the mornings and I’m not too young to do that! »

A young man in his twenties is visiting a sexologist. He walks confidently and is healthy in the waiting room. It is obvious that he is active, so it is likely that he regularly goes to the gym. I conclude that he must also have a healthy lifestyle. He has a calm, well-balanced speech. As usual, we start with

« What can you do for me young man? »

He looks at his feet and says,

« You see, this is one of your youngest patients »

(it was his first visit and he didn’t know my patient base).

« This is not something you would normally consult for. How can I tell ,…, that it doesn’t work anymore? Except I’m too young to do that, and it’s causing problems in my relationship. « 

I’m a seasoned shopper who often answers the question

« What does young to you mean? »

Are you implying that only elderly people can go to sexology for their erectile dysfunction?

[SILENCE]

He is clearly in great embarrassment and attempts to make inaudible excuses.

According to the Internet, the disappearance or reduction of morning erections could be a sign that there is an organic disorder or drop in testosterone!

He has searched the Internet for answers to his most intimate queries, just like everyone else. While the Internet may not provide the most accurate information, they do have the answers that practitioners need. He found himself quickly in a niche of people who are young and had had multiple breakdowns. They don’t think to ask for help, but they can create fame between them by sharing their symptoms and miracle cures. He was already able to determine the treatment and dosage, as well as the course of action. Viagra is not for elderly people.

Cognitive and emotional approach

For emotional rehabilitation, I always approach both at the cognitive level. My patients learn how to make sense of their emotions using a positive therapeutic approach. Therefore, it is important to explain why morning and night erections occur, including their purpose, how they work, and what happens when it stops working.

We will do this in the next five episodes.

  1. Morning erection, or Penile Erections During Paradoxical Sleep?
  2. What does it mean that I no longer have a morning erection?
  3. What can I do to improve my Penile Erections During Paradoxical Sleep?
  4. There are three reasons to love it!
  5. Three important facts aboutPenile Erections During Paradoxical Sleep!

#1. Sleep cycles

Did you know that nocturnal and morning erections are present even in newborns?

We will not be discussing the mechanism or the role of his morning and evening erections. However, we will discuss Penile Erections During Paradoxical Sleep. Sleep cycles are phases of sleep during which electrical activity is recorded using an electroencephalogram. An electroencephalogram (EEG), is a test that measures and records the electrical activity in the brain using electrodes or detectors attached to the head that are connected to a computer via wires. It is painless as there is no electricity, but it will record electrical activity in the brain. Electroencephalogram recordings of physiological human sleep have been used to identify the cycles of sleep. This involves recording the eye movements and breathing and continuously tracking the electrodes that are placed on the scalp. It is also called an electromyogram to study muscle activity. An electromyogram can detect muscle atony in REM sleep. There are many stages to sleep.

The REM phase of sleep

The so-called paradoxical stage is one of the most important phases of sleep. Because it has intense electrical activity, which contrasts with muscular atony, it is called paradoxical. It is important to note the rapid eye movements (REM), and this is why the REM phase of sleep is called « REM Sleep ». There is a non-rapid phase at the start of sleep, followed by a short period of rapid movement sleep. These REM phases can last between 30-40 minutes and are repeated 2-3 times per night.

Penile Erections During Paradoxical Sleep

Penile erections can be observed after the REM phase. These are physiological epiphenomena that are associated with REM sleep in healthy men. Men will often wake up in the morning having an erection that is related to REM sleep. These erections can also be called nocturnal penile tumescences.

Nocturnal Penile Tumescences (Penile erections during sleep)

The erection cycle is strongly associated with spontaneous awakening from sleep. Each person’s sleep cycle is unique, but the average man experiences four to five erections in REM sleep. Each erection lasts between 30-35 minutes. These erections are a normal part of REM. Studies have confirmed the existence of paradoxical erections in both infants and the elderly. The phenomenon of engagement of the clitoris is also seen in women.

Morning erections are similar to Nocturnal Penile Tumescence after you wake up.

Morning erections are actually nocturnal penile erections in men that have just woken from REM sleep, or within a short time after the end of the REM phase. Although men do not always wake up at the end of each REM sleep episode, they are likely to wake up with a REM sleep-related erection. This is the normal and healthy physiological response for all other people.

Measurement of nocturnal penile efficacy (a thing of the future)

The absence or presence of his erections was used for a long time to distinguish between an organic and psychological erectile disorder. The semiological criterion of whether or not he erects in the morning was used to distinguish between psychological and organic physical conditions. It is simple and straightforward enough for a primary school student. If there were still nocturnal or morning erections, it was considered psychological. However, if no more morning erections are present it is an organic medical.

Because nocturnal erections occur in the REM phase, they are often unconscious. Nobody has the ability to remember 4 or 5 erections per night. These erections have been confirmed by recordings made with dedicated devices. RigiScan® is a device that allows us to determine how many erections occur each night in healthy individuals. The penile rigidity assessment system was a non-invasive diagnostic tool that could be used to assess the frequency, duration, and rigidity of erections. This device is no longer being sold. The study’s main conclusion is that patients’ self-assessments of their erectile status are very subjective. 

The physiology of nocturnal penile and tumescence

Each REM cycle is linked to penile erections and clitoral engorgement, most likely by reflex mechanism. The sacral spinal cord is the location of the clitoral or cavernous erection center. Their activity is affected by cortical influences during the day. REM sleep causes a disconnection between the brain, body, and rest (this muscular atony is almost a paralysis). There is a reflex activation in the erectile centers, which creates reflex erections without any erectile stimulation. Erections do not occur due to previous sexual activity, erotic dreams, or full bladder. You can have a good evening relationship, a happy sexual life, and erections without it being pathological.

No! No! No!
Ladies and gentlemen, reflex ejaculations and nocturnal erections are perfectly normal!

The biochemical mechanism for the nocturnal erection is testosterone

Hormones and neurotransmitters are responsible for the mechanism of morning and night erections. Although testosterone can modulate all aspects of erectile function, it has been observed that testosterone levels are greater in the morning than in the afternoon. The levels increase upon sleep onset, but they are lower during transitions from a non REM phase to REM. The REM sleep state peaks around the hour of REM sleep and stays constant until the morning. This would explain the nocturnal penile swelling.

Prolactin, another neurotransmitter suspected, plays a significant role in developing behavior with doctors and sexual partners. Its release is dependent on REM sleep. When REM sleep dominates, its level rises around 3 to 5. Neurologically, the autonomic nervous and especially the parasympathetic control the erection. The activation of the state that is awake during the day by the sympathetic neurovegetative system, causes erections to be blocked. The parasympathetic neurovegetative system of calm, rest and relaxation that dominates at night by lowering adrenergic tone favors nocturnal paradoxical erections.

What role does nocturnal penile tumescence play?

We know how it works. But what about its role in erections.

We know that oxygenation plays a key role!

The corpora cavernosa do not rest during the flaccid phase, but contract. They consume energy.  The dilatation of the sinusoids in erection is what will bring oxygenated blood to the body and play a major role in the smooth functioning of the erection. Men with a sleep disorder called apnea, which is characterized by poor sleep quality and low oxygenation, have a tendency to experience a decrease in nocturnal erections. The use of a nocturnal ventilator systematically can be used to recover erections. The patient underwent a radical prostatectomy and a lesion in the vasculo-nervous band, which resulted in the disappearance of nocturnal penile erections. However, irreversible changes to the corpora cavernosa functionality were also observed. This phenomenon is where the noble erectile tissues are replaced with non-functional tissue. Loss of length and retraction can also be seen. Protocols for erectile rehabilitation would allow you to keep the length and functionality of your erection.

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#2. I don’t have a morning erection anymore: What does this mean?

Did you know that a healthy man can have up to six nocturnal erections lasting between 25 and 35 minutes each?

I no longer have morning erections.

The disappearance of morning erections is a common reason for men to consult sexologists.

We have seen that many men worry about morning erections, especially those between 20 and 40, or the time they « pee » in the morning.

Penile Erections During Paradoxical Sleep: 3-6 erections lasting between 25 and 35 minutes

We’ve seen the importance of the REM phase in our sleep and how it helps to maintain the functionality of the corpora cavernosa through maintaining nocturnal erectile function. These paradoxical erections, in general, are unconscious. RigiScan®, which records the rigidity and tumescence, has shown that there are erections of between 3 and 6 per night and can last up to 20 to 30 minutes. These erections are often not noticed by men because they happen during deep sleep. While it is not difficult to see the semiological significance of these erections disappearing, we must consider them in a wider semiological context by considering all factors that could influence a person’s sexual life.

It’s not like I have an erection every morning.

You must stop doing self-diagnosis, self-assessing, self-treatment and continue to suffer silently and without any action. The RigiScan®, which is no longer available to you, can still be tested by placing a stamp on the penis sheath in the evening. It is usually removed by night erection. It doesn’t bring much into practice.

Erectile disorders must be evaluated in a holistic, individual manner. This includes a physical assessment of each patient and a sexological evaluation of their sexual history.

Organic erectile dysfunction versus psychological erectile disorders: simple, reductive, and out of date

This arbitrary and obsolete distinction between organic and psychological disorders must be forgotten. This distinction is outdated and ineffective. However, every consultation for erectile disorder must be free of cardio-metabolic risk factors. These can cause short- and long-term cardiovascular disorders as well as erectile dysfunction. It is important to evaluate all elements that could be causing arteriosclerosis and atherosclerosis.

Lifestyle, diet, exercise, stress levels, and lifestyle must all be assessed. It is necessary to reevaluate the quality of sleep and eliminate sleep apnea syndrome. The key ingredient of metabolic syndrome is abdominal obesity and a circumference greater than 104 cm. It is important to stop smoking. Even though tobacco is not the cause of erectile dysfunction during most consultations, it will soon be irreparable.

A clinical examination is vital, especially after age 40 or 50. It can be used to assess the presence of obesity and any hormonal deficiencies. The semiological data and clinical examination are used to guide biological examinations. Patients who wish to routinely examine their testosterone levels at ages when there is no shortage of it must be resisted.

If you don’t feel like having a morning erection, or if you have concerns about your sex, consult

Because you will need to consult professionals, I have not intentionally created a checklist. You should consult an andrologist if your family doctor does not have a good understanding of sexual evaluation.

#3 Three Tips to Improve Your Morning Erections

Did you know that nocturnal erections play an important role in maintaining length and functionality?

  • Risk factors for erectile and cardiovascular problems
  • You don’t have a morning erection anymore and your lifestyle is not perfect.
  • You’ve gained weight and have a large belly.
  • If you are obese or overweight, you may eat too much sugar, too much salt, or too much fat.
  • Sandwiches, hamburgers, and sugary sodas are all part of your daily routine.
  • Most of your time is spent behind your computer at work.
  • It’s not easy to imagine what it feels like walking.
  • Your sleep is disturbed, and you wake up tired. Your wife also blames you for your unbearable snoring.
  • You have tried so hard to quit smoking, but you’ve failed every time: neither the patches, gum, vapor nor your resolutions have helped us stop smoking.

It is essential that you continue working for 2×35 hours per week. The workload is overwhelming, Zoom meetings are increasing, more tasks to complete, useless reports to be written (that no one will read), and there is a lot of pressure from your boss. To finish the last week’s tasks, you spend time at your computer.

Your sexuality is only to Saturday nights, or once per month. (I don’t know if that’s still relevant). It’s usually done alone, mostly to escape tension or pressure and more than to share pleasure.

You have also noticed that your morning erections do not occur.

How can I improve my morning erection?

You saw your doctor in andrology if you have not seen them after a consultation. A biological assessment revealed dyslipidemia, with a decrease in the protective cholesterol, HDL, and an increase in the cholesterol at risk, LDL. It also indicated an anomaly in triglycerides and an anomaly of glycemic balance, with pre-diabetes or diabetes.

You’ve decided to take control of your health and have consulted a nutritionist, and a diabetes specialist if needed. You’ve started exercising three times per week. You are now asking yourself how you can improve or get back your morning erections.

The corpora cavernosa gymnastics and oxygenation of tissues are responsible for the nocturnal erection.

Recovering nocturnal or morning erections is an important part of the rehabilitation of erectile tissues. Erectile dysfunctions caused by atheroma and arteriosclerosis can lead to tissue destruction and ultimately to loss of erectile function. Even with tailored treatment, this means that you may not have an effective erection after a while. You must do everything possible to get your erections back.

There are three ways to improve your erections:

1. Sleep: Restorative and well-oxygenated

Sleep enough

Although I am not a specialist in sleep, I understand the importance of nocturnal and nocturnal erections for the phenomenon of tissue repair. Research shows that sleep is less restorative when there are fewer hours of sleep and that REM sleep phases can be reduced. This results in fewer periods of nocturnal tumescence. While it is true that you should get enough sleep, insisting that you have chronic sleep debt can cause you to lose your erection quality may be important. Everybody is different, and everyone has different needs. For mental balance and good erections, it is important to get enough sleep.

The bedroom needs to be aired

Good tissue oxygenation and oxygen are essential for maintaining and improving erection quality. If you have apnea East Saliha, you may be suffering from one of the following conditions: You may not see any improvement in your erections for several weeks or even months. You must ensure that your bedroom is well-oxygenated. This means you should not go to bed every night. Oxygen can be used to treat erectile dysfunction.

2) Reduce negative emotional stimulation prior to bedtime

Also, it has been proven that quality sleep is strongly dependent on the amount of emotional stimulation received at night. Too many people watch Netflix at night, scroll endlessly on their tablets, and stay up late to check out new content. All studies by cognitive psychologists and sleep researchers agree that you should stop at least an hour before bedtime.

Before you fall asleep, you must end all negative stimulation.

Your favorite TV shows are addictive every night. You also have a problem with social media. This creates an emotional stimulation that releases stress neuromediators looking for the dopamine of pleasure. This can have a negative impact on sleep quality and quality. It is better not to use your smartphone as an alarm system. It will be handy to have it on hand when you wake up each morning. If you want to make tender gestures towards your partner in the morning, the first one is toward the smartphone that « sleeps » at the top of your head. Smartphones should be kept in your living room, and they should also serve as a model for your children.

3. Sport in the morning and oxygenation in the evening

Therefore, we are from a society that is profitable. The post-industrial west society’s slogan is « Time is money. » They understand that their time is money. Many gyms stay open late into the night. We don’t have the time to do everything we need, so gyms are open until late at night. But, erection and sleep can be affected by sports that are done in the evening. It is much better to go for a walk than to scroll through Insta late at night. Take your dog on a walk in peace and quiet after dinner. You will feel better if you lower your adrenaline levels. The sympathetic tone is what lowers adrenaline’s excitement. You need to encourage a calm transition between hyperactive activity during the day and night. You can stop engaging in sports at night, and you are free to practice a little sport in the morning or a 20-minute walk before going to work.

4. Pharmacological rehabilitation

You don’t need the « natural » treatments. Instead, you can buy online treatments. The friend will make the treatment for you.

Your doctor may recommend a daily erectile therapy that acts at the molecular level in calcium channels and amplifies the cavernous vasodilator action in the event of stimulation. If this is the case, it’s best to take it at night rather than in the morning. We know that sexual intercourse is more common in the evening than in the morning. Therefore, the plasma consultation will be more effective if the treatment is given in the early evening. You will experience the same nightly erections that are restorative. It can also promote long erections that last until you wake up, which can gradually increase your self-confidence and help with improving your morning erections. Pharmacological rehabilitation by chronic treatment takes place more at night than in the morning. Unless you are able to work during the day and sleep at night, it is a different story. Talk to your doctor.

#4 There are three reasons to love them

Nighttime erections have a higher quality than those that take place during the day.

Morning erections = prolonged nocturnal penile tumescence

We should not be talking about morning erections as much as we should about nocturnal or penile tumescence.

It takes between 3 to 6 erections, with a rigidity greater than 75% and a time of 25 to 35 minutes. These erections are primarily physiological and serve to repair and maintain normal functioning. Is there any enjoyment in erections beyond their physiological purpose?

Nocturnal erection – sexual interest?

In many couples, whose routine has got the better of their eroticism and sexuality, sexual intercourse takes place from time to time, more than in the evening, except that with time, tiredness, children, household chores, the pressure of work, the stress of the previous day and even the meeting that will happen the next day, we all witness an erosion of the couple-erotic. Only the couple-roommate co-managers of the company « tidy family with children » exists. Little by little, sexuality during the week is becoming rare, sometimes even on Saturday nights.

Fatigue and lack of time (forget the headache😉), are the first two excuses for couples who consult. We must ask ourselves how the Prehistoric Hunter-Gatherers did it, who after a day of hunting returned to the cave very tired. We have also seen that these nocturnal erections are related to the implicit quality of the erection outside any psychological context. So perhaps who would have an interest in taking advantage of this.

Nocturnal erections: 3 interests to take advantage of it.

1.      Less fatigue.

If the hunter-gatherer returned tired from the hunt treatment he did not have sex immediately after arrival. Today’s exam with a modern life full of stress, filled with physical and psychological tensions is also very tiring so not very obvious to have sex before falling asleep.

We can therefore imagine that in a complicit couple we can consider sexuality during his nocturnal erections in case of waking up well in the morning. Although men are « ready » 24/24, some women would not be in the morning perhaps because they are less in the control. It is still important to reconnect with the sexuality of the couple which will ensure its complicity and sustainability.

2.      Less anxiety and psychological problems

Whatever the etiology of erectile dysfunction, there is always a psychogenic component. There is always this psychological stress that leads to anxiety and the inability to maintain an erection and therefore loss of maintenance and see where premature ejaculation. Men who have relationship problems with their partners will also be in avoidance of sex due to anxiety.  Even though their partner might encourage them, men would still experience erection and ejaculation problems.

On the side of female partners, it has been shown that during the REM sleep state there is also an increase in venous blood flow to the genitals. So most women Semi watch only resistance to the partner even if outside and are very uncomfortable with the agreement with their partner. Moreover, it has been shown that REM sleep would have had the role of promoting the attachment of sexual partners. So, men who have relationship problems, and anxiety could try to have sex during sleep or during morning erections.

3.      More « lacher-prise » (letting go)

The state of semi-awakening would promote letting go. Couples who had marital conflicts and who had chosen to sleep in separate rooms found more sexual complicity. The women who refused their husbands at other times, no longer rejected them when they came into the room while they were sleeping.

Studies on female orgasm also showed that women who had reported never having had an orgasm during daily intercourse reached a peak of sexual satisfaction when having sex while half asleep.

Many of my patients, who suffered from coital anorgasmia, i.e. the inability to have an orgasm and thus ejaculate during vaginal sex, achieved orgasm during sex while half asleep.

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#5 Three important facts about paradoxical erections

Viagra®, and other on-demand remedies for erectile dysfunction are suppressive.

1. Less Penile Erections During Paradoxical Sleep are a sign of a serious health problem

Morning erections that disappear are simply the continuation of a paranormal erection. Men should consult if the period lasts more than two, three, or even three months. For young, healthy, and athletic men, this is rare. This is rare in men who live a healthy lifestyle. Men with a history of erectile problems, such as cardiovascular risk factors or family history, should consult a doctor. A classic general examination involves a blood pressure measurement and weight-height assessment. This will eliminate excess weight or obesity. It also measures the abdominal circumference. The doctor will recommend a routine biological exam if there are any signs of hormonal deficiencies.

1) testosterone deficiency

During the REM phase, especially the time between 3 and 5 o’clock in the morning there is also a peak in testosterone. This peak in testosterone secretion is what would cause the erections associated with the REM sleep phases. Dyspnea at the onset or recurrence of morning erections is a sign that there may be a testosterone deficiency. It would be easy to diagnose and offer a treatment plan.

2) Sleep Apnea

Sleep apnea is a condition that causes pauses in sleep, which leads to a decrease in oxygenation. This can lead to non-restorative sleeping and, especially, to oxygenation changes during Penile Erections During Paradoxical Sleep. A testosterone deficit will develop over time if sleep apnea is prolonged. In cases of suspicion, it is important to perform polysomnography to diagnose the problem and set up a device.  Using a device assiduously will allow recovery of erectile function through its paradoxical erections.

3) Metabolic syndrome

A metabolic syndrome is a group of anomalies related to excess fat at the belly level. This is called visceral fat. It can lead to cardiovascular risk and intracardiac or cerebral problems. The metabolic syndrome is characterized by a high waist circumference, generally exceeding 105 cm, and an excessive amount of sugar in the blood. This can also be called hyperglycemia. A high level of triglycerides, hypertriglyceridemia (high blood pressure), and low levels of HDL (good cholesterol) are all signs of metabolic syndrome. We will discuss metabolic syndrome if there are more than three of these abnormalities. If the metabolic syndrome is not symptomatic for a prolonged period of time, it should be treated seriously as it can cause serious complications such as diabetes, heart disease, liver disease, cirrhosis, and other health problems. The metabolic syndrome can cause vascular effects of atherosclerosis and arteriopathy, which can lead to erectile dysfunction. This is evident even in paradoxical erections. Studies have shown that there is a 3 to 10-year gap between erectile dysfunction and a cardiovascular event, such as a stroke or heart attack, due to metabolic syndrome.

2. The treatment of paradoxical erection in vasculogenic dysfunction is crucial

Since March 27, 1998, sildenafil, or Viagra®, has been approved for marketing. It is the STAR drug that is well-known all around the globe, from Asia to South America to Nordic countries to Africa. Who doesn’t know Viagra®?

The miracle drug that solved erectile dysfunction has been discovered by accident. There is one drawback. It is quick and effective, lasting only one hour. It is an on-demand treatment, just like sex is always available. These on-demand treatments have become part of the routines of both doctors and patients. It is suppressive, i.e. It is not going to solve the whole problem. However, there is no cure.

Cardiovascular disease rehabilitation should be available for chronic erectile dysfunction (mainly arteriosclerosis, vascular, or atherosclerosis) today.

This is in addition to the fact that Viagra, or any other treatment on demand like sildenafil, tadalafil, or vardenafil, will only be effective for between 8 and 36 hours. There is no real restorative effect.

A man who has cardiovascular risk factors must do everything to restore his Penile Erections During Paradoxical Sleep. This would be possible after a period of time.

3. Penile Erections During Paradoxical Sleep & sexological therapy

1) Less psychogenic disorders

Erections during Paradoxical Sleep and by extension morning erections they occur outside of any psychogenic context. There is no arousal at the origin because of the genital reflexes, nor is there any psychological effect of stress or anxiety that could harm the erections. Therefore, stressed, tired men with sexual avoidance complexes would be more likely to have a better erection.

2) Resolve marital conflicts

However, partners who have experienced clitoral embarrassment are more likely than others to consent to sexual intercourse during the semi-arousal phase. If the couple is still able to be complicit but has difficulty addressing the sexual aspects of the relationship, they implicitly use their erections to create a new dynamic within the couple and relaunch communication and eroticism.

3) Orgasm disorders

Women and men with orgasm disorders, especially women, may experience an inability to have sex during penetration. Letting go, which is associated with Semi Awakening in men, can facilitate orgasm-ejaculation for them and allow women to attain two levels of major satisfaction, or even orgasm. My patients often described experiencing ejaculations at 5 a.m. during intercourse, when they couldn’t have a vaginal sexual desire.

Men can experience physiological erections in the REM phase of sleep due to physiological changes caused by testosterone release. This is provided they have quality erectile tissues. The advantage for men is the ability to have sexual relations that are more exciting, which can help them avoid marital conflict and give them more freedom. Paradoxical sleep can be beneficial for both the development of attachment strategies, including active creams, and productive ones. Its erections of paradoxical five can be very useful for any couple who are under psychological or physical stress. This can be a great opportunity for recreational and creative play.

It’s now your turn!

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