Not waking up with an erection? Don’t panic. While yes, this could be a sign of erectile dysfunction (ED) or low testosterone, it does not mean that you did not experience an erection during the night before. Nocturnal penile tumescence (NPT) is the scientific term that describes the phenomenon that is nocturnal erections, but many men have named this “morning wood,” because of the experience of having an erection when they first wake up [1]. Indeed, males of all ages typically have 3-5 erections per night. As people age, they may naturally notice less nocturnal erections for a variety of reasons:

Your erection could disappear by the time you wake up

In this case, you are still experiencing nightly erections, even if you don’t have one in the morning. To understand why this is happening, it is important to understand why nocturnal erections occur. While the exact reason for nocturnal erections is not fully understood, it seems that they rely heavily on rapid eye movement (REM) sleep, which is the deep-sleep when dreams often occur [2]. Similarly, some authors suggest that during REM sleep, the parts of the brain that constantly inhibit (or stop) erections from happening effectively relax, allowing an erection to occur [3]. A lack of quality REM sleep then, could explain why a nocturnal erection did not occur during a particular night.

Therefore, a nocturnal erection can be a tell-tale sign of whether erectile dysfunction is occurring, and whether it is because of psychogenic (psychological) or physiological (body-related) reasons. An NPT-test can be conducted in a sleep lab to assess whether nocturnal erections are occurring; if so, your clinician may have a better reason to rule out physiological erectile dysfunction, and suggest that your ED is psychological [1]. Caution should be taken though, as this test has its limitations, and a health-care provider can provide context to its results [4].

What if I do have erectile dysfunction?

A lack of nocturnal erections could be explained by erectile dysfunction [5]. There are many physiological reasons for erectile dysfunction, ranging from spinal cord injury to an age-related drop in testosterone and blood-flow to your penis [5]. However, medications are available, including sildenafil and tadalafil, that improve blood-flow into an erection and are the recommended first-line medical treatment to treat a variety of physiological ED [6]. These treatments are available here through scienceandhumans.com, and use has been associated with an increase in nighttime erections [7].

What if my ED is psychological?

Not to worry – while ED can be explained by a variety of physiological reasons, psychological ED is also easily treatable. Guidelines recommend that patients work with their health care providers to make a shared decision of whether sildenafil or another ED medication is appropriate for them [6]. Similarly, a sex therapist can help distinguish some of the thinking patterns that may be leading to your ED; we offer this service through scienceandhumans.com. Notably, ED medications work safely for ED related to antidepressant use [8].

If you are concerned about a sudden loss of nighttime erections, you should speak to your primary care health practitioner. You can also consult one of our medical practitioners for more information on sildenafil and other available treatments of ED. To read more on erectile dysfunction or other sexual dysfunction, visit scienceandhumans.com.