Morning Erections and Mental Health

Remember waking up with an erection? Perhaps some of you still do. As a pelvic floor physical therapist, I am intrigued by the workings of the human penis. Why do men have morning erections, I used to wonder? Is it because they are having erotic dreams, or that they have full bladders at first light?

How erections work

The truth is that morning and nocturnal erections have little to do with whether or not a man is dreaming of orgies or his need to pee. Let’s delve deeper.

When humans are faced with prolonged periods of anxiety and stress, the quality of their erections can suffer, because the nervous system is dedicating all of its efforts to keep the human safe from harm.¹

When a human is in deep sleep, their parasympathetic, or calming, nervous system takes over. The nerves in the sacral plexus (the very end of the low back, near the tailbone) begin to fire during sleep. This results in engorgement of the penile tissues with blood. The average man who sleeps well has between 3 and 5 nocturnal erections, each lasting about 30 minutes in duration. The morning erection is considered the last of them.²

A loss of morning erections

Of the patients I have treated for penile and testicular pain, urinary hesitancy, and leakage or prostate cancer, many of them report a loss of morning erections. What does this tell us?

Well, we know that the fight-or-flight mode that most of us exist within is not ideal for good erections. We need to be calm to have good sex. If we are living under lots of stress, not getting deep rest, or never allowing our parasympathetic nervous system to have its voice, we are setting the system up for erectile dysfunction.

Having a cancer diagnosis is an inherently stressful life circumstance. The anxiety that is experienced by those with such a diagnosis will often manifest in a plunge in sexual ability, simply because the calming waves of the parasympathetic system are not sending the message to the penis to fill with blood. Sleeplessness, panic attacks, depression, and anxiety all prevent good erectile function.

Treatment side effects

Now let’s add to an already overwrought nervous system the side effects of many prostate cancer treatments: urinary leakage and erectile dysfunction. Having foreknowledge of anything in life is good. It lends a sense of control to our lives. But knowing that we might potentially have a side effect that impacts our sexuality can be awful. This plays a major role in the anxiety and depression of those with prostate cancer.

The next question is what to do with these emotions. By ignoring them, we’ll be entrenched with anger regarding our own bodies; yes, we will be angry and our nervous systems will remain in overdrive. We might be able to hide our emotions from friends, spouses, and coworkers, but the nervous system will keep on doing its thing until we take control and tell it to calm down. Like an unruly teenager, it needs to be told to shut up. How can we do that?

What can we do?

Regular exercise not only increases blood flow to all parts of the body, but it releases feel-good chemicals to calm the brain and mollify stress and worry. Exercise can also lead to better sleep. And quality sleep is what stimulates the parasympathetic system to fill the penis with blood.

It may help to find ways of shutting down errant thoughts before bedtime. As crazy as it sounds, writing down thoughts can allow them to be seen in black and white, to question their authenticity. Alternatively, voice recordings on a smart phone can release pent-up anxiety.

Another option

Then there is the question of psychotherapy. Some people love it and get a lot out of it. Others don’t and find a way to navigate through their troubles via meditation, positive self-talk, and doing things they enjoy. Many of my patients with prostate cancer are very honest with me about their perceived loss of virility. I often ask them if they have spoken of their anguish with their significant others.

The men who have someone with whom they can be completely vulnerable and share their fears with are the ones who I find fare best in tackling anxiety and depression associated with prostate cancer. That appears to me to be the number-one indicator of navigating the high seas of this diagnosis. Find someone to talk to. Even if those morning erections never return, people who feel heard can face the impossible. And they can get more easeful sleep as well.