Have you ever watched the TV show Naked and Afraid? The premise is that a man and a woman—both physically fit and expert in wilderness survival—are dropped into a remote location to see if they can survive for 30 days. If you’ve had a chance to catch the show, you know that we’ve never once seen these attractive young contestants having sex, even though they are alone in the jungle. And did you ever wonder why this might be the case? Well, it may be because even though they are naked, they are also afraid.
Fear creates a hormonal outflow of adrenaline that works against erections. If you don’t get erections, your penis does not perfuse with oxygenated blood and stretch out. And as they say, use it or lose it.
So why were cavemen able to procreate if they, too, were naked and afraid? How did they keep their penises well perfused and in good shape? The answer, provided by Nature, is Nocturnal Penile Tumescence (NPT). NPT, also known informally as “morning wood,” occurs in men, boys, babies, and even in utero.
Three to six times a night, while in REM sleep, men get erections that last five to ten minutes. Many in the sexual medicine community believe that the purpose of nighttime erections is to provide oxygenated blood to the penis and to prevent fibrotic scar tissue from building up on the lining of the corpora cavernosa and the spongy tissue of the inside of the corpora. In a 2020 study out of India, 65% of men seeking treatment at a urology clinic had undiagnosed obstructive sleep apnea. Because the sleep apnea reduced their REM sleep and, consequently, their nighttime erections, their erectile function declined more rapidly. In other words, a healthy penis needs 30 to 60 minutes of exercise every day.
But what happens when nighttime erections start to go away?
Nighttime erections are the earliest warning sign of the decline of erectile health!
The loss of nighttime erections is the gradual beginning of the end!
The Massachusetts Male Aging Study showed that 40% of men in their 40s have some degree of erectile dysfunction. However, this loss of function does not occur overnight at age 40. Instead, it is a gradual process. The good news is that with early intervention, it is possible to slow and delay the loss of function that tends to occur gradually with aging.
- Lifestyle: First and most important, make sure that you are living a healthy lifestyle. Remember, erections are a function of blood flow, so we need to keep our heart and blood vessels in good shape. Exercise like your sex life depends on it! If you are not sweating, you are not exercising. So 40 minutes, four times a week, is the recommendation of the American Heart Association. But remember, the coronary arteries are 2-3 times the size of the penile arteries, so throw in an extra day or two for your penis!
- Good food. Ensure that you are eating healthy food low in saturated fats, with quality protein, fresh veggies, salads, and berries, to maintain your energy and ideal body weight. Keep properly hydrated. And of course, limit smoking, alcohol, and drugs, because they will wreak havoc with your sex life.
- Nitric Oxide Boosters: In my experience, nighttime erections become more inconsistent in men in their 30s and 40s. This age is an excellent time to start taking a citrulline based Nitric Oxide (NO) Booster. The great thing about nitric oxide boosters is that they are a natural way to reduce blood pressure without side effects. Elite endurance athletes take NO boosters to improve athletic performance, and seniors take NO boosters to enhance brain function by improving circulation. I formulated AFFIRM to improve circulation in my patients. Speaking personally, I take two tablets every night before I go to sleep, so I wake up with a firm erection. If I miss a night, I can tell the difference.
- Cialis (Tadalafil) 5mg: Now that PDE-5 inhibitors are available in generic form, you should not be paying more than a dollar for a 5mg tadalafil pill (generic Cialis). The benefit of tadalafil is its long half-life. Its effects peak for about 6 hours and then slowly decline over another 30 hours. When my patients in their 50s and 60s are no longer experiencing night time erections, I start them on Tadalafil 5mg in the evening, in addition to a nitric oxide booster like AFFIRM. Remember, NO boosters and PDE-5 inhibitors like tadalafil are synergistic, meaning that they work better when taken together. The added benefit of generic, daily tadalafil (Cialis) is improved erections during the day and improved urination.
- GAINSwave Shockwave Therapy: For men who still are missing morning wood, it may be time to try shockwave therapy. This non-invasive treatment stimulates the body to grow new blood vessels in the penis to improve the firmness of erections and restore your morning glory. Six to twelve 20-minute weekly treatments may be what you need to get back up. The advantage of Shockwave therapy is that the blood vessels that you grow are semi-permanent, as opposed to the effects of PDE-5 inhibitors, which are gone in a day.
- Vacuum Erection Devices: For my patients in their 70s, I recommend using a penis pump to provide penile exercise and healthy stretching. Since their body no longer stretches and oxygenates their penile tissue independently, men in this age group will benefit from using a vacuum device. Many of my patients find this pleasurable and use it to assist with erections for intercourse. Although initially awkward, once they got used to it, it became routine. I recommend five one-minute cycles, morning and night. An additional benefit is the maintenance of penile length. As men age, their erect penile size tends to shrink. However, by exercising your penis a little every day, you can get back to your regular length and sometimes even more.
So, tomorrow morning when you wake up, check to see if your flagpole is at full mast. If not, remember that it is not too late! Nourishing food, exercise, and a healthy lifestyle are the best place to start. But there are several low-risk solutions to help maintain erectile health, including Citrulline based Nitric Oxide Boosters like AFFIRM, Tadalafil 5mg in the evening, GAINSWave Shockwave Therapy, and a little daily penis stretching. And if you decide to make a guest appearance on Naked and Afraid, don’t worry about your erectile function. Just figure out how to make a fire and catch enough food to survive for the next 30 days.