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Does The Presence Of Normal Erections Upon Waking Mean That There Is Not A Physiological Issue?

Posted on Thu, 24 Sep 2020

Question: This question is about E.D. I have morning erections that are routine and 'full'. But generally unable to be erect otherwise. I would be considered pre-diabetic with a well-managed A1C of 5.7 and morning glucose levels of 95-120. I have well-managed hypertension with Losartan. The E.D. has progressed for over 10 years. 10mg Cialis has an effect, but not one that is as good as my typical morning erections (upon waking). I am 6' tall and weight 220. I am otherwise generally healthy.
The question is this: Does the presence of normal erections upon waking mean that there is NOT a physiological issue, and most likely psychological? Or can there be physiological issues remaining despite morning erections?

Answered by Dr. Ornela Ademovi (2 hours later)

Brief Answer:
No physiological causes

Detailed Answer:
Hello,

I understand your concern. The morning erection means the trouble with having and maintaining an erection at other times are not related to a physiological problem. While stress, depression, anxiety or awkward social situations can be possible reasons, given your BMI of 29.8, I am more inclined to think that overweight is the culprit here.

So weight loss, an increase in physical activity, a healthier diet and an overall healthier lifestyle could very well be the solution to this problem. Increasing one’s stamina through a lifestyle change has in most cases greatly improved the sexual activity.

I recommend you work with a dietitian to devise a diet plan that works best for you.

I hope this helps. Please feel free to ask further questions.

Take care

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ornela Ademovi (4 hours later)

Of course that advice is sound regardless, if only to address hypertension and diabetic concerns. I did stop martial arts training and soccer refereeing not long before the onset of this, supporting your conclusion. But my late wife died of cancer in that same time frame...creating a possible psych confound...not mutually exclusive to be sure. I have weighed as low a 200 with no improvement. With that, the follow-up question is: Have you seen personally, and/ or is their clinical evidence that achieving a target BMI (which for me would represent a 35-40 pound weight loss) and having reasonable nutrition and exercise regimens successfully 'manages' this issue? I am not questioning your advice at all. I am wondering how strong the link is between exercise/weight/nutrition and ED. My testosterone tested low/medium-normal. I am on a self-managed keto diet which has profoundly lowered my morning sugar and A1C, but had no effect on the original issue.

Answered by Dr. Ornela Ademovi (2 days later)

Brief Answer:
A strong link between weight loss and better mental health

Detailed Answer:

Yes, I have had patients who, after losing weight and getting fitter, have also experienced markedly decreased stress and anxiety levels, or have felt considerably less depressed as a result of a healthier lifestyle, which has resulted in improvement of their sexual lives as well.

So, I am not saying that losing weight will directly resolve your ED, but getting fitter through weight loss, increased physical activity, and a healthy diet will result in better mental health, which in turn, may also improve your sexual health.

I hope this helps.

Wishing you good health and all the best.

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Above answer was peer-reviewed by : Dr. Vaishalee Punj