Patient's question:
We have been married for almost two years, but we have never been able to have sex successfully. He has been trying very hard, but at the critical moment, the more anxious he gets, the worse it becomes. We have seen specialists, and the doctor suggested taking half a dose of Viagra, but it didn't help. His erections are usually normal, but as his wife, I think he might have a psychological issue. What should we do? We really want to have a child. Please advise us. Thank you very much!!Doctor's answer:
Hello: Many men cannot determine whether they suffer from erectile dysfunction, but in fact, they can judge the nature of ED based on nocturnal penile erections. Normal men of all ages can experience reflexive penile erections during sleep. During adolescence, the average is about 6 erections per night, each lasting 20-30 minutes; young adults have about 4 erections per night on average; and healthy elderly individuals over 65 can still have a total of 1-1.5 hours of erections per night. Even children often experience penile erections during sleep.Clearly, nocturnal penile reflexive erections are unrelated to sexual stimulation and are not influenced by psychological factors. Therefore, they can be used to distinguish whether ED is caused by psychological factors or by underlying diseases. If an ED patient has no nocturnal erections or if the degree of erection is below the normal range for their age group, it may indicate a disease-related cause, requiring further investigation. If an ED patient has normal nocturnal erections, it is unlikely to be caused by a disease but rather by psychological factors.
There are several methods for self-assessing nocturnal penile erections:
(1) Stamp Test: Place four around the penis, stick the overlapping sections together to form a ring, and then go to sleep. In the morning, check if the stamps are torn at the overlapping points. If they are torn, it indicates nocturnal erections. If the overlapping section comes apart due to poor adhesion, it is not meaningful.
(2) Penile Circumference Measurement: Use a commercially available tape measure (usually paper-based) with one end connected to a square buckle. Wrap it around the penis before bed, with one end extending through the buckle. First, measure the baseline circumference when the penis is flaccid. The next morning, check if there is any change in the measurement. The difference between the pre-sleep and post-wake measurements represents the increase in penile circumference due to nocturnal erections. The normal increase is 1.5-4.1 cm. If the increase is greater than 1.5 cm, the ED may be caused by psychological factors; if it is less than 1.5 cm, it may also be psychological; if it is less than 1.5 cm, it may be due to a disease-related cause.
(3) Penile Rigidity Measurement: Use a commercially available paper-based penile rigidity measurement band. Wrap it around the penis before bed and observe the three small colored bands on the band the next morning. If none of the small bands are broken, it indicates no nocturnal erections, and the ED is likely due to a disease. If only the red band is broken, it indicates an ineffective erection, and the cause of ED should still be considered as disease-related. If all three bands (red, yellow, and blue) are broken, it indicates good nocturnal erections, and the ED is likely caused by psychological factors.
In recent years, a new instrument has been developed to monitor nocturnal penile erections. It uses an elastic force-sensing ring placed around the penis for sleep, which automatically monitors and records nocturnal erections. The next day, after computer processing, it provides a graphical report. Of course, this method should be conducted under the guidance of a doctor. Clearly, self-measuring nocturnal penile erections in ED patients can be very helpful in identifying the cause of the dysfunction. Some patients with psychological ED experience a significant boost in confidence when they see that their penis can normally erect at night, and the ED may resolve on its own without treatment.