Dear Dr. Eva,

Guys sometimes wake up with an erection. Is there really a difference between this and an erection caused by sexual arousal?

Mike

Dear Mike,

There is no physical difference. Men have erections periodically through the night as part of the normal sleep cycle, and these are not necessarily associated with sexual dreams. Because of these normal sleep erections, men often wake up with erections whether they need to urinate or not. Erections go down with urination because it is near-impossible to urinate when fully erect. Men can sometimes urinate with a partial erection but they often need to use a lot of pressure to get the urine out. So people think it is the urine or urge to urinate that causes an erection, but it really isn't.

Dr. Eva

Dear Dr. Eva,

I recently turned 50. My erections aren’t as hard as they used to be (still hard enough to have sex) and I notice that the fluid that comes out is more clear, when it used to be more white. Is there something wrong with me?

Worried

Dear Worried,

There is not necessarily anything wrong with you. This is worth a discussion with your health care professional, because there are so many things that can cause decreased erections. They include:

• vascular problems: lack of blood flow to the penis, caused by cholesterol blocking the arteries
• smoking tobacco, which causes narrowing of the arteries in all parts of the body, including the penis. This lasts for 90 minutes after each cigarette smoked!
• nerve problems: erections require good function of the nerves to the penis, which can be damaged by diabetes or viral illnesses such as HIV and chronic hepatitis alcohol use, which affects both libido (sex drive) and physical function
• drug use, especially methamphetamines, but also cocaine and opioids like heroin and Percocet
• many prescription medications, especially two categories of blood pressure medications: beta blockers and thiazide diuretics emotional problems, including anxiety, depression and stress
• lack of sleep
• performance anxiety: If you are concerned that you will not have a firm erection, that worry can become a self-fulfilling prophecy, leading to more problems with erections, leading to more worry, in a vicious cycle
• aging: there is ongoing decrease in the firmness of erections as med grow older. This is a progressive change, gradually increasing with age – not something that happens suddenly when you turn 50.
• low testosterone: low testosterone affects sexual drive or interest more than it directly affects erections, but the lowered interest translates to less stimulation, which causes decreased erections.

Now, about the clearer ejaculate (cum): sperm contribute to the whitish color of ejaculate, so it is possible you are producing less sperm. This is not related to the quality of erections. Men who have had vasectomies have no sperm in the ejaculate, but they have no change in their erections. Unless you are wanting to have a child, this is not something to be concerned about.

Dr. Eva

Dear Dr. Eva,

I have (always) had a ring of little bumps around the base of the head of my penis, like a tiny ruffle. My previous partner thought it was cute and accepted it as part of me. My new partner thinks I have warts and is insisting we use condoms. What do you think? Decorated

Dear Decorated,

You are the proud possessor of pearly penile papules. (See, even the name is cute!) This is a normal variation in the shape of the glans (head of the penis). It is not a form of warts. However, there are so many good reasons to use condoms that I suggest you go ahead and use them, even after you explain to your partner that PPP’s are not warts. Good reasons to use condoms: HIV, syphilis, herpes, warts, Chlamydia, gonorrhea, and more!

Dr. Eva