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The average man has about twelve erections during the day, and three to six more at night. These erections don't happen just because he is sexually stimulated. Many erections take place when there is no sexual stimulation at all.

Frequently erection is the body's way of keeping the blood vessels and connective tissues in the penis elastic. Erections during the day typically last a few seconds to a few minutes, and after adolescence, most men are able to time them so that they don't appear at awkward moments. Erections at night are much longer, lasting 20 to 40 minutes, three to five times a night. Known as nocturnal penile tumescence, nighttime erections may be hard or flaccid but stimulated, usually during rapid eye movement (REM) sleep, when a man is dreaming.

Reflex erections can occur when a man is threatened, angry, scared, or under stress. They can occur in response to recreational drugs, by the need to urinate, or by an enlarged prostate.

If you are having erections that interfere with sleep or that cause pain, what can you do?

  • If you are over 40, probably the first condition your doctor will want to rule out is benign prostatic hyperplasia, or enlarged prostate. Diagnosis of enlarged prostate requires digital prostatic examination, of the well-known finger exam. The prostate may feel "boggy" or enlarged to the doctor, or there could be tumors or stones. There are likely also to be problems with urine retention, anal leakage, and abdominal pain. However, the most common treatment for benign prostatic hyperplasia, finasteride (Propecia), causes problems with erection and ejaculation in about 4 percent of men who use it. "Natural" remedies like saw palmetto extract and beta-sitosterol are the answer for some men, although chances are that your doctor will object to them.
  • Males of any age can develop a tumor of the ventricles (open spaces) of the brain or the open space in the spinal column called an ependymoma that can stimulate the central nervous system so that he deals with priapism (an erection that won't go down) or painful erections in the middle of the night. Problems with erectile function are most likely when the ependymoma is in the spine rather than in the brain. Treating the tumor is necessary for treating painful nighttime erections. Doctors may offer amitriptyline (Elavil) for erections when surgery is not indicated. Baclofen, the muscle relaxant, usually doesn't help if a spinal tumor is the cause of the problem.
  • Peyronie disease, which is due to the accumulation of fibrous tissue bending the penis, causes painful erections both day and night. However, this pain usually resolves without medical intervention.
  • Sickle cell disease can cause painful nighttime erections even in boys who have not reached puberty.
  • Treatments for Parkinson's disease, including bromocriptine (Parlodel), selegiline (Mirapex), and L-dopa (Artane), can cause abnormally prolonged erections both at night and during the day. 
  • Iron-overload diseases in men, including hereditary hemochromatosis and transfusion-related iron overload in beta-thalassemia, can change brain chemistry so that he has more erections during the day and painful erections at night.
  • Cocaine, ginkgo (the herb) taken on the same day as medications for schizophrenia or dementia, SSRI antidepressants (Lexapro, Prozac, and Paxil, in particular), warfarin, heparin, certain blood pressure drugs (especially hydralazine and calcium channel blockers), testosterone, and androstenedione can all induce painful nighttime erections. 

Treating an underlying medical condition, or changing the medication for an unrelated medical condition, is often required for getting over painful nighttime erections. However, in the meantime, it helps to:

  • Strictly avoid the use of any kind of erection enhancer, whether it's a prescription drug like Cialis or a popular herb like horny goat weed.
  • Avoid using supplemental hormones unless you have discussed them with your doctor who is aware of your problem erections.
  • Sleep in bedclothes that allow movement of the penis without constraint, or nude.
  • Avoid any kind of injection into the penis so as to avoid the formation of scar tissue that keeps it stiff.
  • Drink unsweetened cranberry juice (4 ounces/ 100 ml is enough) several times a week to help prevent urinary tract infections, which can make any of these problems much worse.
  • Sleep on a slant, with your head elevated. This sends blood to your feet rather than to your penis.
  • Lose belly fat, which interferes with circulation away from your penis.
  • Do Kegel exercises (the simplest of which is simply stopping the flow of urine for 10 or 15 seconds several times when you go to the toilet) to strengthen the muscles around your penis and avoid muscle cramping that can add to your penile pain.

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