Keep Waking Up with an Erection? Understanding Nocturnal Penile Tumescence
Many men notice that they sometimes wake up with an erection. While it can feel surprising or confusing, this is completely normal. These erections are known as nocturnal penile tumescence (NPT), and they occur naturally during sleep from puberty onwards.
What is Nocturnal Penile Tumescence?
Nocturnal erections are involuntary. They are mediated by the spinal cord and autonomic nervous system, meaning your brain isn’t consciously controlling them. NPT occurs during REM sleep, the stage of sleep associated with vivid dreams, but it does not depend on sexual dreams.
During REM sleep, the body naturally:
Increases blood flow to the pelvic area
Releases testosterone
This combination triggers erections, helping to flush the erectile tissue with oxygenated blood - maintaining penile tissue health.
NPT is a completely normal physiological process and is considered an important indicator of sexual and reproductive health.
Why NPT Matters for Erectile Health
For men experiencing erectile difficulties, knowing whether NPT is occurring can provide key insights for clinicians:
If NPT continues: the physiological mechanisms for erections are generally intact, and difficulties may be more psychological, relational or situational.
If NPT has stopped: this is more suggestive of a physiological cause, such as a vascular, hormonal or neurological issue - and further medical evaluation is strongly recommended.
Understanding this distinction is essential for identifying whether psychosexual therapy or medical intervention is the most appropriate way to address the issue. New onset erectile dysfunction should always be medically assessed.
How a Clinical Consult Can Help
My Clinical Consult provides a structured, professional way to assess and understand erectile or sexual health concerns. The process typically includes:
Pre-assessment via Quenza
Clients complete a structured bundle of assessments before the session.
This helps me to start creating a comprehensive formulation of the issue before we meet - so that our time together is as efficient as possible.
The Clinical Consult
This time is spent filling in any gaps from the pre-assessment and discussing your goals for the process. Partners are encouraged to join where relevant, allowing further additional assessment of any relational impact to be fed into the clinical plan.
Together we’ll decide on next steps, which may include:
Proceeding to regular, ongoing therapy or arranging short-term work together
A one-off “Deep Dive” session
Referral to another private practice professional, such as a pelvic floor physiotherapist
Guidance on self-management strategies
Post-consult resources
Clients gain access to tailored exercises and psychoeducational materials via Quenza, which can be downloaded and kept even if we decide not to proceed with therapy sessions.
Clinical documentation
A summary of your completed assessments and clinical indications - mapped to ICD/DSM criteria - can also be provided where relevant. This can be shared with a GP or other healthcare professional.
My recommendations for next steps or referrals are always included where appropriate.
Key Takeaways
Spontaneous erections during sleep are normal and healthy.
NPT indicates that the body’s physiological mechanisms for erections are functioning properly.
A Clinical Consult can help clarify the cause of erectile difficulties, whether physiological, psychological, or relational, and guide you on appropriate next steps.
Understanding your sexual health is an important step toward sexual confidence and wellbeing. If you have questions about erections, sexual function, or relationship concerns, a Clinical Consult is a safe and structured way to explore these issues with professional guidance.