This may result in inability to get penile erections and erectile dysfunction. Sexual side effects in males may include erectile dysfunction, frequent erections, or prolonged erections. Nocturnal erections and sleeping positions can be another cause of penile injury. However, PDE5 inhibitors do not cause erections without sexual stimulation. Persistent semi-erections and intermittent states of prolonged erections have historically been sometimes called semi-priapism. After reaching puberty, erections occur much more frequently. Conversely, an injury below the S1 level impairs reflex erections but not psychogenic erections. Painful erections appear only during the sleep. It is also normal for erections to occur during sleep and upon waking. In 1944, Ohlmeyer reported 90-minute ultradian sleep cycles involving male erections lasting for 25 minutes. Spontaneous erections are also known as involuntary or unwanted erections and are normal. Medical evaluation is recommended for erections that last for longer than four hours. Jimmy faces a dilemma because he begins to experience random erections. After lengthy touring following the release of "New Erections", The Locust went on hiatus.