Heart rate and breathing rate are irregular during REM sleep, again similar to the waking hours. Body temperature is not well regulated during REM. Erections of the penis (Nocturnal Penile Tumescence or NPT) is an established accompaniment of REM sleep and is used diagnostically to determine if male erectile dysfunction is of organic or psychological origin. Clitoral enlargement, with accompanying vaginal blood flow and transudation (i.e. lubrication) is also present during REM