The relationship between physical fitness and sexual health is bidirectional: good sexual health is associated with higher levels of physical activity, and higher physical activity is associated with better sexual function. This circularity makes it difficult to establish pure causation, but multiple randomised controlled trials have tested exercise as an intervention for sexual dysfunction and found consistent beneficial effects. The mechanisms are multiple and well-characterised, involving vascular endothelial function, gonadal hormone levels, body composition, and psychological factors.
Erectile Function and Vascular Health
Erectile function is fundamentally a vascular phenomenon. Penile erection requires the dilation of penile arteries and relaxation of smooth muscle in the corpus cavernosum, driven by nitric oxide produced by endothelial cells. Erectile dysfunction is therefore an early marker of systemic endothelial dysfunction and is a significant predictor of cardiovascular events, preceding clinical coronary artery disease by an average of two to three years. Aerobic exercise is the most potent non-pharmacological stimulus for endothelial nitric oxide production, and a meta-analysis by Gerbild et al. of 10 randomised trials found that aerobic exercise significantly improved erectile function with an effect size comparable to phosphodiesterase-5 inhibitors in mild to moderate erectile dysfunction.
Exercise and Testosterone
Resistance training produces acute testosterone elevation that, with consistent training, translates to higher baseline testosterone in men with low-normal levels. The effect is most pronounced with compound, multi-joint exercises at moderate to high intensity and is attenuated in overtrained athletes. For women, moderate-intensity exercise is associated with higher androgen bioavailability, while chronic high-volume endurance training is associated with the opposite through effects on sex hormone binding globulin. Maintaining lean body mass through resistance training also reduces oestrogen precursor production from adipose tissue in women, which can disrupt the hormonal balance relevant to libido.
Pelvic Floor and Female Sexual Function
Pelvic floor muscle function is directly relevant to female sexual function. The bulbocavernosus and ischiocavernosus muscles, components of the pelvic floor, contract rhythmically during orgasm and contribute to clitoral blood flow and vaginal lubrication. Both excessive tension and weakness in the pelvic floor are associated with sexual dysfunction. Pelvic floor physiotherapy, including both strength training and relaxation techniques, has consistent evidence for improving arousal, lubrication, and orgasm in women with pelvic floor dysfunction.
- Aim for 150 minutes of moderate aerobic exercise per week to support endothelial function and sexual vascular health
- Include resistance training two to three times weekly for testosterone support and body composition
- Address erectile dysfunction as a cardiovascular screening opportunity: it is an early marker of systemic endothelial disease
- Women with pelvic pain, difficulty with arousal, or orgasm difficulty should be assessed by a pelvic floor physiotherapist
- Avoid chronic overtraining: it depresses testosterone and reduces sexual interest in both men and women
Sources
- Gerbild, H., et al. (2018). Physical activity to improve erectile function: a systematic review of intervention studies. Sexual Medicine, 6(2), 75-89.
- Khoo, J., et al. (2011). Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. Journal of Sexual Medicine, 8(10), 2868-2875.