Physical fitness boosts libido

Several studies have shown that sex is an essential part of human existence and plays a vital role in sustaining and improving quality of life. Sexual health impacts both emotional and physical health, and a satisfying sex life can play a crucial role in intimate relationships.

According to a study published in the Journal of Education and Health Promotion and titled “An investigation of the relationship between physical fitness, self-concept, and sexual functioning,” obesity and inactivity have led to an increasing number of individuals with sexual dysfunctions (43 per cent of women; 31 per cent of men).

The researchers found that small bouts of exercise can drastically improve sexual functioning. The study was designed to examine the effects of physical fitness and self-concept on sexual functioning.

The results indicated that sexual behaviour/experience was predicted by body fat percentage. In men, fantasy was related to total self-concept; sexual behaviour/experience was related to likeability. In women, arousal was predicted by cardiovascular endurance. Total self-concept was related to both orgasm and sex drive/desire. Power and muscular strength were significantly related to number of sexual partners in women but not men.

The researchers concluded: “The present study adds to the growing body of evidence indicating a positive relationship between physical fitness and sexual health. Individuals with sexual dysfunctions, particularly women, who are not persuaded by the currently publicised benefits of physical activity, may be inclined to exercise to improve sexual functioning.”

Another study titled “Enhanced sexual behavior in exercising men” and published in the journal Archives of Sexual Behaviour examined the effects of nine months of aerobic exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality in 78 sedentary but healthy men (mean age, 48 years).

The men exercised in supervised groups 60 minutes per day, 3.5 days per week on average. Peak sustained exercise intensity was targeted at 75–80 per cent of maximum aerobic working capacity. A control group of 17 men (mean age, 44 years) participated in organised walking at a moderate pace 60 min per day, 4.1 days per week on average. Each subject maintained a daily diary of exercise, diet, smoking, and sexuality during the first and last months of the programme. Beneficial effects of chronic, vigorous exercise on fitness and coronary heart disease risk factors were obtained in close agreement with prior studies.

Analysis of diary entries revealed significantly greater sexuality enhancements in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness.

Yet another study published in the journal Reproductive Biology and Endocrinology and titled “Lifestyles and sexuality in men and women: the gender perspective in sexual medicine” reviewed researches concerning healthy and unhealthy lifestyles and their contribution to in the development of sexual quality of life in a gender-dependent manner.

According to the study, among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. It showed tobacco smoking, alcohol – substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.

In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapist.

The modifiable risk factors for male and female sexual dysfunctions are: smoking, physical inactivity, obesity and excessive alcohol and drug consumption. Healthy lifestyle changes could be a useful strategy for decreasing the risk of erectile dysfunction (ED) and the other sexual dysfunctions.

Physical activity is one of the healthiest activities and most of all reduces the risk of chronic diseases (such as diabetes or hypertension) or sexuality. In addition, some studies have shown that an active lifestyle greatly reduces the chance of having an altered blood glucose control or to improve it if already present.

In subjects with sexual dysfunction and suffering from diabetes or severe obesity, physical activity is a very important protective factor: constant physical activity has been a protective effect against ED in men with diabetes as well in women with sexual dysfunction.

From a meta-analysis it has been shown that intense and moderate physical activity is associated with a lower risk of developing ED because it increases endothelial NO production and decreases oxidative stress. In addition, exercise has proven beneficial effects on self-esteem and mental health, with a positive impact on psychological problems associated with sexual dysfunction.

In hypertensive patients with ED, eight-week physical exercise duration of 45 to 60 min per day improved erectile function compared to controls remaining sedentary during the same period. These data were confirmed by a recent study evaluating the effect of an aerobic physical activity protocol (about 150 minutes per week) on the quality of erectile function in middle-aged patients with ED on a vascular basis. After three months, patients in the intervention group showed a significant increase in the abridged International Index of Erectile Function (IIEF-5) score associated with a reduction in pro-apoptotic endothelial cells compared to controls.

In another study, 60 patients with ED were randomised to receive a type 5 phosphodiesterase inhibitor (PDE5i) alone or in association with regular aerobic activity (about three hour a week). After three months in the intergroup there was an improvement in the total score of the IIEF of 77.8 per cent compared to 39.3 per cent of the control suggesting that lifestyle changes can significantly increase the benefits of pharmacological therapy for ED.

Similar results were founded in subjects with Premature Ejaculation (PE). In a recent study, it has been demonstrated that PE symptoms tended to increase with decreasing frequency of physical activity. Being the ejaculatory mechanism itself unrelated to the lifestyle, the unique logical explanation of this effect could be the very frequent comorbidity between ejaculatory and ED, where one exacerbates the other. Moreover, physical exercises improve self-esteem and body image, which are negatively influenced in subjects with PE.

In women, physical exercise can improve many typical symptoms of menopause, particularly mood, sleep, anxiety, depression and musculoskeletal problems.

Together with these, postmenopausal women who do regular physical activity maintain a good quality of sexual life.

In a longitudinal study, menopausal women have a better body image when they exercise a constant physical activity, improving their self-esteem, emotion expression, and maintaining an adequate Body Mass Index (BMI).

Also, weight loss, whether through lifestyle changes or through bariatric surgery, is associated with an improvement of many biological, psychological and sexual factors.

Khoo et al. compared the effects of two-month low calorie diet on insulin sensitivity, plasma testosterone levels, erectile function and sexual desire in obese and diabetic men compared to non-diabetic men but with similar BMI and waist circumference. 10 per cent weight loss was significantly associated with increased insulin sensitivity, plasma testosterone levels, erectile function and desire in diabetics as well as non-diabetic patients. Similar results were obtained with weight loss induced by bariatric surgery as demonstrated by the increase in the quality of erectile function measured with IIEF-5 and the increase in total testosterone levels.

The Mediterranean Diet, that includes a high consumption of legumes, vegetables and fruits, and the limited consumption of red meat, dairy products, high-added foods and beverages is associated with a reduction in the risk of ED and other related sexual complaints in both diabetic and non-diabetic patients.

Sixty-five men with metabolic syndrome and ED have been studied; 35 of these were assigned to the diet of intervention according to the Mediterranean diet model and 30 to another diet model. Subjects in the intervention group were invited to consume at least 250–300 g (g) of fruit, 125–150 g of vegetables, and 25–50 g of nuts per day. In addition, they were encouraged to consume 400 g of whole grain a day (legumes, rice, corn and wheat) and increase the consumption of olive oil.

After two years, men from the Mediterranean diet group had an increased IIEF score compared to men in the control group.

The beneficial effect of the Mediterranean diet on atherosclerosis in general and in particular on ED is mediated by multiple biological pathways, including a reduction in oxidative stress, subclinical inflammation and improved insulin sensitivity, which in turn may increase the release of NO into penile arteries.

Diabetic women who better complied to the Mediterranean diet have reported a lower BMI, a waist circumference and a waist-to-hip ratio, lower levels of depression, obesity and metabolic syndrome, a higher level of physical activity, and better profiles of glucose and lipids compared to women who did not constantly diet. In addition, adherence to the Mediterranean diet has also improved the frequency of sexual intercourse and significantly reduced the prevalence of sexual dysfunction.

The researchers concluded: “Sexual health, a crucial and pivotal part of overall health, is a complex interplay of cultural, social, relational, intrapsychic, and biomedical aspects. In presence of several unhealthy lifestyles, often-sexual dysfunction occurs, which mostly represent the precursor of an underlying physical or mental health condition.

“The analysis of the literature about the impact of healthy and unhealthy lifestyles on sexuality reported differences in men and women but also similar effects. For example, alcohol abuse seems to produce different negative effects in men and women: reduction of erectile function in the first case, paradox loss of libido and unsatisfactory orgasms in the second one; inversely, physical activity increase sexual function and prevent sexual dysfunctions in both middle age men and women. A better comprehension of these gender differences should be more deeply studied in future researches.

“Independently from the organic or non-organic cause of sexual dysfunction, it is important to note that the promotion of correct lifestyles represent the first-line therapeutic option for both sexual physicians and psychosexologists. Changes in lifestyle like alcohol, smoking, and illegal drug cessation, control of diabetes / dyslipidemia, (re) starting physical activity, weight loss and reduction in stress are of prime importance.

“Finally, in evaluating and treating subjects with sexual dysfunctions, it is important to take care of patients on a systems (previously called biopsychosocial) perspective and recognize that both physical factors (obesity, smoking, alcohol and substance abuse) and psychosocial factors (stress, anxiety, depression, income, culture, experiences, and personality) can not only derive from the sexual dysfunction but they also may contribute to and amplify it. On the other hand, combining efficacious pharmacotherapies with successful additional modalities (such as sexual counselling, sexual education or psychotherapy) to reduce sexual symptoms, is to be regarded as a unique and strong tool in order to motivate the needed, but difficult and hard to perform lifestyle modifications requested to the patient.”