The potential role of physical activity in the management of male sexual dysfunction

More than half of Australian men aged between 18-55 experience a sexual health problem that affects them for at least three months over the course of a year. Many of these men have accompanying comorbidities and/or unhealthy behaviours that likely contribute to the aetiology of their sexual dysfunction. Medications can help many patients who experience problems with their sexual function but pharmacotherapy is unsuitable or ineffective for everyone.

A recent systematic review of non-pharmacological treatments for premature ejaculation, together with a prior systematic review of physical activity for improving erectile function, prompted Wilson et al. to explore the existing evidence linking physical activity with sexual function and discuss potential mechanisms.

Male sexual function and physical activity

Observational studies show associations between increased levels of activity and reductions in prevalence of premature ejaculation and erectile dysfunction. Interventional studies show that going for a 30-minute run five days a week is as effective as dapoxetine for reducing premature ejaculation, and that pelvic floor exercises have high cure rates for premature ejaculation and erectile dysfunction.

Male sexual function, health and sleep

Physical activity reduces the prevalence and severity of physical and mental health risk factors for sexual dysfunction, including obesity, Type 2 diabetes, cardiovascular disease, depression, anxiety and stress. Wilson et al. speculate further, suggesting that physical activity might improve sleep quality, which may influence erectile function.

Dose-response relationships between physical activity and improvements in health, and sexual function, suggest that patient benefit may be achieved by those in whom only small increases in activity are possible in the first instance.

Mechanisms

There are a variety of potential mechanisms whereby physical activity can influence male sexual and reproductive function. Wilson et al. suggest physical health may benefit from:

• Reduced inflammation, atherosclerosis and hypertension
• Improved endothelial function
• Reductions in sleep apnoea and insomnia
• Improved sleep quality
• Reduced adiposity and lower leptin levels
• Increased testosterone levels and muscle mass
• Reduced neuropathy
• Improved glycaemic control
• Improved pelvic floor muscle strength

Proposed benefits to mental health include:

• Increased serotonin availability
• Increased expression of neurotrophins
• Improved regulation of the hypothalamic-pituitary-testicular axis
• Fewer and/or less severe symptoms of anxiety and depression
• Reduced distress
• Reduced inflammation
• Improved body image

Not all of these mechanisms are supported by a well-established evidence base, but evidence is accumulating in support of the proposed actions; for example, interactions between leptin and testosterone levels in obesity.

Physical activity tends to be overlooked as a method for treating male sexual dysfunction. While more needs to be learnt about how physical activity influences sexual function, and which types of activities are best suited to different patient populations, the universal health benefit of physical activity suggests this treatment option should be recommended for prevention and treatment of sexual dysfunction in men.