Our Greatest Wealth Is Health

Andrew Siegel MD  2/29/2020  Leap year day

This entry summarizes two articles from December’s Journal of Sexual Medicine, one concerning the relationship between exercise and sexual function in men, and the other exploring the relationship between pelvic floor muscle strength and sexual function in  women who have experienced menopause.  These two articles serve as segues for a review of the means to maintain healthy sexual functioning as we age.

Image above: Pelvic floor muscles that are vital for sexual function, remarkably similar in males (left) and females (right)   Attribution: URL: https://cnx.org/contents/FPtK1zmh@8.108:b3YG6PIp@6/Axial-Muscles-of-the-Abdominal
Version 8.25 from the Textbook
OpenStax Anatomy and Physiology
Published May 18, 2016

First article: Sedentary lifestyles are risk factors for erectile dysfunction.  Resistance training, aerobic exercise, participation in sports, and staying fit can help prevent and manage sexual dysfunction.  Exercise is beneficial via numerous mechanisms, including improved cardiovascular health (erections are all about blood flow), testosterone levels that trend higher, stress management and improved self-esteem and confidence. Clinical trials have demonstrated the benefits of aerobic exercise (running, cycling, swimming, etc.) in increasing levels of nitric oxide, the key agent involved in the chemical cascade that leads to increased penile blood flow and erectile rigidity.  Aerobic workouts have also been shown to decrease inflammation and improve responsiveness to the oral erectile dysfunction medications.  Exercise is also beneficial for improving muscle strength, balance, flexibility, sleeping, cognitive function and mental health.

Summary: Your body, mind, spirit and specifically– your penis– will function better with increasing levels of physical fitness. More motivation to keep on working out!

Second article: Post-menopausal women with weaker pelvic floor muscle strength had impaired sexual function compared to women with stronger pelvic floor muscles. Pelvic floor muscle strength and the anatomical thickness of the pelvic floor muscles correlated positively with better sexual function. The pelvic floor muscles have been shown to be integral to female sexual function and keeping them fit is beneficial not only from a sexual perspective, but also as a safeguard against urinary control issues and pelvic organ prolapse.

Summary: After menopause, with the cessation of estrogen production by the ovaries, there is a tendency for declining sexual function. However, having strong, robust and fit pelvic floor muscles will help preserve optimal sexual functioning. Do your Kegels!

Note well: “What is good for the goose is good for the gander.”                             

Pelvic floor exercises are equally important for male sexual function as they are for female sexual function since they are the muscles vital for both erectile rigidity and ejaculation. By the same token, physical fitness in females (resistance, aerobic, balance and flexibility) is equally helpful in preserving and maintaining sexual function as it is for males.  

 Ten Ways To Maintain Healthy Sexual Function

1. Healthy Weight  If you are overweight, you are more likely to have fatty plaque deposits that clog up your blood vessels, including the arteries to the genitals. Poor blood flow = poor function.
2. Fuel Right Eating nutritionally wholesome and natural foods will help prevent the build-up of harmful plaque deposits within your blood vessels that compromises genital blood flow. Poor dietary choices with meals that are calorie-laden, nutritionally-empty selections (e.g., fast, processed, or refined foods) puts you on the fast track to clogged arteries that can make your sexual function as small as your belly is big.
3. Stress Control  Stress causes the release of the hormones adrenaline and cortisol. Adrenaline constricts blood vessels, which has a negative effect on sexual function.  Excessive cortisol secretion, which helps drives your appetite, causes the accumulation of the bad visceral belly fat (as opposed to subcutaneous fat under the skin).
4. Eliminate Tobacco  Tobacco narrows blood vessels, impairs blood flow, decreases oxygen supply, and promotes inflammation, compromising every organ in your body, including the genitals.
5. Alcohol Moderation  In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow) and may actually improve sexual function, but in large amounts it can be a major risk factor for sexual issues. Everything in moderation!
6. Sleep Soundly Sleep has a vitally important restorative role with an increased rate of tissue growth and synthesis and a decreased rate of tissue breakdown. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in decreased levels of leptin (appetite suppressant), increased ghrelin levels (appetite stimulant), increased cortisol, and increased glucose levels (higher amounts of sugar in the bloodstream).  Exhausted body = exhausted genitals and lack of sex drive.
7. Exercise Exercise has a positive effect on sexual function through  improved cardiovascular health, stress busting, mood improvement, fatigue reduction, increase of energy and better quality sleep.  It reduces risk for diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. Exercise improves muscular strength and tone, reduces body fat and helps with weight control. Exercise makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able at using oxygen.
8. Pelvic Floor Exercise  Exercises that work out the key muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve sexuality.  When on is sexually stimulated, the pelvic floor muscles activate and engage to help maintain penile and clitoral rigidity; these muscles also function as the “motor” of ejaculation and orgasm.  Do your Kegels!
9. Use It (or Lose It)  Keep your genitals fit by using them regularly for the purpose they was designed for—in other words, stay sexually active!  Scientific studies have clearly demonstrated that sexually active people have fewer sexual problems as they age.
10. Healthy Relationship  It takes two to tango, so relationship harmony factors strongly into good sexual functioning, just as discord and interpersonal issues can profoundly contribute to sexual issues. 

Pelvic Exercises For Men, Too (NY Times article)

Author’s book on female Kegels: The Kegel Fix: Recharging Female Pelvic, Sexual, and Urinary Health

Author’s book on male Kegels: Male Pelvic Fitness: Optimizing Sexual and Urinary Health

PelvicRx instructional video on male pelvic floor exercises

Wishing you the best of health,

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

His most recent book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).