First-line Approach to Improved Sexual Function

Andrew Siegel MD   9/5/2020

September is PROSTATE CANCER awareness month. Nearly 200,000 American men will be diagnosed this year. Overall, 1 in 9 men over the course of their lifetimes will be diagnosed. The disease prevalence is highest in African-American men: 1 in 6. Prostate cancer causes NO symptoms in its earliest stages so please consider seeing your doctor annually for a prostate exam and PSA blood test, the means of early detection. When diagnosed early, prostate cancer is eminently treatable.


A large body of evidence documents that sexual issues in both men and women may be a “canary in the coal mine,” or more aptly a “canary in one’s underwear”—an indicator that a more serious underlying medical problem may exist. Sexual function is a barometer of cardiovascular health and sexual dysfunction may represent not only a complication of cardiovascular disease, but an early sign of impending cardiovascular disease. 

Healthy sexual functioning is based upon many factors.  Key is properly functioning arterial inflow to the pelvis and genitals. Since the penile, clitoral and vaginal arteries are tiny in diameter and the coronary arteries substantially larger, it makes sense that if the tiny genital arteries are clogged with fatty plaque deposits, the larger coronary arteries may soon be affected as well, if not already. In fact, sexual dysfunction often predates coronary artery disease by 3 years or so and its presence offers an ideal opportunity to pursue a medical evaluation to screen for heart disease, blood vessel disease and other medical conditions.


Thank you, Mohamed Mahmoud Hassan


Modification of lifestyle should always be the first approach to problems that are brought on by an unhealthy lifestyle, sexual issues included. Healthy lifestyle choices not only can improve sexual function– even when it is satisfactory–but can also reverse sexual dysfunction, prevent its progression and even prevent its onset, as well as improve cardiovascular and general health.

Since sexual functioning is based upon many body components working harmoniously (central and peripheral nerves, hormones, blood vessels, smooth and skeletal muscles), the initial approach is to nurture every cell, tissue and organ in the body.

If a healthy lifestyle can be adopted and maintained, sexual function will often improve dramatically, in parallel to overall health improvements. Since many medications have side effects that negatively impact sexual function, a bonus of lifestyle improvement is the possibility of needing lower dosages or even eliminating medications (blood pressure, cholesterol, diabetic meds, etc.) that will likely result in further improving sexual function.

“The food you eat is so profoundly instrumental to your health that breakfast, lunch and dinner are in fact exercises in medical decision making.”

Thomas Campbell MD

Exercise is the most effective intervention to improve erectile function in men with recent studies highlighting the positive effects of exercise on sexual desire and function. This is primarily due to an increased expression and activity of nitric oxide synthase, strengthened endothelial function, increased testosterone levels, decreased stress and anxiety, improved body composition and consequently body image.”

— Manuel Dote-Montero et al, Journal of Sexual Medicine, May 2020

Think of inactivity as the disease rather than walking as the cure.”

— Sanjay Gupta, MD

10 Ways to Maintain Sexual Fitness

  1. Healthy Weight: Try to get down to “fighting” weight and thereafter remain lean and trim.  This will help clear up/prevent fatty deposits that clog up blood vessels, including the arterial supply to the penis and vulva/vagina.
  2. Healthy Eating: You want your body running on premium fuel.  This can be achieved with a heart-healthy and genital-healthy diet of nutritionally wholesome, natural foods that are nutrient-dense and calorie-light, while avoiding calorie-laden, nutritionally-empty, fast, processed and refined junk foods. The Mediterranean diet is an excellent means to maintain cardiac and sexual health and prevent the build-up of harmful fatty deposits that compromise genital blood flow.
  3. Minimize Stress:  Stress causes the release of adrenaline and cortisol. Adrenaline narrows blood vessels, which has a negative effect on sexual response. Excessive cortisol secretion drives appetite and causes the accumulation of the bad belly fat (as opposed to fat under the skin). There are numerous ways to stress bust, including yoga, meditation, massage, hot baths, etc.
  4. Tobacco Cessation: Tobacco contains nicotine and a cocktail of toxins that impair blood flow and decrease the supply of oxygen, as well as promote inflammation, compromising every organ in your body, including those vital for sexual function.
  5. Easy on Alcohol: In small amounts, alcohol can alleviate anxiety and act as a vasodilator (increasing blood flow), but in large amounts it can be a major risk factor for sexual dysfunction.
  6. Sleep Tight: Sleep has a critical restorative function. During this important downtime there is an increased rate of tissue growth and a decreased rate of tissue breakdown, vital for maintaining integrity of our cells and tissues. Sleep deprivation causes a disruption in endocrine, metabolic, and immune function, resulting in increased appetite, increased cortisol, and higher amounts of sugar in the bloodstream. When exhausted, your genitals will be equally weary.
  7. Exercise: Exercise has a significant effect on sexual function through stress busting, mood improvement, fatigue reduction, increase of energy, improved blood flow and better quality and quantity of sleep. It reduces risk of diabetes, heart disease, stroke, high blood pressure, some cancers, osteoporosis, chronic medical problems, and physical disability. It improves muscular strength and tone, reduces body fat and helps weight control. It makes your heart a better and stronger pump, your blood vessels more elastic, and your muscles better able to use oxygen. 40 minutes of moderate to vigorous aerobic activity, four times weekly, clearly can improve sexual function. The specific type of exercise is immaterial, the key is persistence and intensity. Jogging, cycling, swimming, brisk walking, and circuit-type resistance training are all excellent forms of exercise. Exercises that work out the muscles involved in sex—the core muscles, the external rotators of the hip, and the all-important pelvic floor muscles—will improve bedroom performance. 
  8. Pelvic Floor Exercises: The pelvic floor muscles play a vital role with all aspects of sexual function, from arousal to climax. Numerous scientific studies have documented the benefits of pelvic exercises (Kegels) to improve the strength, power and endurance of the muscles that are integral for sexual function in both genders. The pelvic floor muscles are responsible for achieving erectile rigidity and are the “motor” of ejaculation in men and for achieving clitoral rigidity and are the “motor” of sexual climax in women.  Although concealed from view and located in the nether regions, pelvic floor muscles are vitally important and deserve serious respect. Their strength can be significantly improved/enhanced when intensified by an appropriate training program.                                                                                          Female Kegel book and Male Kegel books.                                                      Male pelvic floor exercise program.
  9. Stay Sexually Active: Keep your genitals fit by using them on a regular basis for the purpose for which they were designed. In other words, stay sexually active as nature intended! Sexual activity is vital for maintaining the ability to have ongoing satisfactory sexual intercourse. Regular sexual activity increases pelvic and genital blood flow and optimizes tissue health and elasticity, while orgasms tone and strengthen the pelvic floor muscles“Disuse atrophy” is a condition that can occur when the genitals adapt to not being used, with tissue wasting, genital shrinkage and weakness of the pelvic floor muscles. Use it or lose it!
  10. Healthy Relationship: It “takes two to tango,” so relationship harmony plays strongly into healthy sexual functioning just as discord and interpersonal issues profoundly contribute to sexual dysfunction.

Note that sexual intercourse in and of itself is a great form of general exercise because of the kinetics involved and the demands on the cardiovascular system, core, pelvic floor and other skeletal muscles. Of the “10 ways to maintain sexual fitness,” staying sexually active covers 6 of them (healthy relationship, staying sexually active, pelvic floor exercises, general exercise, sleeping tight and minimizing stress).

Bottom Line: The “Golden Rule”: Treat your genitals kindly (in terms of a healthy lifestyle) and the favor will be returned; treat your genitals poorly and they will rebel.

Wishing you the best of health,

2014-04-23 20:16:29


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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.

The content of this entry is excerpted from his book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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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). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

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3 Responses to “First-line Approach to Improved Sexual Function”

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