Exercise, Erectile Dysfunction and Sex Drive
Is exercise important in order to have a healthy libido? And can it help cure erectile dysfunction? If so, what are the ways in which exercise does this? I will answer these questions in this section, and I will also tell you how periods of no exercise impacted my sex drive and how it contributed to erectile dysfunction.
Exercise Can Boost Libido And Cure Erectile Dysfunction
We all know that exercise is something we should do often. It’s good for our hearts and our brains, it lowers the risk of many ailments, it makes us generally feel better, etc. But what most people might not know, is that exercise may have a very positive impact on our sex-lives. It may actually significantly improve a man’s libido and his ability to perform sexually. In fact, there are few things that are better for a healthy sex life and proper erectile functioning than exercise. And lack of exercise is often the number one cause of a low libido and erectile dysfunction.
In order for a man to get an erection, his penis needs to be filled with blood. Therefore, proper bloodflow in the body is essential. Anything that impedes blood flowing through the body is likely to have a negative effect on the ability to get and maintain an erection. Exercise maintains but also improves this crucial bloodflow.
The body is an extremely sophisticated and complex system, and as soon as it is given sub-optimal care, or it finds itself in a sub-optimal condition, certain functions will normally stop working properly. And the functions that stop working initially are normally the functions that are not essential for survival. That is because survival is always an organism’s number one priority.
Often, the functions that stop working are the non-essential-for-survival functions like the immune system and reproductive functions. What I have learned, is that when my body is out of balance, two of the first issues I normally experience are: 1) very little interest in sex, and 2) big problems with getting erections.
Throughout my life, I have almost always played sports and been active. As a kid and young adult, I would play team-sports, bike everywhere and generally live an active life. As an adult, I normally go to the gym 3-4 times a week, do at least one running session a week, and I do a few other sports such as tennis, football or group interval training. Overall, I probably get about 5-7 workouts a week.
However, there have also been periods of my life where I have not been able to exercise, either due to physical injuries or due to working too long days at my job. During these non-exercise times (that lasted for a significant periods of time), I have not only gotten out of shape, but I have also experienced both weaker sex drive and a reduced ability to obtain and maintain erections.
After graduating from university, I took a finance job in New York City. I ended up working insane hours, often sitting at the desk past midnight, and normally working weekends and holidays as well. I was sitting on my butt in front of a monitor crunching numbers and putting together presentations for senior people all day long. And I hardly had any time at all to exercise. If I were lucky I would get one session a week – normally a football (soccer) pickup game. This new sedentary lifestyle was probably a shock to my body, because my body was used to exercise almost every day.
My first encounter with erectile dysfunction happened some time after I had started working (and basically stopped exercising). I was with a girl but I was unable to perform – despite herculean efforts from the girl, I just couldn’t get it up. It happened once and then twice, and then again. And then it seemed it was just not working permanently. She got hurt and upset. I was shocked and lost. What on earth was going on!? Why didn’t my body work the way it used to?
After this incident, there have also been other periods of my life where I have been unable to exercise for long periods, and I have had similar experiences. For instance, I had a serious bodily injury that kept me sidelined and off exercise for several months. I couldn’t run and couldn’t lift weights, and basically just had to rest and be patient. I lost several kilos of muscle mass and got severely out of shape. After some time, I stopped thinking about sex. It didn’t interest me much anymore. And I also stopped any masturbation and any sexual activity. I just didn’t want it.
However, I need to say that it is impossible for me to say with certainty that it was indeed a lack of exercise that caused these problems. During the time when I worked a lot, I also didn’t sleep much, I didn’t eat particularly healthy and my stress levels were high. For this period, it may have been a combination of more than one factor. But I do believe that the lack of exercise contributed to my severe struggles with erectile dysfunction as well as a general dis-interest in sex.
There are several reasons why exercise is beneficial for sexual health and for a person to be able to perform sexually at a peak level. The most important of these benefits are explored in this section. However, the red thread that goes through all of the points is improved bloodflow. Good bloodflow is essential for en erection to form and for a body to function well sexually. Bad bloodflow is likely to cause erectile dysfunction and a weak libido.
- Strengthens the cardiovascular system
- Increases the blood vessels ability to produce nitric oxide
- Rebuilds small veins and capillaries
- Increases testosterone levels
- Enables the body to burn excess glucose and fructose
- Causes cholesterol levels to decrease
- Reduces the extent of atherosclerosis
- Reduces high blood pressure (hypertension)
- Reduces triglycerides levels
When a person exercises, the heart and lungs work extra hard to supply blood containing nutrients and oxygen to the muscles, organs and tissues. They do this because the muscles, organs and tissues need more oxygen and nutrients for the increased level of effort. As this happens, the heart, the muscles, the blood vessels, the red blood cells, etc., all grow in size or number as these adjust to a life of increased output and intensity.
The result is that the cardiovascular system is strengthened, improved and trained to handle increased levels of blood flowing through the body. This also improves the ability of muscles to utilize oxygen and nutrients, cleans up dirt and waste from the arteries and overall ensures that the heart, lungs and other vital organs are maintained.
The interior surface of the arteries are lined with special cells called endothelial cells, and the lining of these cells is collectively called the endothelium. Endothelial cells act as selective filters that regulate which gases, fluids and other molecules can enter and exit the blood vessels.
Another very important function of the endothelial cells is their ability to produce a gas called nitric oxide. When the blood vessels need to expand in order to transport more blood, the endothelial cells produce nitric oxide which dilates the blood vessels. When nitric oxide is created and released into the smooth muscles surrounding the blood vessels, these muscles relax and hence the blood vessels have space to expand. The same mechanism takes place in the penis.
When the penis is in a flaccid state, the smooth muscles in the penis are in a state of contraction, or in other words, they clench around the blood vessels and therefore squeeze blood out of the penis. When nitric oxide is released into these smooth muscles, they start to relax and hence give up the tight grip around the blood vessels. Blood is then allowed to flow into the penis and an erection can form. Not only is more nitric oxide produced when a person performs some form of physical exercise, but exercise also improves overall endothelium function. Exercise ensures that the endothelial cells are being pushed and tested, and in doing so, enables them to take on a greater workload. More nitric oxide = more bloodflow = better erections. To learn more about nitric oxide on Truelibido, please go here.
When a person exercises and pushes his body, say training hard to improve the time on a 10 kilometer run, the body will start expanding, rebuilding and creating new veins and capillaries throughout the body. This is referred to as angiogenesis. The body does this in response to a need for more blood to be transported throughout the body for the increased level of physical effort. The result is an improved and even more complex system of highways, roads and side streets of blood vessels through which the body can transport oxygen, nutrients, waste and other components.
Exercise, and particularly high intensity exercise, or anaerobic exercise, will normally lead to a transient spike in testosterone levels lasting up to about an hour after completing the exercise. However this transient increase is of little use or importance when it comes to libido or erectile functioning.
The effect from exercise that is of importance however, is the long-term impact. Long-term, steady and patient, anaerobic exercise will typically increase baseline testosterone levels. In other words, consistent and long-term high-intensity exercise such as weightlifting, sprinting, or interval training will normally increase overall testosterone levels in the body.
In addition, exercise helps to increase muscle mass and decrease body fat. The more overweight a person is, the more aromatase activity that person will have. Aromatase is an enzyme that converts testosterone into estrogen. And the more estrogen a man produces, the more the testosterone / estrogen ratio get tilted out of balance, and the less dominant position testosterone gets. This will normally mean that libido gets weaker and the prevalence of erectile dysfunction increases. By the way, aromatase activity is particularly relevant for abdominal fat.
As a person exercises more and becomes fitter, his testosterone levels will normally increase, he will normally experience a stronger libido and also stronger and more consistent erections. To learn more about testosterone on Truelibido, please go here.
When a person eats, the body breaks this food down into various molecules that can be absorbed by the intestines. One important part of our food are the carbohydrates. And one of the molecules the body breaks down from carbohydrates is called glucose. Glucose is a main energy source for the body, and it is typically released directly into the bloodstream after a meal.
However glucose can’t enter the cells as fuel without the help of a hormone called insulin. Insulin is needed by the cells in order to absorb glucose. When the level of glucose in the blood rises after a meal, the pancreas is instructed to manufacture insulin so that the glucose can be used as energy by the cells.
Any glucose floating around in the bloodstream that is not used as energy by the cells, is normally converted to glycogen by insulin and stored in the liver and muscles for later use. If a person consumes too much glucose, or if the insulin is not able to quickly enough convert the glucose to glycogen, the person will have elevated levels of glucose in the blood, a condition called hyperglycemia. A person with hyperglycemia is at risk of developing atherosclerosis.
Atherosclerosis is a condition where cholesterol, triglycerides, white blood cells, calcium and other substances build up and form a layer of plaque inside the artery walls. This build-up of plaque then narrows the arteries. In response to this, the arteries initially expand to ensure that the blood is allowed to travel through the arteries as before. The plaque also makes the arteries stiffer. This makes the arteries less responsive to a need for increased bloodflow, and also makes the arteries more prone to cracks and damage.
When a portion of plaque is ripped up and taken away by the bloodstream, this may cause clogging of an artery somewhere else. In addition, when plaque is ripped up, the blood vessel may rapture. A raptured blood vessel may have difficulty expanding and working properly. And when atherosclerosis gets severe enough, the blood vessels can’t expand anymore to counter the plaque build-up, and bloodflow is diminished.
Hyperglycemia can cause or accelerate atherosclerosis in several ways, but perhaps the most common is through inflammation of the blood vessels. When the blood vessels are inflamed, cholesterol, triglycerides, white blood cells, calcium and other substances more easily attach to the inner walls of the blood vessels because these walls get sticky and uneven, and the build-up of plaque (atherosclerosis) starts or is accelerated. This way, hyperglycemia can also potentially cause endothelial dysfunction and reduced production of the gas nitric oxide.
Exercise increases the need for energy, and therefore also the need for glucose. Hence, exercise causes the body to burn glucose, and as a result, glucose levels will decrease. This will often reverse hyperglycemia and therefore also hyperglycemia-induced atherosclerosis. Put differently, exercise can restore the glucose balance in the body.
Insulin resistance is a condition in which cells fail to respond to the normal actions of the hormone insulin. Excess glucose levels in the blood can cause insulin resistance, as the cells and insulin become overloaded with glucose and become desensitized to it. Exercise can restore this balance in two ways.
Firstly, exercise makes the body use larger quantities of glucose as energy, simply because the body needs more energy to do the exercise. This reduces the quantities of glucose in the blood. Secondly, exercise also makes the cells more sensitive to insulin. This latter point means that there is a boost in the effectiveness of cells ability to use insulin, which enables the cells to absorb more glucose.
In addition, excess glucose levels will also normally lead to reduced nitric oxide levels. This is because as a response to elevated levels of glucose, the body will typically produce a molecule called superoxide. Superoxide is a free radical, and as such is highly reactive with other elements, such as nitric oxide. When superoxide is exposed to nitric oxide, the two will normally react with each other, and as a result the nitric oxide will be eliminated. Because exercise will normally lead to an increase in glucose metabolism, exercise will therefore also normally lead to reduced levels of superoxide. As a result, a person will typically have higher levels of nitric oxide.
In addition to glucose, there is fructose. Fructose is a natural simple sugar found in many fruits and vegetables. Refined fructose, such as high fructose corn syrup, is also used as a sweetener in various consumer products such as candy, chocolate and beverages. While every cell in the body can use glucose for energy production, the liver is the only organ that can metabolize fructose in significant amounts, and when the liver gets overloaded, it starts turning fructose into fat which is then stored around the body.
Consuming excessive amounts of fructose is likely to increase levels of triglycerides, increase LDL cholesterol (bad cholesterol), decrease HDL cholesterol (good cholesterol) and increase uric acid levels. All of these are major risk factors for heart disease and are likely to eventually clog up arteries and therefore diminish bloodflow throughout the body. Also, elevated fructose levels, similarly to elevated glucose levels, will normally lead to an increase in superoxide which in turn will normally reduce nitric oxide levels.
Atherosclerosis isn’t only caused by excess glucose levels. Atherosclerosis can have several factors such as smoking and substance abuse, a diet rich in fat and cholesterol, etc. Exercise will normally slow down atherosclerosis, and if done adequately, will also normally be able to reverse it.
Cholesterol is found in every cell of the body. It is manufactured by the body but can also be supplied from various foods. It serves important functions such as being an essential structural component of cell membranes and is a precursor of steroid hormones, bile acids, and vitamin D. Its substance is waxy or fat-like, and because it’s oil-based it doesn’t mix with the blood, which is water-based. It is therefore carried around the body in the blood by something called lipoproteins. There are two kinds of lipoproteins: Low-density lipoprotein (‘LDL’) (cholesterol carried by this type is known as ‘bad’ cholesterol), and high-density lipoprotein (‘HDL’) (cholesterol carried by this type is known as ‘good’ cholesterol).
Cholesterol carried by LDL is called ‘bad’ because it floats around in the bloodstream looking for something to do. If it can’t find anything productive to do, it will often be deposited on the wall of a blood vessel as plaque. This can eventually lead to atherosclerosis if the plaque becomes substantial. Atherosclerosis at an advanced stage will normally reduce bloodflow and may therefore lead to erectile dysfunction.
Cholesterol carried by HDL is called ‘good’ because it is on its way to the liver for destruction. Adequate exercise will cause a normal body to burn energy, which in turn may stop the build-up of cholesterol plaque. Sufficient exercise will also normally reverse this cholesterol plaque level as HDL transports cholesterol to the liver to be broken down and flushed out of the body.
The cholesterol plaque also covers the endothelial cells so that these cells have difficulty performing their tasks properly, meaning less nitric oxide is likely to be produced. Less nitric oxide will normally mean that it will be more difficult for a man to obtain and keep an erection.
High blood pressure, or hypertension, occurs when the flow of blood is pushing harder against the artery walls then what is normal. High blood pressure is typically caused by either a thickening of the blood or narrowing of the arteries (or both). Either factor will need the heart to pump harder to push the blood around the body. If blood pressure is elevated over longer periods of time, this high pressure may damage the endothelial lining of the blood vessels. If this lining is damaged, plaque more easily builds up along the artery wall, and this may cause atherosclerosis.
This is likely to impair bloodflow, and may if the condition becomes severe enough, lead to erectile dysfunction. Exercise will normally slow down or stop the deposits of cholesterol, calcium and other components inside the arteries, and may also reverse this build-up to make the arteries fully recover.
Exercise will also clean up the arteries so that this plaque is transported by HDL to the liver and broken down. In addition, exercise will expand and stretch the blood vessels to keep them in good shape. The result is a decrease in blood pressure, and with adequate exercise over time, blood pressure can be normalized.
When a person eats fat which is not immediately used as a source of energy, this will be broken down into something called triglycerides. Also, carbohydrates and protein that are not used immediately are converted to triglycerides.
These triglycerides are transported through the blood by lipoproteins. High level of triglycerides normally causes the blood to thicken and may therefore increase blood pressure. It is also associated with increased risk of blood clots and strokes.
High triglyceride levels are also associated with what is called inflammatory response – an over-active immune system that can cause damage to cells, tissues and arteries. Because high triglyceride levels may impair bloodflow, it is also likely to contribute to or cause erectile dysfunction when it gets severe enough.
When a person exercises, he will have a need for larger amounts of energy. Some of this energy will be taken from fat reserves, and will therefore lead to a reduction in triglycerides. Less triglycerides, or triglycerides at base level = better bloodflow.
As explained in this section, exercise has several positive effects on erectile functioning as well as libido. Most forms of regular exercise such as running, swimming, biking, interval training, weight lifting, team sports, etc. will typically have these effects.
Both aerobic exercise such as long distance running, as well as anaerobic exercise such as high intensity sprints, will normally have beneficial effects. Anaerobic exercise is high-intensity activity where the muscles’ need for oxygen (and nutrients) exceed the supply available from the bloodstream. Anaerobic exercise therefore also relies on energy stored in the muscles. Aerobic exercise is supported by oxygen (and nutrients) that are available from the bloodstream.
Bowles DK, Woodman CR, Laughlin MH. Coronary smooth muscle and endothelial adaptations to exercise training. Exerc Sport Sci Rev. 2000 Apr; 28(2):57-62.
Breen EC, Johnson EC, Wagner H, Tseng HM, Sung LA, and Wagner PD. Angiogenic growth factor mRNA responses in muscle to a single bout of exercise. J Appl Physiol 81: 355–361, 1996.
Calles-Escandon J, Cipolla M. Diabetes and endothelial dysfunction: a clinical perspective. Endocr Rev. 2001; 22:36–52.
Carrow RE, Brown RE, and Van Hess WD. Fiber sizes and capillary to fiber ratios in skeletal muscle of exercised rats. Anat Rec 159: 33–39, 1967.
Craig BW, Brown R, Everhart J. Effects of progressive resistance training on growth hormone and testosterone levels in young and elderly subjects. Mech Ageing Dev. 1989 Aug; 49(2):159-69.
Cullen P. Evidence that triglycerides are an independent coronary heart disease risk factor. Am J Cardiol. 2000 Nov 1; 86(9):943-9.
Derby CA, Mohr BA, Goldstein I, Feldman HA, Johannes CB, McKinlay JB. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology. 2000; 56:302–306.
Esposito K, Giugliano F, DiPalo C, Giugliano G, Marfella R, D’Andrea F, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004; 291(24):2978–2984. 23.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994 Jan; 151(1):54-61.
Freeman MW, Junge C. New York. Understanding cholesterol: the good, the bad, and the necessary. The Harvard Medical School Guide to Lowering Your Cholesterol. McGraw-Hill, 2005.
Furchgott RF, Ignarro LJ, Murad F. Discover concerning nitric oxide as a signaling molecule in the cardiovascular system. Nobel Prize in Medicine and Physiology 1998
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med. 1977 May; 62(5):707-14.
Gorostiaga EM, Izquierdo M, Ruesta M, Iribarren J, González-Badillo JJ, Ibáñez J. Strength training effects on physical performance and serum hormones in young soccer players. Eur J Appl Physiol. 2004 May; 91(5-6):698-707
Gustafsson T, Knutsson A, Puntschart A, Kaijser L, Nordqvist AC, Sundberg CJ, and Jansson E. Increased expression of vascular endothelial growth factor in human skeletal muscle in response to short-term one-legged exercise training. Pflügers Arch 444: 752–759, 2002.
H Basciano, L Federico, K Adeli. Fructose, insulin resistance, and metabolic dyslipidemia. Nutrition & Metabolism 2005, 2:5 DOI:10.1186/1743-7075-2-5.
Hackett G, Kell P, Ralph D, Dean J, Price D, Speakman M, Wylie K. British Society for Sexual Medicine Guidelines on the Management of Erectile Dysfunction. J Sex Med. 2008 Aug; 5(8):1841-65. DOI: 10.1111/j.1743-6109.2008.00773.
Hackney AC, Premo MC, McMurray RG.Influence of aerobic versus anaerobic exercise on the relationship between reproductive hormones in men. J Sports Sci. 1995 Aug;13(4):305-11.
Hawley JA, Lessard SJ. Exercise training-induced improvements in insulin action. Acta Physiol (Oxf). 2008 Jan; 192(1):127-35. DOI: 10.1111/j.1748-1716.2007.01783.
Higashi Y, Yoshizumi M. Exercise and endothelial function: role of endothelium-derived nitric oxide and oxidative stress in healthy subjects and hypertensive patients. Pharmacol Ther. 2004 Apr; 102(1):87-96.
Hoogeveen AR, Zonderland ML. Relationships between testosterone, cortisol and performance in professional cyclists. Int J Sports Med. 1996 Aug;17(6):423-8.
Horasanli K, Boylu U, Kendirci M, Miroglu C. Do lifestyle changes work for improving erectile dysfunction? Asian J Androl. 2008; 10(1):28–35.
Izquierdo M, Ibáñez J, Häkkinen K, Kraemer WJ, Ruesta M, Gorostiaga EM. Maximal strength and power, muscle mass, endurance and serum hormones in weightlifters and road cyclists. J Sports Sci. 2004 May; 22(5):465-78.
Kałka D, Sobieszczańska M, Pilecki W, Szawrowicz-Pełka T, Marciniak W, Sebzda T, Turbański J, Palczewska V, Adamus J. Evaluation of ambulatory cardiac rehabilitation influence on the intensity of erectile dysfunction in patients with ischemic heart disease. Pol Merkur Lekarski. 2009; 27(160):290–295.
Kimura C, Oike M, Koyama T, Ito Y. Impairment of endothelial nitric oxide production by acute glucose overload. Am J Physiol Endocrinol Metab. 2001 Jan; 280(1):E171-8.
Lamina S, Agbanusi EC, Nwacha R. Effects of Aerobic Exercise in the Management of Erectile Dysfunction: A Meta Analysis Study on Randomized Controlled Trials. Ethiop J Health Sci. 2011 Nov; 21(3): 195–201.
Lamina S, Okoye CG, Dagogo TT. Managing erectile dysfunction in hypertension: the effects of a continuous training programme on biomarker of inflammation. British Journal of Urology International. 2009; 103(9):1218–1221.
Lamina S, Okoye CG, Dagogo TT. Therapeutic effect of an interval exercise training program in the management of erectile dysfunction in hypertensive patients. J Clinical Hypertension. 2008; 11(3):125–129.
Laughlin MH, Korthuis RJ, Duncker DJ, and Bache RJ. Control of bloodflow to cardiac and skeletal muscle during exercise. In: Handbook of Physiology. Exercise. Regulation and Integration of Multiple Systems.
Bethesda, MD: Am. Physiol. Soc., 1996, sect. 12, chapt. 16, p. 705–769.
Lisak M, Demarin V, Trkanjec Z, Basić-Kes V. Hypertriglyceridemia as a possible independent risk factor for stroke. Acta Clin Croat. 2013 Dec; 52(4):458-63.
MacDonald JR, Hogben CD, Tarnopolski M, McDougall JG. Post exercise hypertension is sustained during subsequent bouts of mild exercise and simulated activities of daily living. J Hum Hypertens. 2001; 15:567–571.
Maio G, Saraed S, Marchiori A. Physical activity and PDE5 inhibitors in the treatment of erectile dysfunction: results of a randomized controlled study. Journal of Sex Med. 2010; 7(6):2201–2208.
Meuleman EJ, Diemont WL. Investigation of erectile dysfunction. Diagnostic testing for vascular factors in erectile dysfunction. UrolClin North Am. 1995; 22:803–819.
Mineo C, Shaul PW. HDL stimulation of endothelial nitric oxide synthase: a novel mechanism of HDL action. Trends Cardiovasc Med. 2003 Aug; 13(6):226-31.
Plante GE, Perreault M, Lanthier A, Marette A, Maheux P. Reduction of endothelial NOS and bradykinin-induced extravasation of macromolecules in skeletal muscle of the fructose-fed rat model. Cardiovasc Res. 2003 Oct 1; 59(4):963-70.
Prior BM, Lloyd PG, Yang HT, Terjung RL. Exercise-induced vascular remodelling. Exerc Sport Sci Rev. 2003 Jan; 31(1):26-33.
Roberts C, Vaziri ND, Barnard RJ. Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availability. Circulation. 2002; 106:2530–2532.
S Kim. Hyperlipidemia and erectile dysfunction. Asian J Androl 2000 Sep; 2: 161-166.
Seidell JC, Björntorp P, Sjöström L, Kvist H, Sannerstedt R. Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels. Metabolism. 1990 Sep; 39(9):897-901.
Simonsen U, Garcia-Sacristan A, Prieto D. Penile arteries and erection. J Vasc Res. 2002; 39:283–303.
Smilios, Pilianidis T, Karamouzis M, Parlavantzas A, Tokmakidis SP. Hormonal responses after a strength endurance resistance exercise protocol in young and elderly males. Int J Sports Med. 2007 May; 28(5):401-6.
The Journal of Biological Chemistry, May 23, 2003, 278:18791-18797. High Glucose Inhibits Insulin-stimulated Nitric Oxide Production without Reducing Endothel.