Healthy Sex
Part 4: Three Key Issues

Dr. Phil Maffetone

There are many aspects of healthy sex. In this column I’ll highlight three important ones. The first has to do with misinformation—it’s been said that engaging in sexual activity can actually kill you. Second is the misunderstanding of erectile dysfunction, and its hidden meaning. And finally, a very simple and successful form of biofeedback can help many people have better sex.

Can Sex Kill?

A recent study published in the Journal of the American Medical Association in 2011 showed that engaging in sex can significantly increase the risk of death during or just afterwards. It cited evidence that the act of sex can increase the risk of a heart attack by 2.7 times. This is a dilemma, because having sex is great—and it’s a fitness activity that also has potent health benefits as discussed in Part 3. The problem with this study is not the study, but how the media reported it. They made it seem like sex was to blame, when, in fact, it’s poor health and fitness.

Having sex a few times a week can actually make it a legitimate part of your aerobic training. In fact, regular sexual activity can reduce the risk of death from a heart attack during or after sex. That’s because, as the fine print of the study showed, those who are physically active don’t have the high level of health risk as those who are inactive. And, should these two sexually active individuals eat well and manage stress, their risks of death during sex would be further significantly lowered—more than inactive people.

Unfortunately, most major newspaper headlines read something like this one: “Yes, sex can kill you, U.S. study shows.” That’s sufficient enough misinformation to create additional mental and emotional stress (which becomes another risk factor) in some people having sex, which could actually further increase their chances of death even more. Another disservice is what the media reports don’t say: Sex doesn’t kill, poor health does when triggered by any kind of exertion, whether it’s sex, sprinting to get out of the rain, or climbing a flight of stairs.

Erectile Dysfunction

Erectile Dysfunction or E.D. is defined as a male difficulty in initiating or maintaining penile erection adequate for sexual relations. E.D. may be present in up to half of the male population over the age of 40 years, affecting an estimated 150 million individuals worldwide.

While the inability for a man to have sex can be emotionally and morally devastating, E.D. is usually an indication that more serious health problems exist. Two common primary conditions are carbohydrate intolerance and chronic inflammation, with other secondary problems developing. These include hypertension, diabetes, obesity, cardiovascular disease, sleep apnea, and both over- and under-active thyroid conditions.

Clusters of signs and symptoms often include E.D. A common example is that E.D. is frequently associated with both depression and heart disease.

E.D. is specifically associated with diminished blood flow (poor circulation)—not just into the penis, but elsewhere throughout the body, including the heart. An early sign of heart problems, as an example, is a reduction in penile hardness. Some men experience E.D. for several years prior to a first heart attack. Often, the reduction in blood flow—to the penis, heart or brain—is due to chronic narrowing of the arteries from calcium or cholesterol deposits.

Separately, various types of drugs can contribute to E.D. Alcohol abuse, illicit hard drug use, and prescription drugs such as beta-blockers, ACE inhibitors, diuretics, and antidepressants may contribute to or cause the condition. In fact, up to 25 percent of newly diagnosed E.D. may be due to side effects of prescription drugs.

The inability to achieve penile erection can involve a combination of factors. These can be mental/emotional (such as depression or anxiety), neurological (autonomic imbalance), hormonal (adrenal and sex hormones, especially testosterone), and vascular (blood circulation). Any or all of these problems can stem from aerobic deficiency, poor stress regulation, and improper diet.

Nutritional factors can directly contribute to E.D., especially oxidative stress, which is kept in check by dietary antioxidants. Balancing fats is also important as those with E.D. often have low levels of inflammatory chemicals (derived from omega-6 fats).

For most men, treating E.D. with a prescription drug is clearly not addressing the cause of the problem. Despite the multimillion-dollar ad campaigns, there is no magic pill for all patients with E.D. The main ingredient in many of these E.D. drugs is sildenafil citrate—sold as Viagra, Revatio and under various other trade names— But these drugs are not effective in all cases, including those with circulatory problems.

Sildenafil is not a magic bullet—a man must be sexually aroused for it to work. And, this medication is ineffective unless taken on an empty stomach at least 1 hour before sexual activity. So this drug is not a treatment for low libido.

Reduced libido is not uncommon, often worsening with age. The use of testosterone replacement therapy is sometimes recommended, for both men and women (this hormone is also important in women’s libido). But this must be prescribed based on a proper evaluation, including a blood test that demonstrates low levels of testosterone, and not just on the symptom of low libido.

Below are some common symptoms associated with abnormally low levels of testosterone in men:
1. Decreased frequency of morning erection
2. Decreased frequency of sexual thoughts
3. Erectile dysfunction
4. An inability to engage in physical activity such as walking or running for exercise or lifting heavy objects.
5. The inability to bend, kneel, or stoop during a typical day.
6. Sadness.
7. Fatigue.
8. Bone loss.

The incidence of E.D. is growing—not just because of an aging population but in younger men as well. Those who are healthy and fit generally don’t have E.D.

Sex Biofeedback for Men and Women

It’s important to do more than just talk about sex. And when there’s a problem, it’s even more important to discuss possible remedies. In addition to building better health and fitness, which can dramatically improve the ability to have healthy sex, an important form of biofeedback was developed decades ago.

Born in 1894, Dr. Arnold H. Kegel was an Assistant Professor of Gynecology at the University of Southern California School of Medicine. He invented a series of exercises to help strengthen muscles of the lower pelvic region as a non-surgical treatment of genital relaxation. Kegel first published his ideas in 1948. Today, Kegel exercises are commonly used as an early treatment for urinary stress incontinence and female genital prolapse, when a portion of the vaginal canal protrudes from the opening of the vagina. (The condition usually occurs when the pelvic floor collapses as a result of childbirth.)

Kegel exercises are a relatively simple form of biofeedback helping to improve the function of the muscles that make up the bottom of the pelvis, often called pelvic floor muscles. They help support the bladder, lower intestine, and uterus. For men and women who have sexual dysfunction, these muscles may not work well, but improving their actions can increase sexual pleasure significantly. For women the exercises can help improve having an orgasm, and in men, it makes it easier to delay ejaculation. In fact, erectile dysfunction (ED) can be successfully treated with Kegel exercises; it can also be more effective than taking Viagra.

The first step in using Kegel exercises is to feel the pelvic muscles contract. This can be accomplished while you're urinating. Squeeze your pelvic floor muscles to stop the flow of urine. Once you’re able to accomplish this, perform it each time you urinate—stop the flow of urine for five to ten seconds, and then release it. Another option is to contract the muscle when not urinating—just think about relaxing your pelvis as if you are urinating, then tighten the muscles to hold it for five to ten seconds. Perform these with the rest of your body relaxed, several times or more each day. Once you’re able to contract these muscles, they will start functioning better. After a few weeks, improved pelvic floor muscles will be more evident because you’ll easily be able to stop your urine flow at any time—and sexual function may improve too.

For women who have a difficult time contracting these pelvic muscles, it’s often recommended to insert a finger into the vagina and attempt to contract—trying to squeeze the surrounding muscles. You should feel your vagina tighten and your pelvic floor move upward.

For men and women, contracting the pelvic floor muscles during sex can be an additional pleasure. Have fun and experiment. Give it a try—it just might increase the quality, and quantity, of your sexual experience.

If you’re unable to successfully contract the pelvic muscles, or are not sure what to do, seek help from a reliable healthcare practitioner.

You can find all of the past and future columns on Healthy Sex in the Members section of the website (under Articles).
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