Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

One of the less-publicized reported repercussions of COVID-19 infection has been male sexual health, specifically erectile dysfunction (ED).

Erections require blood flow to the penis, so erectile dysfunction often results from conditions that restrict blood flow or damage nerves and arteries.

This article is a repost which originally appeared on The Philadelphia Inquirer

Edited for content

More than 850,000 Pennsylvanians have tested positive for COVID-19, and while the vast majority of those infected are recovering, long-term effects of the disease are still largely unknown. While pulmonary, cardiac and neurologic complications from COVID-19 are widely recognized, one of the less publicized reported repercussions of infection has been on male sexual health, specifically erectile dysfunction (ED).

More men are experiencing and seeking medical care for sexual dysfunction during the pandemic, with the greatest increase seen in younger men in their 40s and 50s.

A July study published in the Journal of Endocrinological Investigation examined the effects of COVID-19 on male sexual and reproductive health. The study identified a correlation between COVID-19 and ED, likely caused by many factors, ranging from physiological changes to changes in the way we interact with others.

One of the hallmarks of a COVID-19 infection is an exaggerated inflammatory response. The resulting storm of pro-inflammatory signals, called cytokines, causes inflammation of the lining of blood vessels. The hyperinflammatory state triggered by COVID-19 infection can cause vascular damage, ultimately disrupting blood flow — the key component of getting and maintaining an erection.

ED has long been recognized as an excellent marker for physiological well-being. Specifically, ED functions as the “canary in a coal mine” for cardiovascular disease, often predating symptomatic heart disease up to several years in advance. People with preexisting medical conditions are at higher risk for serious COVID-19 infection, but the converse is also true: COVID-19 infection can worsen preexisting medical conditions, such as heart disease and diabetes.

In addition, many of the medications used to treat common heart conditions can have a negative effect on erectile dysfunction. The decline in overall health in COVID-19 survivors and the medications used to manage this can both result in ED.

Also, mental and emotional health plays a large role in men’s sexual health. Being in the right mindset is a vital component of achieving an erection and having a satisfactory sexual experience. There is no doubt that there has been a negative mental and emotional toll from the pandemic regardless of personal COVID-19 infection. The impact of social isolation, worry for family and self during the pandemic, and economic toll from quarantine is demonstrated with increasing rates of stress, anxiety and depression. All of these feelings can be detrimental to sexual function.

With COVID-19 having such a sweeping effect on our daily lives, finding ways to improve quality of life has become more important than ever. ED is more common than most men realize — it is recognized in more than 50% of men over the age of 50 — and may be occurring at even higher rates during the pandemic.

If you are experiencing ED, you should speak to your doctor or urologist to be evaluated and discuss treatment options. And remember that one of the best ways to lower your risk of long-term complications from COVID-19 is to prevent infection in the first place by getting vaccinated when you can, observing social distancing, masking, and using good hand hygiene.

Joceline S. Fuchs is a board-certified urologist with MidLantic Urology in Abington.

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months []; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus []. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic []. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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13 health benefits of sex

13 health benefits of sex

Medically reviewed words Rosie Saunders, Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP

·10-min read

This article is a repost which originally appeared on yahoo!style

Edited for content

Not only does a healthy sex life boost levels of intimacy, affection and wellbeing in your relationship, according to science, but it’s also great for your physical and mental health.

And while we all know between-the-sheets action is a calorie burner – it can torch through calories equivalent to a 30-minute jog – there are so many great health benefits of sex that go way beyond energy expenditure.

With Tracey Cox, sex and relationships educator, and Mia Sabat, in-house sex therapist at Emjoy, we run through 13 evidence-backed health benefits of sex – plus, tips for fostering a healthy sex life:

13 health benefits of sex

Sex can be beneficial to your health in many ways, from boosting your immune function to reducing your risk of heart disease and supercharging your self-esteem. Here, we run through 13 evidence-based health benefits of sex, according to science:

1. Sex helps you sleep

During climax, the brain releases a hormone called oxytocin, which induces a relaxed feeling that helps you sleep better. ‘Great sex is one of the best cures for sleeplessness and insomnia – oxytocin is the hormone that promotes feelings of intimacy, and it jumps to five times its normal level during climax,’ says Cox. ‘It also makes you feel sleepy. While men drift off two to five minutes after orgasm, women usually take 20 to 30 minutes.’

2. Sex makes you look younger

Couples who have sex at least three times a week look more than 10 years younger than those who get frisky less often, according to research by Dr David Weeks, clinical neuropsychologist at the Royal Edinburgh Hospital. He adds, the pleasure from having sex is a ‘crucial factor’ in staying young. Additionally, having sex boosts blood circulation and causes your body to release endorphins, giving your skin a natural glow. Human Growth hormone (HGH) somatotropin is also released, which improves skin elasticity and fends off wrinkles.

3. Sex reduces headaches

Sex can be a powerful painkiller, especially for headache sufferers. A study carried out by the University of Munster in Germany found that sex can actually be more effective than painkillers when it comes to reducing headache pain. This is because sex triggers the release of endorphins – the body’s natural painkillers – into the central nervous system. The effect is so powerful, their research shows, that more than half of people who have sex during a headache experience an improvement in symptoms.

Some headaches occur as a result of sexual activity and this should be discussed with your doctor.

4. Sex relieves stress

Given that so many mood-boosting chemicals are released during sex, it makes sense that getting frisky can act as a natural, powerful stress-reliever. In one rodent study, having sex daily for a fortnight caused cell growth in the hippocampus, the part of the brain that keeps stress levels under control. And in a similar human study, people who had daily intercourse for two weeks experienced a reduction in stress-related blood pressure.

5. Sex promotes healthier food choices

Believe it or not, sex can help to curb sugar and fat cravings. How? By lowering levels of the stress hormone cortisol, which stimulates fat and carbohydrate metabolism for fast energy, promotes insulin release and impacts blood sugar levels. This trifecta of actions not only boosts your appetite, but leads you to crave sweet, high-fat foods, which are typically lower in nutrients.

6. Sex boosts immunity

Research from Wilkes-Barre University found that the intimacy of sex stimulates the body to produce Immunoglobulin A (IgA), an antibody that forms a barrier against a cold. People who have sex more than once or twice a week, they found, have more of these antibodies than those who are less sexually active. Obviously in the unusual context of covid – awareness of symptoms of infection is important in making decisions about intimacy.

7. Sex eases period pain

At the moment of climax, the uterine muscles contract and send pain-relieving and mood-enhancing endorphins to the brain. These act as a natural painkiller, and help to ease menstrual cramps, depression and irritability associated with PMS. The muscle contractions that occur when you orgasm may also help to relieve tension in your uterus, providing relief from cramps.

8. Sex reduces prostate cancer risk

The prostate is important in the male reproductive system – it produces the alkaline components of semen, which help to protect the sperm. Research from Harvard found that men who ejaculate on a regular basis – defined as five times or more each week – are less likely to develop prostate cancer.

9. Sex boosts heart health

The less frequently you have sex, the higher your risk of heart disease, according to an observational study spanning more than 1,000 men published in the American Journal of Cardiology. Compared to men who reported having sex a minimum of two or three times per week, men with sexual activity of once per month or less were 45 per cent more likely to be diagnosed with cardiovascular disease.

10. Sex increases self-esteem

Having sex can help boost self-confidence and develop a more better positive attitude about yourself. ‘Never underestimate the power of confidence,’ says Sabat. ‘Expressing what you want clearly and without fear is one of the most desirable things you can do, especially while being intimate with another person. Love the power of your body and acknowledge that you deserve to experience pleasure. Doing this will help you to communicate with more clarity and confidence.’

11. Sex boosts libido

The more frequently you have sex, the more likely you are to want to do it again. This is because getting frisky prompts your brain to release dopamine, a neurotransmitter involved in the motivation and reward process. And among women specifically, sex boosts estrogen levels and blood flow, which increases the desire for sex.

12. Sex improves memory

Getting intimate may boost your brain function by stimulating areas of the brain that are associated with memory. In a long-term study by the University of Wollongong, frequent sexual activity was found to be associated with better performance in a short-term memory test. This research is supported by the findings of a study by Manchester University, which revealed that sexually active adults have better brain power.

13. Sex enhances sperm quality

Ejaculating every day for seven days improves men’s sperm quality by reducing the amount of DNA damage, according to research by the European Society of Human Reproduction and Embryology. As well as seeing ‘substantial and statistically highly significant’ changes in the quality of the sperm, ‘in addition, we found that although frequent ejaculation decreased semen volume and sperm concentrations, it did not compromise sperm motility and, in fact, this rose slightly but significantly,’ said lead author Dr David Greening.

10 tips for a healthy sex life

Having regular sex may bring about a variety of health benefits, but being able to communicate and experience sexual satisfaction is key to making the experience pleasurable. Here, we run through 10 tips for a healthy sex life:

1. Connect with self-pleasure

Make time to get to know yourself – self pleasure is still a form of sex. ‘Every sexual experience begins within ourselves, and masturbation embodies this experience,’ says Sabat. ‘Beyond stimulating our sex drive, self-pleasure allows us to connect with our minds and bodies to focus on our desires and sexuality. This helps us to better communicate our needs and preferences, and ultimately engage in a more fulfilling sexual experience.’

2. Talk to your partner

Talk openly with your partner before entering the bedroom to establish consent, work out what you are both comfortable with, and what you’d like to explore, Sabat recommends. ‘Not only is consent always key, but ensuring you talk openly about your preferences gives everyone involved time to decide if they do, or do not, want to explore a specific type of sexual activity,’ she says.

3. Learn about erogenous zones

An erogenous zone is an area of the body that has heightened sensitivity, which may elicit a sexual response when stimulated. ‘Everyone has unique parts of their body which they love being touched, or gain arousal from,’ says Sabat. ‘You’d be surprised where you can find them – but the best places to start are often sensitive areas like the lips, neck and breasts.’

4. Bring erotica into the bedroom

To spice things up, why not talk to your partner about exploring different kinds of erotica together? ‘I recommend couples engage with audio erotica because, when listening, each individual can engage with their own fantasies, preferences and turn-ons, while still connecting over the same storyline or narrative,’ says Sabat.

5. Explore your biggest organ

Your skin, of course! ‘The skin is a highly responsive organ, and finding new ways to stimulate it can be very arousing,’ says Sabat. ‘Consider investing in new materials that will play on your sense of touch. This could be anything from leather and silk to latex or sensory lubricants. Just be careful of any allergies and introduce objects to both of your bodies in a responsible way.’

6. Try a new location

Sex doesn’t have to stay between the sheets, says Sabat. ‘Next time you’re feeling more adventurous, try taking it to the kitchen, bathroom, or even the hallway – these new locations will mean you have to work out new positions while enjoying the excitement of a new situation,’ she says.

7. Grab a toy

Sex toys can be used to complement both penetrative and oral sex throughout your experience – and they don’t need to be focused on penetration to create pleasure, says Sabat. ‘If your partner is open to bringing items like leashes, feathers, whips, and bondage toys such as handcuffs into the bedroom, bringing toys that focus on stimulating external areas into the bedroom can often lead to a more fulfilling sexual experience,’ she adds.

8. Engage with your fantasies

We all have fantasies, Sabat says, so it’s important to embrace them without shame. ‘Not only do fantasies increase sexual desire and arousal, but they let us explore facets of our sexuality that can often be forgotten or neglected,’ she says. ‘In fact, they can even help you to become more creative in the bedroom. While not every fantasy should be acted upon, discussing the parts of the fantasy that make you most excited with your partner can lead to healthy conversations about your sexual needs.’

9. Try different positions

Inject a sense of adventure into your bedroom antics by trying out different positions. ‘We often fall back on techniques that we know will result in orgasm – be it specific types of stimulation, favourite positions, or repeating the same moves over and over again,’ says Sabat. ‘Trying new positions helps us to experience intimacy in different ways. Explore new angles by using pillows, or mix things up by switching roles – if you’d normally be in control or on top, why not let your partner take the reins?’

10. Communication is key

Every sexual encounter is different, even if it’s happening with the same person, says Sabat. ‘What matters is that you learn your partner’s preferences and desires, and focus on communicating what you do and do not like,’ she explains. ‘Not only will this lead to more pleasure for you both, but it helps us reject the stigma that one partner is responsible for the other’s pleasure. Remember that sex is a shared experience, with shared responsibility. Communicate with your partner, feel empowered by your desires and let go.’

Last updated: 10-09-2020