Physical Activity, Fitness, and Sexual Dysfunction

  • Konstantinos P. Imprialos
  • Konstantinos Stavropoulos
  • Michael Doumas


Erectile dysfunction is a major health problem that affects approximately 15–20% of the general population. Its prevalence is significantly higher (30–80%) in patients with cardiovascular (CV) risk factors or disease. Erectile dysfunction shares common pathophysiological mechanisms with CV disease which include a complex interaction between subclinical inflammation, endothelial dysfunction, atherosclerosis, and arterial structural damage. Roles of exercise and cardiorespiratory fitness (CRF) have been well established as first-line recommendations in the management of hypertension, diabetes, dyslipidemia, obesity, or overt CV disease. In the setting of erectile dysfunction, several observational studies have assessed the impact of exercise on sexual dysfunction, with various studies showing promising results. In addition, randomized trials in various subpopulations with sexual dysfunction suggest significant ameliorating effects of exercise on erectile function. However, these studies are few, and most are not adequately powered to strongly support these benefits. Nevertheless, international guidelines recommend lifestyle interventions – including exercise – as the first step in the management of all patients with sexual dysfunction. Larger well-designed trials are needed to prove the benefits observed in the few available studies.


Sexual dysfunction Erectile dysfunction. Cardiovascular disease Cardiovascular fitness Exercise Physical activity 


  1. 1.
    Manolis A, Doumas M. Sexual dysfunction: the 'prima ballerina' of hypertension-related quality-of-life complications. J Hypertens. 2008;26(11):2074–84.PubMedCrossRefGoogle Scholar
  2. 2.
    NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA. 1993;270(1):83–90.CrossRefGoogle Scholar
  3. 3.
    Bachman GA, Avci D. Evaluation and management of female sexual dysfunction. Endocrinologist. 2004;14:337–45.CrossRefGoogle Scholar
  4. 4.
    Gandaglia G, Briganti A, Montorsi P, Montorsi F, Vlachopoulos C. Erectile dysfunction in coronary artery disease and heart failure. In: Viigimaa M, Vlachopoulos C, Doumas M, editors. Erectile dysfunction in hypertension and cardiovascular disease. Springer International Publishing: Switzerland; 2015. p. 59–71.Google Scholar
  5. 5.
    Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, et al. Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract. 2010;64(7):848–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013;34(27):2034–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Viigimaa M, Vlachopoulos C, Lazaridis A, Doumas M. Management of erectile dysfunction in hypertension: tips and tricks. World J Cardiol. 2014;6(9):908–15.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Menezes A, Artham S, Lavie CJ, Milani RV, O'Keefe J. Erectile dysfunction and cardiovascular disease. Postgrad Med. 2011;123(3):7–16.PubMedCrossRefGoogle Scholar
  9. 9.
    Manolis A, Doumas M. Antihypertensive treatment and sexual dysfunction. Curr Hypertens Rep. 2012;14(4):285–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 year old: longitudinal results from the Massachusetts male aging study. J Urol. 2000;163(2):460–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Prins J, Blanker MH, Bohnen AM, Thomas S, Bosch JL. Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impot Res. 2002;14(6):422–32.PubMedCrossRefGoogle Scholar
  12. 12.
    Shabsigh R, Perelman MA, Laumann EO, Lockhart DC. Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries. BJU Int. 2004;94(7):1055–65.PubMedCrossRefGoogle Scholar
  13. 13.
    McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res. 2000;12(Suppl 4):S6–S11.PubMedCrossRefGoogle Scholar
  14. 14.
    Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57.PubMedCrossRefGoogle Scholar
  15. 15.
    Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20(5):607–17.PubMedCrossRefGoogle Scholar
  16. 16.
    Imprialos KP, Stavropoulos K, Doumas M, Tziomalos K, Karagiannis A, Athyros VG. Sexual dysfunction, cardiovascular risk and effects of pharmacotherapy. Curr Vasc Pharmacol. 2017;
  17. 17.
    Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A, et al. Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl. 2006;27(3):469–77.PubMedCrossRefGoogle Scholar
  18. 18.
    Doumas M, Douma S. Sexual dysfunction in essential hypertension: myth or reality? J Clin Hypertens. 2006;8(4):269–74.CrossRefGoogle Scholar
  19. 19.
    Burke JP, Jacobson DJ, McGree ME, Nehra A, Roberts RO, Girman CJ, et al. Diabetes and sexual dysfunction: results from the Olmsted County study of urinary symptoms and health status among men. J Urol. 2007;177(4):1438–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25(8):1458–63.PubMedCrossRefGoogle Scholar
  21. 21.
    Penson DF, Latini DM, Lubeck DP, Wallace KL, Henning JM, Lue TF. Do impotent men with diabetes have more severe erectile dysfunction and worse quality of life than the general population of impotent patients? Results from the ExCEED database. Diabetes Care. 2003;26(4):1093–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998;338(10):1397–404.PubMedCrossRefGoogle Scholar
  23. 23.
    Nikolaidou B, Nouris C, Lazaridis A, Sampanis C, Doumas M. Diabetes mellitus and erectile dysfunction. In: Viigimaa M, Vlachopoulos C, Doumas M, editors. Erectile dysfunction in hypertension and cardiovascular disease. Springer International Publishing: Switzerland; 2015. p. 119–28.Google Scholar
  24. 24.
    Smith NJ, Sak SC, Baldo O, Eardley I. The prevalence of newly diagnosed hyperlipidaemia in men with erectile dysfunction. BJU Int. 2007;100(2):357–61.PubMedCrossRefGoogle Scholar
  25. 25.
    Gunduz MI, Gumus BH, Sekuri C. Relationship between metabolic syndrome and erectile dysfunction. Asian J Androl. 2004;6(4):355–8.PubMedGoogle Scholar
  26. 26.
    Vrentzos GE, Paraskevas KI, Mikhailidis DP. Dyslipidemia as a risk factor for erectile dysfunction. Curr Med Chem. 2007;14(6):1765–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Pittaras A, Avranas K, Imprialos K, Faselis C, Kokkinos P. The association between dyslipidemia and its treatment with erectile dysfunction. In: Viigimaa M, Vlachopoulos C, Doumas M, editors. Erectile dysfunction in hypertension and cardiovascular disease. Springer International Publishing: Switzerland; 2015. p. 129–38.Google Scholar
  28. 28.
    Kaya E, Sikka SC, Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med. 2015;12(4):856–75.PubMedCrossRefGoogle Scholar
  29. 29.
    Esposito K, Giugliano F, Ciotola M, et al. Obesity and sexual dysfunction, male and female. Int J Impot Res. 2008;20:358–65.PubMedCrossRefGoogle Scholar
  30. 30.
    Diaz-Arjonilla M, Schwartz M, Swerdloff RS, Wang C. Obesity, low testosterone levels and erectile dysfunction. Int J Impot Res. 2009;21(2):89–98.PubMedCrossRefGoogle Scholar
  31. 31.
    Kloner RA, Mullin SH, Shook T, Matthews R, Mayeda G, Burstein S. Erectile dysfunction in the cardiac patient: How common and should we treat? J Urol. 2003;170(2Pt2):S46–50.PubMedGoogle Scholar
  32. 32.
    Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27(22):2632–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Gandaglia G, Briganti A, Jackson G, Kloner RA, Montorsi F, Montorsi P, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65(5):968–78.PubMedCrossRefGoogle Scholar
  34. 34.
    Montorsi F, Briganti A, Salonia A, Rigatti P, Margonato A, Macchi A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44(3):360–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Alberti L, Torlasco C, Lauretta L, Loffi M, Maranta F, Salonia A, et al. Erectile dysfunction in heart failure patients: a critical reappraisal. Andrology. 2013;1(2):177–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Apostolo A, Vignati C, Brusoni D, Cattadori G, Contini M, Veglia F, et al. Erectile dysfunction in heart failure: correlation with severity, exercise performance, comorbidities, and heart failure treatment. J Sex Med. 2009;6(1):2795–805.PubMedCrossRefGoogle Scholar
  37. 37.
    Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction Urol. Clin North Am. 2005;32(4):379–95.Google Scholar
  38. 38.
    Moreland RB, Traish A, MA MM, Smith B, Goldstein I, Saenz de Tejada I. PGE1 suppresses the induction of collagen synthesis by transforming growth factor-beta 1 in human corpus cavernosum smooth muscle. J Urol. 1995;153(3Pt1):826–34.PubMedGoogle Scholar
  39. 39.
    Nehra A, Gettman MT, Nugent M, Bostwick DG, Barrett DM, Goldstein I, et al. Transforming growth factor-beta1 (TGF-beta1) is sufficient to induce fibrosis of rabbit corpus cavernosum in vivo. J Urol. 1999;162(3Pt1):910–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Saenz de Tejada I, Moroukian P, Tessier J, Kim JJ, Goldstein I, Frohrib D. Trabecular smooth muscle modulates the capacitor function of the penis. Studies on a rabbit model. Am J Physiol. 1991;260(5Pt2):H1590–5.PubMedGoogle Scholar
  41. 41.
    Nehra A, Azadzoi KM, Moreland RB, Pabby A, Siroky MB, Krane RJ, et al. Cavernosal expandability is an erectile tissue mechanical property which predicts trabecular histology in an animal model of vasculogenic erectile dysfunction. J Urol. 1998;159(6):2229–36.PubMedCrossRefGoogle Scholar
  42. 42.
    Mulvany MJ. Small artery remodeling in hypertension. Curr Hypertens Rep. 2002;4:49.PubMedCrossRefGoogle Scholar
  43. 43.
    Okabe H, Hale TM, Kumon H, Heaton JP, Adams MA. The penis is not protected--in hypertension there are vascular changes in the penis which are similar to those in other vascular beds. Int J Impot Res. 1999;11(3):133.PubMedCrossRefGoogle Scholar
  44. 44.
    Toblli JE, Stella I, Inserra F, Ferder L, Zeller F, Mazza ON. Morphological changes in cavernous tissue in spontaneously hypertensive rats. Am J Hypertens. 2000;13(6Pt1):686–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Hale TM, Okabe H, Heaton JP, Adams MA. Antihypertensive drugs induce structural remodeling of the penile vasculature. J Urol. 2001;166(2):739.PubMedCrossRefGoogle Scholar
  46. 46.
    Norman RA Jr, Dzielak DJ. Immunological dysfunction and enhanced sympathetic activity contribute to the pathogenesis of spontaneous hypertension. J Hypertens Suppl. 1986;4(3):S437–9.PubMedGoogle Scholar
  47. 47.
    Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. Am J Cardiol. 2005;96(12B):19M–23M.PubMedCrossRefGoogle Scholar
  48. 48.
    Sattar AA, Salpigides G, Vanderhaeghen JJ, Schulman CC, Wespes E. Cavernous oxygen tension and smooth muscle fibers: relation and function. J Urol. 1995;154(5):1736–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Leite R, Giachini FR, Carneiro FS, Nunes KP, Tostes RC, Webb RC. Targets for the treatment of erectile dysfunction: is NO/cGMP still the answer? Recent Pat Cardiovasc Drug Discov. 2007;2(2):119–32.PubMedCrossRefGoogle Scholar
  50. 50.
    Toda N, Ayajiki K, Okamura T. Nitric oxide and penile erectile function. Pharmacol Ther. 2005;106(2):233–66.PubMedCrossRefGoogle Scholar
  51. 51.
    Jeremy JY, Angelini GD, Khan M, Mikhailidis DP, Morgan RJ, Thompson CS. Platelets, oxidant stress and erectile dysfunction: an hypothesis. Cardiovasc Res. 2000;46(1):50–4.PubMedCrossRefGoogle Scholar
  52. 52.
    Jones RW, Rees RW, Minhas S, Ralph D, Persad RA, Jeremy JY. Oxygen free radicals and the penis. Expert Opin Pharmacother. 2002;3(7):889–97.PubMedCrossRefGoogle Scholar
  53. 53.
    Prieto D, Kaminski PM, Bagi Z, Ahmad M, Wolin MS. Hypoxic relaxation of penile arteries: involvement of endothelial nitric oxide and modulation by reactive oxygen species. Am J Physiol Heart Circ Physiol. 2010;299(3):H915–24.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Khan MA, Thompson CS, Mumtaz FH, Mikhailidis DP, Morgan RJ, Bruckdorfer RK, et al. The effect of nitric oxide and peroxynitrite on rabbit cavernosal smooth muscle relaxation. World J Urol. 2001;19(3):220–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Zalba G, Beaumont J, San Jose G, Fortuno A, Fortuno MA, Diez J. Vascular oxidant stress: molecular mechanisms and pathophysiological implications. J Physiol Biochem. 2000;56(1):57–64.PubMedCrossRefGoogle Scholar
  56. 56.
    Warnholtz A, Nickenig G, Schulz E, Macharzina R, Bräsen JH, Skatchkov M, et al. Increased NADH-oxidase-mediated superoxide production in the early stages of atherosclerosis: evidence for involvement of the renin-angiotensin system. Circulation. 1999;99(15):2027–33.PubMedCrossRefGoogle Scholar
  57. 57.
    Seftel AD, Vaziri ND, Ni Z, Razmjouei K, Fogarty J, Hampel N. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology. 1997;50(6):1016–26.PubMedCrossRefGoogle Scholar
  58. 58.
    Chen D, Shan YX, Dai YT. Advanced glycation end products and their receptors elevate the activity of endothelin-1 in rat cavernosum. Zhonghua Nan KeXue. 2008;14(2):110–5.Google Scholar
  59. 59.
    Musicki B, Kramer MF, Becker RE, Burnett AL. Inactivation of phosphorylated endothelial nitric oxide synthase (Ser-1177) by O-GlcNAc in diabetes-associated erectile dysfunction. Proc Natl Acad Sci U S A. 2005;102(33):11870–5.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Usta MF, Bivalacqua TJ, Yang DY, et al. The protective effect of aminoguanidine on erectile function in streptozotocin diabetic rats. J Urol. 2003;170(4Pt1):1437–42.PubMedCrossRefGoogle Scholar
  61. 61.
    Usta MF, Kendirci M, Gur S, Ramanitharan A, Sell DR, Viswanathan A. The breakdown of preformed advanced glycation end products reverses erectile dysfunction in streptozotocin-induced diabetic rats: preventive versus curative treatment. J Sex Med. 2006;3:242–50. discussion 50–2.PubMedCrossRefGoogle Scholar
  62. 62.
    Blumentals WA, Gomez-Caminero A, Joo S, Vannappagari V. Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res. 2004;16(4):350–3.PubMedCrossRefGoogle Scholar
  63. 63.
    Ponholzer A, Temml C, Obermayr R, Wehrberger C, Madersbacher S. Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol. 2005;48(3):512–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Vlachopoulos C, Rokkas K, Ioakeimidis N, Aggeli C, Michaelides A, Roussakis G, et al. Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol. 2005;48(6):996–1003.PubMedCrossRefGoogle Scholar
  65. 65.
    Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996–3002.PubMedCrossRefGoogle Scholar
  66. 66.
    Schouten BW, Bohnen AM, Bosch JL, Bernsen RM, Deckers JW, Dohle GR, et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. Int J Impot Res. 2008;20(1):92–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Araujo AB, Travison TG, Ganz P, Chiu GR, Kupelian V, Rosen RC, et al. Erectile dysfunction and mortality. J Sex Med. 2009;6(9):2445–54.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Banks E, Joshy G, Abhayaratna WP, Kritharides L, Macdonald PS, Korda RJ, et al. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalization and all-cause mortality: a prospective cohort study. PLoS Med. 2013;10(1):e1001372.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Batty GD, Li Q, Czernichow S, Neal B, Zoungas S, Huxley R, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol. 2010;56(23):1908–13.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Bohm M, Baumhakel M, Teo K, Sleight P, Probstfield J, Gao P, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iN tolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation. 2010;121(12):1439–46.PubMedCrossRefGoogle Scholar
  71. 71.
    Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011;58(13):1378–85.PubMedCrossRefGoogle Scholar
  72. 72.
    Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK, Aznaouridis KA, Stefanadis CI. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. CircCardiovasc Qual Outcomes. 2013;6(1):99–109.CrossRefGoogle Scholar
  73. 73.
    Hsiao W, Shrewsberry AB, Moses KA, Johnson TV, Cai AW, Stuhldreher P, et al. Exercise is associated with better erectile function in men under 40 as evaluated by the International Index of Erectile Function. J Sex Med. 2012;9(2):524–30.PubMedCrossRefGoogle Scholar
  74. 74.
    Kokkinos P, Myers J. Exercise and physical activity: clinical outcomes and applications. Circulation. 2010;122(16):1637–48.PubMedCrossRefGoogle Scholar
  75. 75.
    Ettala OO, Syvänen KT, Korhonen PE, Kaipia AJ, Vahlberg TJ, Boström PJ, et al. High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects. J Sex Med. 2014;11(9):2277–84.PubMedCrossRefGoogle Scholar
  76. 76.
    Rosen RC, Wing RR, Schneider S, Wadden TA, Foster GD, West DS, et al. Erectile dysfunction in type 2 diabetic men: relationship to exercise fitness and cardiovascular risk factors in the Look AHEAD trial. J Sex Med. 2009;6(5):1414–22.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Simon RM, Howard L, Zapata D, Frank J, Freedland SJ, Vidal AC. The association of exercise with both erectile and sexual function in black and white men. J Sex Med. 2015;12(5):1202–10.PubMedCrossRefGoogle Scholar
  78. 78.
    Pohjantähti-Maaroos H, Palomäki A, Hartikainen J. Erectile dysfunction, physical activity and metabolic syndrome: differences in markers of atherosclerosis. BMC Cardiovasc Disord. 2011;11:36.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Compostella L, Compostella C, Truong LV, Russo N, Setzu T, Iliceto S, et al. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol. 2017;24(5):460–7.PubMedCrossRefGoogle Scholar
  80. 80.
    Ventus D, Jern P. Lifestyle factors and premature ejaculation: are physical exercise, alcohol consumption, and body mass index associated with premature ejaculation and comorbid erectile problems? J Sex Med. 2016;13(10):1482–7.PubMedCrossRefGoogle Scholar
  81. 81.
    Yang YQ, Xu Q, Tong WJ, Gao CL, Li HM. Sexual dysfunction among Chinese nurses: prevalence and predictors. Biomed Environ Sci. 2017;30(3):229–34.PubMedGoogle Scholar
  82. 82.
    Çayan S, Yaman Ö, Orhan İ, Usta M, Başar M, Resim S, et al. Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women. Eur J Obstet Gynecol Reprod Biol. 2016;203:303–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Amidu N, Owiredu WK, Woode E, Addai-Mensah O, Quaye L, Alhassan A, et al. Incidence of sexual dysfunction: a prospective survey in Ghanaian females. Reprod Biol Endocrinol. 2010;8:106.PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Nazarpour S, Simbar M, Ramezani Tehrani F, AlaviMajd H. Sexual function and exercise in postmenopausal women residing in Chalous and Nowshahr, Northern Iran. Iran Red Crescent Med J. 2016;18(5):e30120.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Paiva CE, Rezende FF, Paiva BS, Mauad EC, Zucca-Matthes G, Carneseca EC, et al. Associations of body mass index and physical activity with sexual dysfunction in breast cancer survivors. Arch Sex Behav. 2016;45(8):2057–68.PubMedCrossRefGoogle Scholar
  86. 86.
    Smits A, Smits E, Lopes A, Das N, Hughes G, Talaat A, et al. Body mass index, physical activity and quality of life of ovarian cancer survivors: time to get moving? Gynecol Oncol. 2015;139(1):148–54.PubMedCrossRefGoogle Scholar
  87. 87.
    Vafaeimanesh J, Raei M, Hosseinzadeh F, Parham M. Evaluation of sexual dysfunction in women with type 2 diabetes. Indian J Endocrinol Metab. 2014;18(2):175–9.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Ioakeimidis N, Samentzas A, Vlachopoulos C, Aggelis A, Stefanadis C, Tousoulis D. Chronotropic incompetence and dynamic postexercise autonomic dysfunction are associated with the presence and severity of erectile dysfunction. Ann Noninvasive Electrocardiol. 2016;21(3):256–62.PubMedCrossRefGoogle Scholar
  89. 89.
    Lamina S, Okoye CG, Dagogo TT. Therapeutic effect of an interval exercise training program in the management of erectile dysfunction in hypertensive patients. J ClinHypertens (Greenwich). 2009;11(3):125–9.CrossRefGoogle Scholar
  90. 90.
    Lamina S, Okoye CG, Dagogo TT. Managing erectile dysfunction in hypertension: the effects of a continuous training programme on biomarker of inflammation. BJU Int. 2009;103(9):1218–21.PubMedCrossRefGoogle Scholar
  91. 91.
    Kałka D, Domagała Z, Rusiecki L, Karpiński Ł, Gebala J, Kolęda P, et al. Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease. Anatol J Cardiol. 2016;16(4):256–63.PubMedGoogle Scholar
  92. 92.
    Kalka D, Domagala ZA, Kowalewski P, Rusiecki L, Koleda P, Marciniak W, et al. Effect of endurance cardiovascular training intensity on erectile dysfunction severity in men with ischemic heart disease. Am J Mens Health. 2015;9(5):360–9.PubMedCrossRefGoogle Scholar
  93. 93.
    Kałka D, Domagała Z, Dworak J, Womperski K, Rusiecki L, Marciniak W, et al. Association between physical exercise and quality of erection in men with ischaemic heart disease and erectile dysfunction subjected to physical training. Kardiol Pol. 2013;71(6):573–80.PubMedCrossRefGoogle Scholar
  94. 94.
    Begot I, Peixoto TC, Gonzaga LR, Bolzan DW, Papa V, Carvalho AC, et al. A home-based walking program improves erectile dysfunction in men with an acute myocardial infarction. Am J Cardiol. 2015;115(5):571–5.PubMedCrossRefGoogle Scholar
  95. 95.
    Cho DY, Yeo JK, Cho SI, Jung JE, Yang SJ, Kong DH, et al. Exercise improves the effects of testosterone replacement therapy and the durability of response after cessation of treatment: a pilot randomized controlled trial. Asian J Androl. 2017;19(5):602–7.PubMedCrossRefGoogle Scholar
  96. 96.
    Khoo J, Tian HH, Tan B, Chew K, Ng CS, Leong D, et al. Comparing effects of low- and high-volume moderate-intensity exercise on sexual function and testosterone in obese men. J Sex Med. 2013;10(7):1823–32.PubMedCrossRefGoogle Scholar
  97. 97.
    Maresca L, D'Agostino M, Castaldo L, Vitelli A, Mancini M, Torella G, et al. Exercise training improves erectile dysfunction (ED) in patients with metabolic syndrome on phosphodiesterase-5 (PDE-5) inhibitors. Monaldi Arch Chest Dis. 2013;80(4):177–83.PubMedCrossRefGoogle Scholar
  98. 98.
    Condorelli RA, Calogero AE, Di Mauro M, Mongioì LM, Russo GI, Morgia G, et al. Effects of tadalafil treatment combined with physical activity in patients with low onset hypogonadism: results from a not-randomized single arm phase 2 study. Aging Male. 2016;19(3):155–60.PubMedCrossRefGoogle Scholar
  99. 99.
    Kirilmaz U, Guzel O, Aslan Y, Balci M, Tuncel A, Atan A. The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus. Aging Male. 2015;18(4):244–8.PubMedCrossRefGoogle Scholar
  100. 100.
    Maio G, Saraeb S, Marchiori A. Physical activity and PDE5 inhibitors in the treatment of erectile dysfunction: results of a randomized controlled study. J Sex Med. 2010;7(6):2201–8.PubMedCrossRefGoogle Scholar
  101. 101.
    Lamina S, Agbanusi E, Nwacha RC. Effects of aerobic exercise in the management of erectile dysfunction: a meta-analysis study on randomized controlled trials. Ethiop J Health Sci. 2011;21(3):195–201.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Silva AB, Sousa N, Azevedo LF, Martins C. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med. 2017;51(19):1419–24.PubMedCrossRefGoogle Scholar
  103. 103.
    Halis F, Yildirim P, Kocaaslan R, Cecen K, Gokce A. Pilates for better sex: changes in sexual functioning in healthy Turkish women after pilates exercise. J Sex Marital Ther. 2016;42(4):302–8.PubMedCrossRefGoogle Scholar
  104. 104.
    Kim HN, Ryu J, Kim KS, Song SW. Effects of yoga on sexual function in women with metabolic syndrome: a randomized controlled trial. J Sex Med. 2013;10(11):2741–51.PubMedCrossRefGoogle Scholar
  105. 105.
    Anderson D, Seib C, McGuire A, Porter-Steele J. Decreasing menopausal symptoms in women undertaking a web-based multi-modal lifestyle intervention: the Women’s Wellness Program. Maturitas. 2015;81(1):69–75.PubMedCrossRefGoogle Scholar
  106. 106.
    Lara LA, Ramos FK, Kogure GS, Costa RS, Silva de Sá MF, Ferriani RA, et al. Impact of physical resistance training on the sexual function of women with polycystic ovary syndrome. J Sex Med. 2015;12(7):1584–90.PubMedCrossRefGoogle Scholar
  107. 107.
    Lorenz TA, Meston CM. Acute exercise improves physical sexual arousal in women taking antidepressants. Ann Behav Med. 2012;43(3):352–61.PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Lorenz TA, Meston CM. Exercise improves sexual function in women taking antidepressants: results from a randomized crossover trial. Depress Anxiety. 2014;31(3):188–95.PubMedPubMedCentralCrossRefGoogle Scholar
  109. 109.
    Claudino MA, Delbin MA, Franco-Penteado CF, Priviero FB, De Nucci G, Antunes E, et al. Exercise training ameliorates the impairment of endothelial and nitrergic corpus cavernosum responses in diabetic rats. Life Sci. 2011;88(5–6):272–7.PubMedCrossRefGoogle Scholar
  110. 110.
    La Favor JD, Anderson EJ, Dawkins JT, Hickner RC, Wingard CJ. Exercise prevents Western diet-associated erectile dysfunction and coronary artery endothelial dysfunction: response to acute apocynin and sepiapterin treatment. Am J Physiol Regul Integr Comp Physiol. 2013;305(4):R423–34.PubMedPubMedCentralCrossRefGoogle Scholar
  111. 111.
    Meldrum DR, Gambone JC, Morris MA, Meldrum DAN, Esposito K, Ignarro LJ. The link between erectile and cardiovascular health: the canary in the coal mine. Am J Cardiol. 2011;108(4):599–606.PubMedCrossRefGoogle Scholar
  112. 112.
    Buga GM, Gold ME, Fukuto JM, Ignarro LJ. Shear stress-induced release of nitric oxide from endothelial cells grown on beads. Hypertension. 1991;17(2):187–93.PubMedCrossRefGoogle Scholar
  113. 113.
    Zheng H, Mayhan WG, Patel KP. Exercise training improves the defective centrally mediated erectile responses in rats with type I diabetes. J Sex Med. 2011;8(11):3086–97.PubMedPubMedCentralCrossRefGoogle Scholar
  114. 114.
    Haram PM, Adams V, Kemi OJ, Brubakk AO, Hambrecht R, Ellingsen O, et al. Time-course of endothelial adaptation following acute and regular exercise. Eur J Cardiovasc Prev Rehab. 2006;13(4):585–91.CrossRefGoogle Scholar
  115. 115.
    Ignarro LJ, Balestrieri ML, Napoli C. Nutrition, physical activity and cardiovascular disease: an update. Cardiovasc Res. 2007;73(3):326–40.PubMedCrossRefGoogle Scholar
  116. 116.
    Ozbek E, Tasci AI, Ilbey YO, Simsek A, Somay A, Metin G. The effect of regular exercise on penile nitric oxide synthase expression in rats. Int J Androl. 2010;33(4):623–8.PubMedGoogle Scholar
  117. 117.
    Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143–211.PubMedPubMedCentralGoogle Scholar
  118. 118.
    Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766–78.PubMedPubMedCentralCrossRefGoogle Scholar
  119. 119.
    Viigimaa M, Doumas M, Vlachopoulos C, Anyfanti P, Wolf J, Narkiewicz K, et al. Hypertension and sexual dysfunction: time to act. J Hypertens. 2011;29(2):403–7.PubMedCrossRefGoogle Scholar
  120. 120.
    Manolis AJ, Doumas M, Viigimaa M, Narkiewitz K. Hypertension and sexual dysfunction. European Society of Hypertension Scientific Newsletter: Update on Hypertension Management. 2007;8Google Scholar
  121. 121.
    Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. Management of arterial hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.PubMedCrossRefGoogle Scholar
  122. 122.
    Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27:2121–58.PubMedCrossRefGoogle Scholar
  123. 123.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.PubMedCrossRefGoogle Scholar
  124. 124.
    Sánchez-Cruz JJ, Cabrera-León A, Martín-Morales A, Fernández A, Burgos R, Rejas J. Male erectile dysfunction and health-related quality of life. Eur Urol. 2003;44(2):245–53.PubMedCrossRefGoogle Scholar
  125. 125.
    Fujisawa M, Sawada K, Okada H, Arakawa S, Saito S, Kamidono S. Evaluation of health-related quality of life in patients treated for erectile dysfunction with viagra (sildenafil citrate) using SF-36 score. Arch Androl. 2002;48(1):15–21.PubMedCrossRefGoogle Scholar
  126. 126.
    Litwin MS, Nied RJ, Dhanani N. Health-related quality of life in men with erectile dysfunction. J Gen Intern Med. 1998;13(3):159–66.PubMedPubMedCentralCrossRefGoogle Scholar
  127. 127.
    Intili H, Nier D. Self-esteem and depression in men who present with erectile dysfunction. Urol Nurs. 1998;18(3):185–7. 208.PubMedGoogle Scholar
  128. 128.
    Pozzo MJ, Mociulsky J, Martinez ET, Senatore G, Farias JM, Sapetti A, et al. Diabetes and quality of life: initial approach to depression, physical activity, and sexual dysfunction. Am J Ther. 2016;23(1):e159–71.PubMedCrossRefGoogle Scholar
  129. 129.
    Jønler M, Moon T, Brannan W, Stone NN, Heisey D, Bruskewitz RC. The effect of age, ethnicity and geographical location on impotence and quality of life. Br J Urol. 1995;75(5):651–5.PubMedCrossRefGoogle Scholar
  130. 130.
    Shabsigh R, Klein LT, Seidman S, Kaplan SA, Lehrhoff BJ, Ritter JS. Increased incidence of depressive symptoms in men with erectile dysfunction. Urology. 1998;52(5):848–52.PubMedCrossRefGoogle Scholar
  131. 131.
    Müller MJ, Ruof J, Graf-Morgenstern M, Porst H, Benkert O. Quality of partnership in patients with erectile dysfunction after sildenafil treatment. Pharmacopsychiatry. 2001;34(3):91–5.PubMedCrossRefGoogle Scholar
  132. 132.
    Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: The female experience of men’s attitudes to life events and sexuality (FEMALES) study. J Sex Med. 2005;2(5):675–84.PubMedCrossRefGoogle Scholar
  133. 133.
    Öberg K, Fugl-Meyer KS. On Swedish women’s distressing sexual dysfunctions: some concomitant conditions and life satisfaction. J Sex Med. 2005;2(2):169–80.PubMedCrossRefGoogle Scholar
  134. 134.
    Seidman SN, Roose SP, Menza MA, Shabsigh R, Rosen RC. Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate. Am J Psychiatry. 2001;158(10):1623–30.PubMedCrossRefGoogle Scholar
  135. 135.
    Moncada I, Martinez-Jabaloyas JM, Rodriguez-Vela L, Gutierrez PR, Giuliano F, Koskimaki J, et al. Emotional changes in men treated with sildenafil citrate for erectile dysfunction: A double-blind, placebo-controlled clinical trial. J Sex Med. 2009;6(12):3469–77.PubMedCrossRefGoogle Scholar
  136. 136.
    McLaughlin T, Harnett J, Burhani S, Scott B. Evaluation of erectile dysfunction therapy in patients previously nonadherent to long-term medications: a retrospective analysis of prescription claims. Am J Ther. 2005;12(6):605–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Konstantinos P. Imprialos
    • 1
  • Konstantinos Stavropoulos
    • 1
  • Michael Doumas
    • 1
  1. 1.2nd Propedeutic Department Internal MedicineHippokration HospitalThessalonikiGreece

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