Figure 1 How bicycle riding can affect the nerves and arteries to the penis
When I was undergoing my medical training, one of my mentors (a great former penis doctor) asked our eager team of students, “What is the most important organ in the body?” We thought for a second, and then the most eager (and most cutthroat) shouted out “the heart!” “Yes, indeed,” said the professor. “And do you know why the heart is the most important organ in the body? Because it pumps blood to the penis!”
Of course, the heart pumps blood to every body part, and every part is important, but let’s face it, the penis is in a class by itself. Exercise is critical to penis health because it keeps the heart and blood vessels strong and healthy and, the better they pump and flow, the better things are for your penis. Exercise not only strengthens the heart muscle, it releases a cascade of molecules that protects the blood vessels from disease. Exercise also helps you cut fat, which is a source of toxins for your chubby and a drain on your testosterone. Almost all exercise is good for the penis, but there are specific situations where exercise may cause more harm than good. Although the penis is not a muscle, much of it is surrounded by specialized muscles. Exercises of these specific muscles—let’s call them “sexercises”—can help keep the penis pumping stronger and longer.
When you sit on the couch all day, you don’t just get soft, you actually get inflamed. Being sedentary allows you to accumulate actual inflammatory molecules in your bloodstream that hurt those precious penis blood vessels, turning you into a couch potato spud—not stud. Fortunately, exercise clears the inflammatory molecules from your blood. When your muscles contract, they release molecules that spring into action, fighting back the inflammatory molecules and restoring nitric oxide (NO) to the blood vessels. Additionally, the sheer force of blood pumping through the blood vessels during exercise results in molecules being released that pump up the NO.1
The more you exercise, the more you win this war against inflammation. Of course, like anything, you can overdo it and push so hard you get tissue damage, which is a whole different kind of inflammation. This is occasionally seen in marathoners or other extreme endurance athletes. But for the vast majority of us, overdoing it is not the concern. We have to get off the couch if we want quality time in bed. Study after study show that exercise prevents erection problems. A study demonstrated that even if you account for age, smoking, obesity, and cholesterol, the fitness and activity level of a guy is incredibly important for his sexual function. Inactive men had more than 10 times the risk of having erection problems compared to active guys. And it matters how fit you are. Merely “tolerably fit” guys had four times the risk of problems, compared to guys whose fitness was measured as “good.”2
Exercise can reverse erection problems, even in men for whom pills such as Viagra or Cialis fail!3 The amazing thing about exercise is that it seems to have a benefit to the penis that is not just related to weight loss or lower blood pressure. Even if a person is thin, he may have better erections with exercise versus without. Guys who don’t exercise seem to have more adrenaline-like signals constricting their penis bloodflow even when they are resting.4
Even men who control their blood pressure and cholesterol with medication will still have better erections with exercise.5
And the more, the better. Compared to long walks at sunset, vigorous exercise for an hour three or four times a week resulted in substantially better erections.6 So no cheating—get out there and get pumped!
Are you too sexy for your shirt? Or just too big for it? When you look down, can you still see Mr. Happy? Overweight is the new thin, and obesity is at epidemic proportions. That spare tire isn’t just embarrassing at the beach; it is actually making you sick. The fat cells themselves are like little factories that belch pollution into your bloodstream. These “free radicals” are inflammatory, and they go to work destroying your circulation. They go by the names of tumor necrosis factor alpha (TNF-a), interleukin 6 (IL-6), C-reactive protein (CRP), and arginase. They cause your body to stop responding to insulin, which then leads to the metabolic syndrome and diabetes. These molecules, along with excess cholesterol and other fats, increase plaque buildup in the walls of the blood vessels. Perhaps most importantly, they directly decrease the production of NO, which is the key trigger to bloodflow throughout all blood vessels and to your penis. So excess fat isn’t just hiding your penis, it’s hurting it too.
A gut also increases the risk of high blood pressure and can even lower testosterone. Guys have to lose the gut if they want to keep the spark. Fortunately, many studies prove that staying lean prevents erection problems and losing weight can restore your chubby. It turns out that overweight men as measured with a body mass index (BMI) of 25 to 30 have a 30 percent chance of having erection problems, and that number goes up as the BMI goes up. A BMI above 30 is considered obese. Losing weight significantly restored normal sexual function in men in clinical trials. Furthermore, these guys benefited from an increase in testosterone and improvement in blood pressure.7, 8
Contrary to popular belief, lifting weights does not boost your testosterone in a meaningful way. It is true that the muscles will release micro amounts of testosterone as they are actively straining, but not enough to make a measurable difference over the course of a day. Excess fat will lower testosterone by converting it to estrogens, which are female hormones. Exercise helps you burn off excess fat so, in this way, exercise can help raise your testosterone. This is true whether we are talking about weight training or cardiovascular conditioning.9 Exercise taken to an extreme, however, can actually lower your testosterone. Elite endurance athletes often have testosterone levels at the lower end of the range. Soldiers subjected to severe boot camp training do as well. This is probably a “low-battery mode” type of mechanism of the body to preserve itself in extreme states since testosterone makes the body utilize energy to build up tissues.10
Not all exercise is created equal, and one exercise may even hurt your erections. That exercise is bicycle riding. Now, this is a bit of a tricky area because there is no question that bicycle riding is an excellent way to promote your cardiovascular conditioning. It gets the heart working and the blood pumping with that great cascade of molecules that improves the health of your penis but ever notice that sometimes your nub gets numb after a good bike ride? This can be a problem. The nerves can get pinched and injured from what is otherwise great exercise.
Unfortunately, the traditional bicycle seat is perfectly shaped to press right on the very tips of your ischial tuberosities, the butt bones you feel when you sit on something hard. The problem here is that the arteries and the nerves that go to your penis run right along the rim of these bones and get squeezed from the pressure of the bike seat. Not only that, the nose of the bike seat pushes up towards your pubic bone as you lean forward on the seat, and this squeezes the nerves of the penis. These nerves start in the spine and have to wrap around the rim of your pelvic bones to get to the penis, and leaning forward on a bicycle also stretches those nerves a bit. Between the pressure on the butt bones, the pressure on the pubic bone, and the overall stretch, the nerves get injured and you may start to feel numbness in your penis. You may also feel it in your scrotum and even behind your scrotum, in the perineum. In some cases you may have trouble feeling your urine pass.
The more you ride, the more likely you are to get this numbness. It’s like sitting on a toilet seat too long and having your legs go numb. Up to 70 percent of competitive cyclists have complained of this.11 It is usually a temporary annoyance, lasting hours to days, depending on how intensely you are riding. Every now and then, a biker will get a nerve injury that takes months or years to heal. In a small percentage of men there can be a loss of erections and sexual enjoyment. When the bike seat is pinching the nerves, it is also pinching the arteries that pump blood to the penis. In fact, the bloodflow to the penis drops by 70 percent!12
Decreased bloodflow to the penis during bicycle riding can result in erection problems later because the tissues inside the penis don’t like getting suffocated like that and the cells react by making more collagen, which is hard, like scar tissue, and doesn’t stretch very well. As a result, the penis can become less able to stretch and fill with blood, which is what an erection is all about. These changes are gradual and may sneak up on you. A study of bicycle cops showed that all of the policemen in the study experienced an abnormal decrease in their erections while they were asleep even though they did not notice erection problems when they were awake and trying.13 For most casual bike riders, nerve and blood-flow problems are not an issue, but the more you ride, the greater the risk. An analysis of men from various walks of life did show improvement in erections with moderate riding, likely due to the general exercise benefit to the heart and blood vessels, but once men rode more than 3 hours a week, a gradual drop-off began. The most at risk are competitive riders, with up to 24 percent developing erectile dysfunction.14 About 13 percent of amateur riders will have trouble.15
Fortunately, there is a fix. Newer bicycle seats have been designed that take the pressure off—somewhat. These are split seats with no nose or a downward-pointing nose, which takes pressure off the pubic bone. Even so, some men are built so that the nerves and blood vessels still get pinched on the butt bones that sit on those split seats. If you still feel numbness, then go for a more padded split seat. Also, riding in a standing position keeps the pressure off and improves bloodflow. Taking frequent breaks to take off the pressure and restore bloodflow is a good idea if you are getting symptoms. Another option is to ride a recumbent bike, which doesn’t put any pressure on the nerves or arteries since you don’t lean forward. If you find after a hard ride that you go soft, give bicycling a rest and later, you will typically be able to get back in the saddle (and get back in the other saddle).
Figure 1 How bicycle riding can affect the nerves and arteries to the penis
So how fit do you have to be to have sex? Can sex be dangerous if you have a weak heart? The answer is that sex is almost never too much for anyone’s heart. In fact, less than 1 percent of sudden deaths due to heart attacks are due to sex!16 Even if you have had a heart attack and are a higher-risk heart patient, the risk is only barely higher than 1 percent (besides, there are worse ways to go). When scientists measure exactly how much energy it takes to have sex they use a measurement called a MET, which stands for “metabolic equivalent” of energy expended. When a person is running a treadmill stress test to see how strong his heart is, he may expend up to 13 or 14 METs, but when he has sex, the energy expended is more like 2 to 4 METs, about the equivalent of walking up two flights of stairs. (According to my wife, it’s like I use the elevator.) Now, this does not apply to the acrobatic sex depicted in porn and perhaps attempted by honeymooners and show-offs. But for the vast majority of us, sex is not the workout we may think it is. The energy expended during orgasm adds an extra MET or two, depending on the intensity. Younger folks will tend to steam up the windows a bit more than older folks. If you are into energy conservation, you can drop a MET when your partner is on top. Heart rates seem to peak at about 130 beats per minute for an aggressive missionary, but drop down to 110 when you are lying back and enjoying the show.17
The penis is not a muscle, but it is largely surrounded by muscles that spring into action during sex, and these can be exercised to a degree. There are muscles at the base of the penis that squeeze during orgasm and help to propel the semen during ejaculation. They go by the names bulbospongiosus muscle and ischiocavernosis muscle. These muscles are at the base of your pelvis, between the back of your scrotum and your anus, an area officially called the perineum but commonly referred to as the taint “(‘tain’t your balls and ’tain’t your ass). When these muscles squeeze, they also compress the blood chambers of the penis at its base and make the pressure in the erection spike, causing the visible “throb” of an erection. The compression also helps keep the blood trapped in the penis so it doesn’t leak out the veins and deflate the erection. It turns out that if you strengthen these muscles, you can actually reverse erectile dysfunction, if not prevent it.
Figure 2 Pelvic muscles that cause ejaculation
You can work out your sex muscles with special exercises called Kegel exercises. Kegel exercises consist of voluntarily squeezing these muscles. The squeeze is basically the movement you make when you are trying to stop yourself from having a bowel movement or from peeing. When you are doing a Kegel squeeze, avoid using other muscles such as your abdominal muscles or your gluteus maximus (butt muscles.) After all, you wouldn’t do an abdominal crunch if you were trying to hold in your poop. Squeezing your butt muscles doesn’t hurt anything, but it distracts you from feeling and focusing on the target muscles in your perineum. If you stand in front of a mirror when you do Kegel exercises, you should see your penis pull in and lift slightly at the base. Studies have shown that some men get the same benefit from 3 months of Kegel exercises as they do from Viagra!18
The Kegel is a stealth exercise. When you are doing it right, no one but you can tell. You can do Kegel exercises anywhere, anytime, in front of anyone—and only you will know. There are many variations on Kegel workouts, but one of the simpler ones is to hold for 10 seconds, then release slowly for 10 seconds, then repeat. A good workout would be three to five sets of 10 reps each over the course of the day. You can also do short 1- to 2-second squeezes more frequently, and you can see how long you can hold one long squeeze. Perform these exercises first standing, then sitting, then lying on your back, then on all fours. You can mix it up. Hey, it’s your pelvis—have fun!
In addition to greater erection strength, other benefits of doing Kegel exercises can be greater control during sex and possibly a more intense orgasm or ejaculation. In a study of men who had premature ejaculation, the men were taught to do Kegel exercises, along with biofeedback sessions with a pelvic physical therapist in which special probes allowed them to really isolate the feeling of their Kegel muscles (yeah, you know where those probes went). These men went on to have better control and keep from ejaculating as quickly.19 The idea is that because these men were more familiar with the way their perineal muscles feel when they contract, they could feel when there was mounting tension and deliberately relax those muscles to prevent the onrush of the climax and ejaculation. Another strategy is to contract those muscles strenuously just before reaching the point of no return as way of “rebooting” them before the unwanted contraction rushes on.20
As far as intensity of orgasm and ejaculation, scientists have determined that part of the pleasure a man feels during ejaculation is from the pressure created in the base of the urethra when the sex muscles are squeezing it. These squeezes during ejaculation are not under your voluntary control, they are a complex reflex, but some claim that one can enhance the intensity of the ejaculation by voluntarily squeezing these muscles as well. It’s like deliberately kicking harder when the doctor taps your knee with the little hammer. Does it really work? Well, try it and find out.
Kegel exercises are good for your partner too. For women, strengthening the targeted muscles can increase the tone or tightness of the vagina. They surround the vagina as it passes through the pelvic floor, holding it in place. The added tone in these muscles may enhance a woman’s orgasm intensity because, just as in a guy, these muscles squeeze during her climax. Other benefits of strengthening the pelvic floor muscles with Kegel exercises include preventing accidental urinary leakage (incontinence), which might happen when someone coughs or sneezes or even just rises to a standing position. Stronger pelvic muscles can also keep a woman’s uterus and rectum from dropping. These muscles do weaken over the years due to age, childbirth, excess weight, and gravity, so the sooner a person starts, the better.