Adopt a Mediterranean diet, engage in regular cardiovascular and resistance exercise (especially large muscle groups), manage blood pressure and diabetes, and ensure adequate sleep and early morning light exposure to boost testosterone. These foundational health practices are crucial for overall well-being and sexual function, and quitting smoking/vaping is essential as they impair erections.
If experiencing symptoms like painful urination, pain with erections/ejaculation, or difficulty emptying, consult a urologist or pelvic floor specialist for assessment. Ensure the therapist is certified in pelvic floor physical therapy and experienced with your specific gender’s anatomy.
Discuss sexual preferences (likes/dislikes) with your partner in a neutral setting outside the bedroom, using ‘I’ statements to avoid blame. Understand that these are ongoing, multi-conversation processes that may require patience and potentially the help of a sex therapist (find one at AASECT.org).
Drink 2-3 liters of water daily, ensure complete bladder emptying (sitting, relaxing, leaning forward, or double voiding), and avoid spermicides. For women with low estrogen, consider vaginal estrogen (cream, suppository, or ring) 2-3 times weekly, and a soluble cranberry supplement with 36mg of PACs daily or 2 grams of D-mannose daily may also reduce UTI risk.
Avoid douching and excessive cleaning, as the vagina is a self-cleaning organ, and such practices can disrupt its natural microbiome and pH, increasing infection risk. Only wash hair-bearing external areas with soapy water, and seek evaluation for new, strong, or fishy odors, or changes in discharge (e.g., cottage cheese-like), itching, or discomfort.
Understand that pornography is a produced product that can set unrealistic expectations for sexual encounters. To avoid habituation and potential difficulty with real-world arousal, vary your masturbation techniques and the types of stimulation you seek.
If you have a tight pelvic floor, consider massage, vaginal dilators, or muscle relaxant suppositories (Valium, Baclofen) for temporary relief. The most effective approach is working with a pelvic floor physical therapist who can teach specific exercises like ‘happy baby pose’ to lengthen and down-train the muscles.
Overdoing Kegel exercises can lead to a tight pelvic floor and dysfunction, so if you experience adverse symptoms or are unsure, consult a pelvic floor physical therapist to ensure correct technique and necessity. Strengthening is beneficial for a weak pelvic floor, but detrimental if already strong or over-trained.
For weak pelvic floor, stress urinary incontinence, or pelvic organ prolapse, squeeze pelvic floor muscles (like stopping urine flow or lifting the penis) for 5 seconds, relax for 5, doing 10-15 repetitions, 1-3 times daily. Start lying down to focus on the muscles, then progress to sitting and standing as strength improves.
For prostate health and urinary symptoms (urgency, frequency, difficulty emptying), consider medications like daily low-dose Cialis (Tadalafil) or Flomax as prescribed by a doctor. Additionally, pay attention to and potentially limit bladder irritants such as caffeine, alcohol, carbonated beverages, spicy foods, and acidic foods.
Increase fluid intake to 2-3 liters daily, reduce oxalate-rich foods (e.g., spinach, rhubarb, excessive nuts), increase citrate (e.g., fruits, vegetables, Crystal Light), and decrease high-purine protein intake (e.g., red meats). If you have a stone, get a 24-hour urine analysis to identify metabolic abnormalities for targeted treatment, and seek immediate medical attention for fever, chills, or blood in urine.
To mitigate genital numbness, erectile dysfunction, or decreased arousal from cycling, ensure proper posture and use a noseless, wider bike seat that supports your ischial tuberosities. Avoid leaning forward (aero riding) and bike seats with cutouts, as these can increase pressure on the pudendal nerve and artery.
When engaging in anal sex, always use a condom and adequate, isoosmolar lubrication, as the anal tissue is thin and friable, increasing STI transmission risk. Take your time, start with smaller items, and never force penetration to avoid trauma.
Recognize that desire (wanting to have sex) and arousal (physical signs like nipple erection or lubrication) are distinct and don’t always occur in the same order. It’s normal for arousal to precede desire, especially for some women, so understand both components of sexual response.
For men, daily low-dose Tadalafil (2.5-5mg) can be an effective treatment for erectile dysfunction, especially with psychogenic issues, and is also effective for enlarged prostate (BPH). It can be tried off-label for women with sexual dysfunction and vascular issues for at least a four-week trial, but always consult a physician.
If experiencing low libido, pelvic pain, or other sexual dysfunction while on oral contraceptives, discuss alternative contraception methods like IUDs with your doctor. Oral contraceptives can increase sex hormone binding globulin (SHBG), reducing free testosterone and estrogen, which may persist for at least four months after discontinuation.
If experiencing sexual dysfunction from SSRIs, discuss with your doctor reducing the SSRI dose, switching to an antidepressant with fewer sexual side effects (e.g., Wellbutrin), or adding medications like Cialis or Viagra to manage symptoms if the SSRI cannot be changed.
For women with low libido and clinically low testosterone, consider off-label transdermal testosterone (e.g., 1/10th of an Androgel tube on a hairless area like the calf or buttock) to improve overall desire. For vestibulodynia (pain in the vaginal vestibule), a compounded estrogen-testosterone cream applied locally can reduce discomfort, but always consult a physician.
For premenopausal women experiencing low sexual desire disorder, discuss with a physician the FDA-approved injectable medication Vyleesi (bremelanotide), taken 45 minutes before desired sexual activity, or the daily oral medication Addyi (flibanserin) at 100mg before bedtime. Both can increase desire, but require a prescription and may be costly.
If you experience priapism (an erection lasting longer than four hours without sexual arousal), seek immediate emergency medical attention. This is a medical emergency that can lead to decreased blood flow and permanent tissue damage if not treated promptly.
Practice diaphragmatic breathing during exercise, exhaling on the effort (e.g., during a crunch or squat). This helps stabilize the pelvic floor by contracting it during increased intra-abdominal pressure, preventing strain and potential dysfunction.
When trying supplements for sexual function, introduce them one at a time to identify their specific effects, and understand that benefits typically build over time rather than being immediate. Consult reputable resources like examine.com for evidence-based information on efficacy.