Electronic Journal of Human Sexuality, Volume 17, September 23, 2014

Linking Exercise and Sexual Satisfaction among Healthy Adults

Alexandra Marshall, Ph.D., M.P.H., CHES
Assistant Professor, Department of Health Behavior & Health Education
University of Arkansas for Medical Sciences

Duston Morris, Ph.D., M.S., CHES
Assistant Professor, Department of Health Sciences
University of Central Arkansas

Jacquie Rainey, DrPH, M.S., MCHES
Professor, Department of Health Sciences
University of Central Arkansas

Contact and Additional Information to be addressed to: Alexandra Marshall
Fay W. Boozman College of Public Health, UAMS
4301 W. Markham Street, slot 820 Little Rock, AR 72205
Email: smarshall(at)uams.edu
Fax: 501-526-6709, Phone: 501-526-6623

Abstract

The purpose of the study was to examine the relationship between exercise and physical activity (PA) and markers of sexual satisfaction. There were 509 male and female participants ages 18-74 who completed a 30-item questionnaire. Exercise/PA was measured using performance indicators of frequency, intensity, duration, and mode. Sexual satisfaction was measured by self-reported overall sexual satisfaction, overall satisfaction with quality of orgasm, and overall satisfaction with number of orgasms. Results of the study according to Chi-square demonstrated that there was not a significant association between overall sexual satisfaction and the different levels of frequency, intensity, and modes of exercise/PA. However Spearman’s rho correlation demonstrated a significant relationship between overall sexual satisfaction, satisfaction with orgasm, satisfaction with number of orgasms, and levels of frequency for all modes of exercise/PA (i.e., sports, aerobics, recreation, and strength training).

Introduction

Continued quality of life across the lifespan is the universal ideal for most people. The decline of biologic, cognitive, and social factors makes the concept of aging less appealing (Branch, Katz, & Kniepman, 1984). Specifically, one of the most unappealing factors related to aging is the decline in sexual functioning in people of both sexes (Masters & Johnson, 1970).  For males, such loss has been related to erectile competence (Gupta et al., 2011), while the loss for females has been linked to untreated menopausal conditions and decreased social opportunities (Addis et al., 2006).  Both genders report a desire for increased sexual activity. In other words, what they currently report about their sexuality is unsatisfying (Rosen et al., 2009).

One of the most important factors contributing to quality of life for adults is sexuality (Robinson & Molzahn, 2007; Gelfand, 2000). Sexuality is consistently defined to include numerous interrelated factors such as biological, emotional, spiritual, intellectual, and sociocultural components (Johnson, 1998). Combined, these factors may improve healthy sexuality and overall quality of life for adults.  Sexuality is a major aspect of relational intimacy and incorporates sexual health indicators such as sexual performance and sexual satisfaction (Penhollow, Young, & Denny, 2009).

Research has shown an improvement in sexual health indicators among adults, particularly unhealthy adults, such as those who suffer from obesity, COPD, dyspareunia, or erectile dysfunction, as a result of increased physical activity. For example, Dabrowska, Drosdzol, Skrzypulec and Plinta (2010) demonstrated that females with and without sexual dysfunction improved on sexual performance scores related to participation in physical activity. Research by the National Institutes of Health indicates that most cases of ED are a result of several conditions such as heart disease which impairs healthy blood flow to the penis and diabetes which impacts genital nerve function (Esposito, et al., 2004). A Harvard study of 22,086 men showed that those who exercised vigorously 30 minutes per day were two and a half times less likely to suffer from ED as compared to men who had limited exercise/PA (Bacon, Mittleman, Kawachi, Glasser, & Rimm, 2006). 

However, little research has examined the relationship in sexual performance or sexual satisfaction as a result of physical activity among a broad population of healthy adults. One study by Meston (2000) addressed exercise/PA and only the female sexual response; findings from the study demonstrated that vigorous physical exercise/PA activated the woman’s sexual response. Another study by Penhollow and Young (2004) showed that specifically college-aged adults indicated that above average levels of fitness improved perceptions of sexual performance and sexual desirability. Bortz and Wallace (1999) demonstrated that improved fitness showed a strong positive correlation for sexual satisfaction among men.

The current study contributed to the literature by examining the relationship in sexual satisfaction as a result of exercise/PA among healthy adults. It was of particular interest to explore the relationship between frequency, intensity, duration, and mode of exercise/PA and sexual satisfaction of both men and women ages 18 to 74. The researchers identified four different exercise/PA performance indicators (i.e. frequency, intensity, duration and mode) that were associated with self-reported levels of improved sexual satisfaction.

While practitioners often speak about how exercise can reduce problems, such as managing Type II diabetes (Kashfi, Jeihooni, Rezaianzedeh, & Amini, 2012) or alleviating stress (Koplas, Shilling & Harper, 2012), it is important for health care providers/practitioners to consider the holistic benefits of exercise. The Health Belief Model (HBM) provides a conceptual framework for understanding a patient/client’s perceived benefits as it relates to the adoption of healthy behavior (Glanz, Rimer, & Viswanath, 2008). Individuals conduct an internal cost-benefit analysis of the new behavior to determine if the perceived benefits of the behavior outweigh the barriers of performing the behavior (Glanz, Rimer, & Viswanath, 2008).

Practitioners may need to identify the value placed on sexual function and sexual satisfaction among healthy adults. If sexual function and satisfaction are indeed highly valued as perceived benefits of exercise that will outweigh their perceived barriers to exercise, seeking such a reward may be the encouragement many adults need to start or to increase their participation in regular exercise. By being able to potentially determine exercise/PA indicators that are related to improvement in sexuality, practitioners may be more likely to identify exercises/PA that promote healthy sexual function and satisfaction among healthy adults. This may lead to longer lasting, more satisfying relationships and higher quality of life overall.

The purpose of the study was to explore and determine the possible link between different components of exercise/PA and markers of sexual satisfaction. If such a connection can be established, this will provide some initial evidence to support that exercise/PA behavior can be utilized as a perceived benefit within the HBM framework to promote the adoption of other healthy lifestyle characteristics.

Specific questions addressed in this study were: 1) Is mode of exercise/PA related to self-reported levels of sexual satisfaction? 2) Is there a link between exercise/PA duration and sexual satisfaction? 3) Does level of exercise/PA intensity influence sexual satisfaction? 4) Is there a link between exercise/PA frequency and sexual satisfaction?

The researchers developed four hypotheses that were addressed based on the proposed research questions and findings from previous studies. The specific hypotheses that were explored in this study are as follows: 1) Levels of sexual satisfaction will be significantly higher among adults who report higher frequency levels of exercise/PA as compared to adults who report lower frequency levels of exercise/PA. 2) Levels of sexual satisfaction will be significantly related among adults who participate in aerobic exercise/PA as compared to adults who participate in other modes (i.e., strength training, sports, and recreation) of exercise/PA. 3) Levels of sexual satisfaction will be significantly higher among adults who participate in higher levels of exercise/PA duration as compared to adults who participate lower levels of exercise/PA duration. 4) Levels of sexual satisfaction will be significantly higher among adults who participate in higher intensity levels of exercise/PA as compared to adults who participate in lower intensity levels of exercise/PA.

Methods

Research Design

The non-experimental research design for this study was conducted using quantitative methods by collecting data through the use of an online self-report survey. The data collected were used to provide descriptive and correlational analyses regarding the interaction between exercise/PA and sexual satisfaction. This approach was selected primarily for two reasons: 1) to achieve a higher level of confidentiality and anonymity regarding a sensitive topic (i.e., exercise/PA and sexuality), and 2) to achieve larger sample size by using a self-selected sample and a self-report survey.

Given the context of the study, this research design allowed the researchers to collect sensitive data on subjects with greater protection of the subjects’ privacy, without threatening the reliability of the study design.  Researchers (Ritter, Lorig, Laurent, & Matthews, 2004; Gosling, Vazire, Srivastava, & John, 2004) have demonstrated that internet samples are shown to be relatively diverse with respect to gender, socioeconomic status, geographic region, and age. Moreover, internet findings generalized across presentation formats are reliable, and are not adversely affected by non-serious or repeat responders, and are consistent with findings from traditional methods (Basnov, Kongsved, Bech, & Hjollund, 2009; Kongsved, Basnov, Holm-Christensen, & Hjollund, 2007). Based on these findings, the researchers concluded that Internet methods may contribute toward many areas of behavioral studies without jeopardizing validity, reliability, and response rates.

Subjects

Participants for this study were recruited by using online social networking sites, such as Facebook, Twitter, IamTri, Active.com, and an email listserv of triathlon clubs provided by the USA Triathlon Organization (USAT). Participants were adults between 18-74 years of age that either: a) viewed an ad containing an online invitation to the study via one of the social networking platforms, or b) received an invitation email through the USAT email listserv. 

The sample consisted of 509 respondents who completed the online survey (Table 1). The age of participants ranged from 18 to 74 years, with the highest percentage (23.6%) of the sample falling within the 18-24 age group. The sample was predominantly white (81%) with 45% of the sample being male and 55% of the sample being female. The majority of the sample (36%) had completed college while 37% had completed a post-graduate degree. There was a split with income level among the sample. Roughly 26% reported an annual income at less than twenty thousand dollars while the majority (50%) of the sample reported an annual income of $50,000 or more.

Procedures

This research was approved by the University’s Institutional Review Board. The recruitment of participants occurred through two Internet channels in the spring of 2013.

First, researchers used the email listserv provided by USAT to contact all USAT club organizers in each state across the United States. Researchers provided the USAT club organizers with an email which they could forward to their perspective members asking for their voluntary participation in the study. A link to the online survey was provided in the email. Participants clicked on this link, which redirected them to the online survey. Once redirected to this site, they were introduced to the 30-item questionnaire that asks various questions regarding exercise/PA, sexual satisfaction.

The participant then chose to proceed with the survey or chose to terminate participation at that point or at any other point during the completion of the questionnaire. Participation was anonymous and confidential. There were no personal identifiers collected. All information collected was assigned arbitrary code numbers via the Qualtrics database system which de-identified subjects' data.

Testing Instrument

The instrument used in the study was a self-report questionnaire which included demographic items, items related to sexual satisfaction, and items related to exercise/PA. Six items included on the questionnaire were derived from the Sexual History Form (SHF) (Nowinski & LoPiccolo, 1979).  Previous research that utilized these items from the SHF demonstrated the temporal stability ranged from .92 (Creti el al, 1988) to .98 (Libman et al, 1989). Originally the SHF was developed for clinical use but has often been used item-by-item to assess frequency of sexual behaviors and sexual functioning. For this study, four of the six items used from the SHF pertained to sexual satisfaction. Cronbach’s alpha for these four items was .96.  The additional two items addressed sexual functioning for men only and had a Cronbach’s alpha of 1.0.

Ten items were used from the Changes in Sexual Functioning Questionnaire (CSFQ). Total item correlations range from 0.45-0.60.  Cronbach’s alpha coefficient of internal reliability ranged from .90 for females to .89 for males (Keller, McGarvey & Clayton, 2006).

Two items that assessed perceived satisfaction with the number and quality of orgasms during sexual activity with a partner were taken from the Female Orgasm Scale (McIntyre-Smith & Fisher, 2010).   Internal consistency demonstrated a Cronbach’s alpha from .84-.86 across three different studies while item total correlations ranged from r=.41 to .77.  Reliability was also addressed over a four-week test-retest period with r=.82 (McIntyre-Smith & Fisher, 2010).

The researchers also developed four additional items to assess likelihood of orgasm and time between multiple orgasms (or refractory period) for both women and men. For the two items unique to women, the Cronbach’s alpha was .89.  For the two items given to men only, the Cronbach’s alpha was .97.

To measure exercise/PA, the researchers utilized three items from the Behavior Risk Factor Surveillance Survey (BRFSS) that addressed frequency, duration, and general level of physical activity related to each of the four modes (sports, aerobics, recreation, and strength training) of exercise/PA.   To measure perceived level of exertion for each mode of exercise/PA, the researchers created an item based on the Borg CR10 Scale.  This scale is an adaptation of the original Borg RPE Scale (Borg, 1970) and measures self-reported rate of perceived exertion (RPE) during exercise/PA. This scale ranges in number from 0-10, with 0 indicating no effort at all, while 10 identifies extreme intensity during exercise/PA (Borg, 1998).  These four items demonstrated a high level of consistency with a Cronbach’s alpha of .997.

Participation in sport, aerobics, recreation, and strength training was categorized as low, moderate and high frequency. Low frequency was defined as a range from “never to 2-3 times a month.” Moderate frequency was defined as a range from “once a week to 2-3 times a week.”  High frequency was defined as a range from “daily to more than once a day.” Duration in sport, aerobics, recreation, and strength training was also categorized as low, moderate, or high. Low duration was defined as “never or less than 30 minutes.” Moderate duration was defined as “approximately 30 minutes to 45-60 minutes”, and high duration was defined as “more than 60 minutes.” General level of physical activity participation as it related to sport, aerobics, recreation, and strength training was categorized as low, moderate, and high activity. Low activity was defined as “never or physically inactive or irregular activity.” Moderate activity was defined as “regular activity”, while high activity was defined as “regular and vigorous activity.” Additionally, the exercise item measuring perceived level of exertion was categorized as low intensity, moderate intensity, and high intensity based on the Borg CR10 Scale of 0-10. Low intensity was defined as “did not participate to light and easy breathing (0-2).” Moderate intensity was defined as “moderate breathing to becoming uncomfortable to breathe (3-6).” High intensity was defined as “very hard to breathe to impossible to maintain (7-10).” The final version of the instrument used to collect data for this study consisted of 30 questions.   Reliability of the data using Cronbach’s alpha for the scaled items was determined to be .927.     

Data Analysis

All data were collected via Qualtrics utilizing an online survey. Once the questionnaire was completed through the online link, data for each participant were automatically stored with no personal identifiers in this online database. Data were cleaned and then analyzed using SPSS to perform descriptive statistics to summarize data according to various demographic variables and determine measures of central tendencies regarding self-reported levels of exercise/PA and sexual satisfaction. Correlation analysis was used to test the statistical hypotheses and determine the strength of the relationship between exercise/PA and sexual satisfaction. 

Results

Frequency distribution for the sexual satisfaction variables of interest indicated that the majority (74%) of participants overall were satisfied with the number of orgasms they typically had during sexual activity with their partners. The majority (82%) were also satisfied with the quality of their orgasm. The frequency was more evenly distributed regarding the overall sexual satisfaction of participants with only 40% of the sample reporting being highly satisfied, 43% reported a moderate level of satisfaction, and 17% reported a low level of satisfaction.

Frequency distribution for exercise/PA indicated that the majority of participants (78%) reported low levels of participation in sports, such as basketball, football, softball, tennis or golf. Results determined that about half of the participants (51%) also reported low levels of participation in recreation; this included canoeing, hiking, fishing, hunting or leisurely walking. Half of participants (50%) had high levels of participation in aerobics, which included running, cycling, swimming, aerobics class or power walking. About half of participants (54%) reported moderate levels of participation in strength training; this included basic calesthenics, weight-lifting, yoga and pilates.

Chi-square tests of independence were performed to examine the relationship between overall sexual satisfaction and frequency of participation in aerobics, strength training, sports, and recreation. Results of the chi-square analyses revealed that there was no significant difference between overall sexual satisfaction and frequency of participation in aerobics (X2 (1, N = 431) = 4.94, p = .08), strength training (X2 (N = 431) = .72, p = .70), sports (X2 (N = 431) = 1.00, p = .61), or recreation (X2 (N = 431) = 3.25, p = .20). However, there was a positive trend in the direction of the hypotheses related to high frequency participation in exercise/PA and overall sexual satisfaction.  A general review of the data output indicated that the more frequently participants reported doing any type of exercise/PA, they also reported higher levels of sexual satisfaction as compared to those participants who reported lower frequency of exercise/PA.   

Participants were categorized into two groups on overall sexual satisfaction: satisfactory and unsatisfactory. Data was dichotomized into two groups (satisfactory vs. unsatisfactory) in order to have sufficient cell values for the Chi-square analyses (Table 2). Among those who reported being satisfied 52% reported high frequency of aerobic participation while 17% reported low frequency of aerobic participation. Among those who reported being satisfied 14% reported high frequency of strength training participation while 31% reported low frequency of strength training participation. Among those who reported being satisfied 8% reported high frequency of sport participation while 78% reported low frequency of sport participation. Among those who reported being satisfied 12% reported high frequency of recreation participation while 49% reported low frequency of recreation participation.   

Spearman’s rho analyses revealed a statistically significant relationship between overall sexual satisfaction, overall satisfaction with quality of orgasm, overall satisfaction with number of orgasms, and self-reported perceived level of exertion (intensity measured according to the Borg CR10 Scale) among all the modes of exercise/PA (Table 3). The strongest positive correlation existed between overall satisfaction with quality of orgasms and strength training (rs[509] = .39, p < .01). Squaring the correlation coefficient demonstrated that 15% of the variance was explained by perceived level of exertion in strength training.

Spearman’s rho analyses revealed a statistically significant relationship between overall sexual satisfaction, overall satisfaction with quality of orgasm, overall satisfaction with number of orgasms, and general level of physical activity (i.e. general measure of participation) among all the modes of exercise/PA (Table 4). The strongest positive correlation existed between overall satisfaction with quality of orgasms and aerobics (rs[509] = .42, p < .01). Squaring the correlation coefficient demonstrated that 18% of the variance was explained by level of physical activity in aerobics. 

Spearman’s rho analyses revealed a statistically significant relationship between overall sexual satisfaction, overall satisfaction with quality of orgasm, overall satisfaction with number of orgasms and the duration among all the modes of exercise/PA (#T5). The strongest positive correlations existed between overall satisfaction with quality of orgasms, aerobics (rs[509] = .40, p < .01), and strength training (rs[509] = .40, p < .01). Squaring the correlation coefficient revealed that 16% of the variance was explained by duration in aerobics and strength training. 

Spearman’s rho analyses revealed a statistically significant relationship between overall sexual satisfaction, overall satisfaction with quality of orgasm, overall satisfaction with number of orgasms and frequency of participation in exercise/PA (Table 6). The strongest positive correlation existed between overall satisfaction with quality of orgasms and aerobics (rs[509] = .43, p < .01). Squaring the correlation coefficient revealed that 19% of the variance was explained by frequency of activity.

Discussion

In this study, researchers collected data using various social networking sites to determine the relationship between exercise/PA and overall sexual satisfaction. Variables were analyzed using basic frequency counts, chi-square, and Spearman’s rho correlations. Results of the study supported the hypotheses that overall sexual satisfaction is related to participation in exercise/PA.  Findings from this did not support the hypothesis that levels of sexual satisfaction were significantly higher among adults who participate in aerobic exercise/PA as compared to other modes of exercise/PA. Although, overall sexual satisfaction was significantly associated with all modes of exercise/PA (i.e., sport, aerobics, recreation, and strength training).  The relationship between exercise/PA and sexual satisfaction has been demonstrated in previous work (Belardinelli et al., 2005; Gerber et al., 2005; Lindeman et al., 2007; Meston & Gorzalka, 1996; White et al., 1990; Whitten, 1994).

Furthermore, considering the additional hypotheses stating that levels of sexual satisfaction will be significantly higher for adults who participate in aerobic exercise in relation to the variables of levels of intensity of exercise and duration of exercise, actually markers of sexual satisfaction were significantly associated with all modes of exercise. The strongest relationship existed between general participation in aerobic exercise and the specific variable of satisfaction with quality of orgasms.  Similarly, the relationship between duration of aerobic exercise and the specific variable of satisfaction with quality of orgasms was the strongest.  Interestingly when using the Borg CR10 Scale of intensity, strength training as a particular mode of exercise had the strongest relationship to overall satisfaction with quality of orgasm, and this was unexpected.  Overall, our findings support previous research that indicated orgasmic pleasure could be enhanced through exercise/PA (Mandall, 1979).

Limitations

Other facets of sexual satisfaction, such as relationship status and relationship satisfaction as well as psychological or emotional characteristics of individuals contribute to an individual’s perceived overall sexual satisfaction. These factors should also be considered in the context of future work. An inherent limitation to the current study is that these factors were not evaluated.

Other limitations that are associated with the present study are those that are commonly attributed to self-report surveys. Participants may not be answering entirely accurately – may be over-reporting or under-reporting their behaviors and perceived levels of participation in various modes of exercise/PA and with markers of sexual satisfaction.  Furthermore, since the responses were anonymous and confidential, they could not be traced to individuals who may participate in a multi-sport lifestyle or not; thus, the results may be unique to the sample and caution should be taken when generalizing the findings. Additional studies may compare differences in reported sexual satisfaction between multi-sport lifestyle participants and non-participants. 

Conclusions

From the current study, the data showed a relationship between satisfaction with quality and experience of orgasm as well as the number of orgasms and the frequency of participation in aerobic exercise. We know that aerobic activity has been linked to improved overall cardiovascular function and reduction of chronic disease and illness (Willis, Morrow, Jackson, Defina & Cooper, 2011). Healthy cardiovascular function improves blood flow to both male and female genitalia which is required for healthy sexual function and orgasm (Karatas et al., 2009; Spatz, Canavan, Desai, Krumholz, & Lindau, 2013). Thus findings from this study support the notion that improved blood flow leads to improved sexual satisfaction as a result of aerobic activity.

Also, unique to this study was considering how the different exercise/PA variables are directly related to sexual satisfaction. This differs from other studies that demonstrated how exercise improved a known physical condition/limitation which led to improved sexual satisfaction. For example, Pujols and colleagues (2009) looked at improved body image; Friedenreich, et al., (2010) looked at improved libido through hormone change; and Laumann, et al. (2006) looked at improved erectile functioning; each of these factors improved as a result of exercise making the case for how sexual satisfaction is a tertiary benefit of exercise/PA. In addition, regardless of frequency, intensity, or duration of exercise/PA, general participation in exercise/PA seems to be related in sexual satisfaction for both men and women.

This suggests something as simple as walking or raking leaves can potentially improve sexual satisfaction.
Possible future research could look at levels of exercise/PA frequency and high exercise/PA volume that exceeds recommended standards to determine if sexual satisfaction is a primary outcome of exercise/PA. Additional research is needed to identify particular factors of exercise/PA mode, frequency, intensity and duration that can directly affect markers of sexual satisfaction among people who exercise at various levels.

Exercise/PA and sexuality are viable factors of health living among adults. Exercise and PA add to health and fitness levels, which in turn can promote healthy sexual function, and healthy sexual functioning is commonly linked to sexual satisfaction (Cormie et al., 2013; Karatas et al., 2009). A quick internet search reveals a plethora of articles and sites that tout the relationships between exercise and sex. Popular periodicals include health and exercise magazines with many articles focused on improving sex through exercise. Many of these claims are validated based on findings in peer-reviewed work (Belardinelli et al., 2005; Gerber et al., 2005; Lindeman et al., 2007; Meston & Gorzalka, 1996; White et al., 1990; Whitten, 1994). 

Furthermore, while studies have contributed to the literature by showing a relationship between exercise and sexual functioning and sexual desire, the current project fills a gap in the literature by demonstrating a relationship between exercise and sexual satisfaction among healthy adults. This relationship has been shown in other sub-groups, such as among college students (Lindeman et al., 2007), males (White et al., 1990; Belardinelli et al., 2005), females (Gerber et al., 2005; Meston & Gorzalka, 1996), athletes (Whitten, 1994), and sexually dysfunctional individuals (Belardinelli et al., 2005; Meston & Gorzalka, 1996; White et al., 1990).  The sample for the current study is unique in that it was collected from a varied pool spanning a large age-range, and participants were recruited from social networking sites and email listservs – some for the general public and some specific to individuals who participate in a multi-sport lifestyle. 

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Table 1. Self-Reported Demographic Characteristics of Participants (N = 509)

Table 2. Crosstabulation of Frequency Participation in Aerobics and Overall Sexual Satisfaction

Table 3. Correlations for Overall Sexual Satisfaction and Level of Perceived Exertion during Exercise and Physical Activity

Note. *p < .01. N = 509 for all analyses.

Table 4. Correlations for Overall Sexual Satisfaction and Level of Activity during Exercise and Physical Activity

Note. *p < .01. N = 509 for all analyses.

Table 5. Correlations for Overall Sexual Satisfaction and Duration of Exercise and Physical Activity

Note. *p < .01. N = 509 for all analyses.

Table 6. Correlations for Overall Sexual Satisfaction and Frequency of Participation in Exercise and Physical Activity

Note. *p < .01. N = 509 for all analyses.