Exploring the link between muscle quality and erectile dysfunction: assessing the impact of mass and strength

Sexual dysfunction is a prevalent issue affecting quality of life. Skeletal muscle mass and strength are emerging biomarkers for overall health. Considered in tandem, sexual function and muscle mass have significant implications for well-being.

We aim to explore the relationship between skeletal muscle parameters and sexual function via mechanisms and discuss the role of testosterone.

PubMed literature searches were conducted using MeSH: "Muscle, Skeletal," "Sexual Dysfunctions, Physiological," and "Sexual Dysfunctions, Psychological." Keywords included "sarcopenia," "muscle mass," "muscle strength," "hand strength," "resistance training," "skeletal muscle," "weight lifting," "sexual function," "sexual dysfunction," "erectile function," "erectile dysfunction," and "male sexual function."

This yielded 355 results and 32 were included. Skeletal muscle mass and strength contribute independently to healthy sexual function through metabolic and endothelial mechanisms, particularly in aging adults and men with comorbidities like sarcopenia, diabetes, and obesity. Cross-sectional studies using muscle volume, hand-grip strength (HGS), and bioelectrical impedance assessment show correlations between muscle parameters and erectile function, sexual desire, and overall sexual satisfaction. In older men, HGS correlates with decreased erectile dysfunction risk (OR: 0.86 per 5 kg, 95% CI 0.78-0.96). Despite the established influence of testosterone on muscle and endothelial health, an independent correlation between HGS and International Index of Erectile Function-5 (IIEF-5) score persists after adjustment for serum testosterone (β = .169, P = .037) showing the strength of this relationship independent of testosterone.

There is a positive correlation between erectile function and muscle health. Maintaining skeletal muscle with nutrition and physical activity improves erectile and overall health outcomes. Therapies that target sexual function and muscle health simultaneously (eg, testosterone and L-carnitine) may further benefit sexual function. Future studies are warranted to strengthen and elucidate this relationship and to follow the longitudinal outcomes of these therapies on sexual health.