Effect of sexual intercourse on knee extension and flexion strength in strength-trained males

Leah Valenti, Claudia Suchil, Gabriel Beltran, Roman Rogers, Emily Massey, and Todd A. Astorino

Ph. D
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Abstract:

Background: Sex has been deemed taboo for athletic performance going back to Rome and ancient

Greece, as the act of sex was thought to promote ease and a sense of relaxation (Anshel, 1981; Stefani

et al., 2016). Aim: This study examined the effect of sexual intercourse on muscle force production in

men. Method: 12 healthy physically active men (age = 25.6 ± 3.8 years) who were sexually active

participated in this study. After men completed a familiarization session on day 1, muscle force was

measured during maximal unilateral knee extension (KE) and knee flexion (KF) at 30 deg/s after men

engaged in, or abstained from sexual intercourse within the previous 12 hours. The order of this

treatment was randomized across participants and time of day was maintained across all sections.

Results: Data showed no significant effect (p=0.34 and p=0.39) of sexual intercourse on peak KE or

KF torque. After sexual intercourse, KE torque was similar in set 1 (198.9 ± 39.1 ft/lb vs 190.2 ± 28.7

ft/lb) and set 5 (163.2 ± 30.8 ft/lb vs 159.4 ± 35.2 ft/lb) compared to abstention from sexual

intercourse. Conclusion: Results suggest that sexual intercourse does not negatively impact lower

extremity muscle force, which suggests that restricting sexual activity before short-term, high-force

activity is not needed.

Keywords: Sexual intercourse, Isokinetic, Knee Extension/Flexion, Force, Male, strength trained

Introduction:

Engagement in sexual intercourse before competition has been a subject of controversy in athletics

for many years. It is not uncommon for coaches to recommend that athletes refrain from sexual

intercourse preceding an event in fear that it could harm their performance. Athletes such as

Muhammad Ali and Brian Bosworth proclaimed that engaging in sexual intercourse prior to
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competition was detrimental to their athletic ability (Fischer, 1997; Thornton, 1990). It is suggested

that this commonly held belief stems from the idea that abstaining from sexual intercourse elicits an

increase in rage and aggressive behavior resulting in improved athletic performance (Krieger, 1997).

Consequently, partaking in sexual intercourse resulting in orgasm is thought to reduce the positive

effects associated with abstinence and may reduce testosterone levels, which in turn may be

detrimental to sports performance (Krieger, 1997). It is evident that sexual intercourse leading to

orgasm elicits various physiological changes including reduced testosterone, slower recovery

response, and increased happiness, which may decrease physical function (Krieger, 1997). In

addition, there are reports that abstinence may promote a drive to excel in sports, as a world

renowned 5K runner famously said, “Sex makes you happy, and happy people don't run a 3:47 mile”

(Bloom, 1994; McGlone & Shrier, 2000).

Despite these mostly anecdotal reports, literature pertaining to this topic is relatively limited. Boone

& Gilmore (1995) showed that sexual intercourse, which was defined as sexual intercourse finishing

in orgasm, led to no change in maximal oxygen uptake (VO2 max), heart rate (HR), or blood pressure

in inactive men compared to abstinence from sexual intercourse. Almost 30 years earlier, Johnson

(1968) reported no changes in grip strength in response to sexual intercourse in former male athletes.

However, sexual intercourse between a man and a woman has been found to be correlated with

improved psychological and physiological function. Participants who partook in penile-vaginal

intercourse demonstrated an improved response to stress and increased emotional awareness (Brody,

2006), which would potentially enhance exercise performance. Additionally, there is evidence for a

relationship between frequency of orgasm via sexual intercourse and risk for mortality. Smith et al.

(1997) reported that individuals who experienced more frequent orgasms had 50% lower all-cause
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mortality versus individuals with less frequent orgasms. From this, it was concluded that sexual

intercourse may improve health status in men. While much of the current literature focuses on the

changes in hormone levels or aerobic performance in response to sexual intercourse, no studies have

examined changes in dynamic muscle function after sexual intercourse (Phoenix, 1977; Escasa et al.,

2011; Fox et al., 1972). This omission is unfortunate considering that many sports rely heavily on

muscle strength in order to achieve peak performance.

The aim of this study was to examine the effects of sexual intercourse resulting in orgasm on lower

extremity muscle force in strength trained men. It was hypothesized that sexual intercourse would

diminish lower extremity force production compared to abstention. This line of inquiry applies to

coaches who wish to optimize performance in their athletes.

Methods:

Participants

Twelve healthy active men (age, height, and mass = 25.6 ± 3.8 yrs, 84.9 ± 11.5 kg, and 178.3 ± 8.4

cm) who currently partake in strength training for a minimum of 2 hours per week in the last 12

months participated in the study. They were recruited from the surrounding areas through word of

mouth. They had no current or previous knee injuries and were not taking any medications or

supplements which may alter the study outcomes. Prior to providing written informed consent, all

participants filled out a health-history questionnaire to ensure that they met all inclusion criteria. All

procedures were approved by the University Institutional Review Board.

Design
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Participants completed three sessions held at the same time of day within subjects (8:30-11:30 am).

Participants refrained from physical activity for 24 hours before all sessions and maintained their

dietary intake, which were confirmed with a written log. They underwent testing of muscle force after

partaking in, or abstaining from, sexual intercourse, whose order was randomized across subjects.

Experimental Procedures

The 3 testing sessions were separated by 3 to 7 days and were held within a 3 week period.

Participants were asked to complete muscle force testing after abstaining from sexual intercourse, or

performing sexual intercourse within the past 12 hours, which were verified through surveys as well

as verbal confirmation on each day. On day 1, participants reported to the lab dressed in exercise

attire, and completed a 5 minute warm-up of light cycling (Monark 894e, Vansbro, Sweden).

Subsequently, they completed a familiarization session of muscle force testing on the isokinetic

dynamometer (BioDex System 3, Shirley, NY). Straps were placed over the exercising limb, trunk,

and hips to restrict work to the exercising limb, and settings for the chair height and seat angle were

set and recorded. Then, knee extension (KE) and flexion (KF) range of motion was determined for

each participant. Participants were instructed to exert maximal effort during five sets of four

repetitions of unilateral KE and KF exercise at 30 deg/s, which was used to measure muscle force

production. There was a 30 second recovery between each set. From this bout, peak and average KE

and KF torque was measured. Verbal encouragement was not provided during the sessions. In

strength trained men, our lab’s coefficient of variation for KE and KF torque is between 5 and 6 %.

Participants returned a minimum of 72 hours later to a maximum of 7 days later at the same time of

day within subjects, following the aforementioned pre-test guidelines, which were confirmed with a
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written survey. In addition, participants filled out a Fatigue Inventory Scale (R Kreider, personal

communication) consisting of various questions (0-10 Likert scale) pertaining to general feelings of

fatigue and a brief survey to confirm that each subject satisfied sexual activity criterion for that

session (i.e. they had abstained or participated in sexual activity leading to orgasm in the preceding

12 hours). They were also asked if the duration of sexual intercourse lasted less than or greater than

30 minutes.

Statistical Analysis

Data were analyzed using SPSS software Version 22.0 (IBM, Chicago, IL) and are reported as mean

± SD. The Shapiro-Wilks test was used to assess normality. Two-way repeated measures ANOVA

was used to examine changes in peak and average KE and KF torque between the conditions. If a

significant F ratio was obtained, Tukey’s post hoc test was used to identify differences between

means. If the sphericity assumption was not met, the Greenhouse Geisser was used. Significance was

set at p < 0.05.

Results:

Sexual Intercourse Duration

All participants complied with the requirement to perform sexual intercourse or abstain from it in the

12 hours preceding each session. Data show that 4 of 12 participants reported intercourse lasting

longer than 30 minutes; whereas, the remaining eight reported sexual intercourse lasting less than 30

minutes. The amount of sleep completed by each participant on the night before each session was not

different across sexual intercourse or abstinence conditions (6.4 ± 1.0 h and 6.6 ± 0.8h respectively).
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Changes in Knee Extension and Flexion Torque

Two-way repeated measures ANOVA showed no main effect (p=0.34) or conditionXset interaction

(p=0.89) for peak KE torque, although it did decline across sets (p < 0.001). Across participants, 6

showed little difference (< 10ft/lb change) in KE torque across conditions; whereas; 3 showed a

higher KE torque after partaking in sexual intercourse, and 3 displayed a higher KE torque after

abstention. Similar results were demonstrated for peak KF torque as there was no main effect

(p=0.39) or interaction (p=0.24), although it declined across sets (p=0.001) (Figures 1 and 2).

Additional data revealed no effect (p=0.28) of sexual intercourse or interaction (p=0.80) on average

KE torque although it declined across sets by 15 % (p < 0.001) in both conditions. Average KF torque

revealed similar findings as no main effect (p=0.40) or interaction (p=0.66) were shown. These

results are demonstrated in Figures 3 and 4.

Figure 1. Changes in torque produced during unilateral knee extension with and without sexual

intercourse. All values are mean ± SD.

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Figure 2. Change in KF torque produced during unilateral KF with and without sexual intercourse.

All values are mean ± SD.

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Figure 3. Change in average KF torque produced during unilateral KF with and without sexual

intercourse. All values are mean ± SD.

Figure 4. Change in average KE torque produced during unilateral KE with and without sexual

intercourse. All values are mean ± SD.

Changes in fatigue

Results demonstrate similar levels of mental and physical fatigue prior to both sessions. Participants

rated mental and physical fatigue on a scale from 0 to 10, with 10 representing the highest fatigue.

Mental and physical fatigue were equal to 1.4 ± 1.7 and 2.1 ± 2.0 before the sexual intercourse trial

and 2.7 ± 2.2 and 2.9 ± 3.1 before the abstinence trial, and there did not differ (p=0.08 and 0.37

respectively) across conditions. Participants reported similar leg fatigue (p=0.50) before the trial

requiring sexual intercourse (1.7 ± 1.6) compared to abstention (2.5 ± 3.0). General tiredness was also
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similar (p=0.77) across conditions (2.1 ± 2.4 vs 2.0 ± 2.4 for sexual intercourse and abstinence,

respectively).

Discussion:

The purpose of this study was to measure the effects of a single bout of sexual intercourse resulting in

orgasm on quadriceps and hamstring torque in healthy, strength trained males. The findings showed

that sexual intercourse completed within 12 hours of muscle force testing had no detrimental effect on

the maximal or average torque achieved. Results of the present study corroborate prior findings

showing no effect of sexual intercourse on athletic performance, and suggest that abstention from

sexual intercourse prior to brief bouts of high force activity is not warranted.

To our knowledge, only a few studies have examined the effects of a single session of sexual activity

on exercise performance. Exercise studies (Boone & Gilmore, 1995; Sztajzel et al., 2000) consisted

of lab-based graded exercise tests during which cardiac parameters were measured. In both studies,

no changes in performance were shown between sessions following sexual intercourse versus

abstention from intercourse. In a sample of active and inactive men and women, Vouyoukas (2011)

reported no change in grip strength, vertical jump, or submaximal exercise between conditions.

Johnson (1968) tested potential changes in grip strength in former male athletes ages 24 – 49 years,

and there was no effect of sexual intercourse performed the previous evening on this parameter

compared to when sexual intercourse was completed at least 6 days prior. Lastly, cross sectional data

in marathon runners (Anderson et al., 2011) showed no relationship between running performance

and sexual activity in the 48 hours before the race. Overall, there are no data which support the long-

held belief that sexual intercourse is detrimental for athletic performance, although existing studies
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are characterized by small and heterogeneous samples, use of lab-based exercise tests rather than

protocols mirroring the demands of sport, and minimal use of elite athletes as participants, where

small changes in performance are potentially detrimental or beneficial. Further study is merited to

clarify this issue as it has great application to the preparation of competitive athletes as well as

weekend warriors who seek to optimize performance in competition.

Findings from Vouyoukas (2011) may help explain why our results showed no significant effect of

sexual intercourse on muscle force. Sexual intercourse activates both the sympathetic and

parasympathetic nervous system similar to exercise. Immediately following orgasm, release of

neurotransmitters such as dopamine and serotonin provide a sense of relaxation and calmness

(Vouyoukas, 2011) yet shortly after, neurotransmitter levels begin to return to baseline values.

However, little is known regarding the duration of this state of relaxation, called the refractory period,

as existing studies have focused on animals (Bliss et al., 1972; Fox et al., 1972; Phoenix et al., 1977).

One study suggests the refractory period lasts no longer than 30 minutes (Aversa et al., 2000), which

would explain why performance is not impaired when morning exercise is preceded by sexual

intercourse on the night before. Furthermore, a lack of effect could be due to the duration of sexual

intercourse, which was not standardized in our participants and may have led to different capacity for

exercise testing on the following morning. For example, 25 % of men showed meaningful increases

in muscle torque after abstaining from sexual intercourse; whereas, an additional 25 % demonstrated

higher torque when tested the morning after sexual intercourse. Individual responses to acute (Skelly

et al., 2017) and chronic exercise training (Astorino & Schubert, 2014) have been demonstrated, and

it is likely that a single session of sexual intercourse affects men differently. This is an area of future
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study considering the desire to personalize exercise training to maximize the benefits of regular

physical activity (Buford et al., 2013).

Past studies have associated plasma testosterone levels with changes in muscle mass, strength, and

skeletal muscle tissue modification (Kraemer & Ratamess, 2005), which have the potential to affect

long-term exercise performance (Cook & Beaven, 2013). Previously, sexual intercourse was thought

to be linked to a decrease in testosterone levels (Krieger, 1997). However, Phoenix et al. (1977)

found that Rhesus monkeys showed no significant change in blood testosterone before and 50, 80,

and 140 minutes after ejaculation. In contrast, Dabbs and Mohammed (1992) showed that

testosterone levels in both men and women increase both before and after sexual intercourse with a

partner, and decreased when they abstained from sexual intercourse. Nevertheless, these data may be

of limited impact since results from only four couples were examined. However, data from a recent

study (Morton et al., 2016) showed that in men who completed 12 weeks of resistance training,

resultant increases in strength and muscle mass were unrelated to changes in anabolic hormones

including testosterone. This suggests that any change in testosterone induced by sexual intercourse

may not have any effect upon the force generating ability of the muscle. This belief is further

supported as muscle strength attained for a single exercise session is determined by phosphocreatine

content, muscle fiber type, muscle mass, and neuromuscular attributes rather than changes in various

hormones such as testosterone (Robergs & Keteyian, 2003).

The study had several limitations that need to be addressed. First, participants were limited to young,

healthy men who participated in strength training, which limits the application of our findings to

different populations including women. We chose men, as males and females respond differently to
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sexual activity, in which frequency of orgasm and the duration of the refractory period between males

and females varies (Vouyoukas, 2011). Another limitation was an inability to standardize the exact

time and duration of sexual intercourse in each male, although each participant came to the lab well-

rested. However, energy expenditure of only 25 kcal has been reported (Stefani et al., 2016) to occur

in response to sexual intercourse, so it is unlikely that this has any detrimental effect upon subsequent

exercise capacity. Furthermore, our exercise protocol only involved the knee joint, and it is unknown

if whole-body exercise mirroring the demands of sport, such as a cycling time trial, running test,

resistance training performance, or performance in sports requiring cognitive processing (soccer,

volleyball, tennis, etc.) would also be unaffected by a single session of sexual intercourse performed

the previous evening. Moreover, participants were free to select various modalities of sexual

intercourse and were not questioned about the gender of their partner. Lastly, we required men to

engage in sexual intercourse within a 12 hour period of our testing, and it is possible that sexual

intercourse leading to orgasm completed directly before the testing could elicit different results.

Conclusion:

Our data found that partaking in sexual intercourse 12 hours prior did not affect KE or KF torque.

These findings support past studies which conclude that sexual intercourse the day before exercise

does not impact athletic performance (Boone & Gilmore, 1995; Johnson, 1968; Sztajzel et al., 2000;

Vouyoukas, 2011). Coaches often prefer for athletes to abstain from sexual intercourse prior to games

in fear that it may negatively impact their performance the following day. Due to a lack of empirical

evidence, high-quality, randomized studies are still needed to further test the impact of sexual

intercourse on athletic performance. In addition, data pertaining to the effect of sexual intercourse on

performance in athletes competing in individual and team sports are limited (Stefani et al., 2016).
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Further investigation into this topic may include comparing the effects of sexual intercourse on

athletic performance of male athletes versus female athletes of the same sport, as a majority of the

studies were conducted in men. Additionally, future analysis is needed comparing the effects of

masturbation versus sexual intercourse on performance (Stefani et al., 2016). Aside from these areas

of future investigation, additional study should consider the psychological factors associated with

sexual intercourse. As Casey Stengel, past New York Yankees manager, mentioned, it may not be the

act of performing sexual intercourse affecting the athletes, but rather a result of depriving themselves

of sleep looking for sex (McGlone & Shrier, 2000). Consequently, the impact of sexual intercourse

on sports performance is still unclear, and future studies are needed to clarify the misconceptions

surrounding this controversial topic.

Acknowledgements:

We would like to thank Vanessa Vanegas, whose assistance in our research helped us to reach our

goal.

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Figure Legends

Figure 1. Change in peak muscle torque produced during unilateral knee extension with and without

sexual intercourse. All values are mean ± SD.

Figure 2. Change in peak muscle torque produced during unilateral knee flexion with and without

sexual intercourse. All values are mean ± SD.

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Figure 3. Change in average muscle torque produced during unilateral knee extension with and

without sexual intercourse. All values are mean ± SD.

Figure 4. Change in average muscle torque produced during unilateral knee flexion with and without

sexual intercourse. All values are mean ± SD.