Section 1: Introduction
Sexual dysfunction is one of the important public health concerns present globally, and many emotional problems likely contribute to the experience of such problems.
According to the National Health and Social Life Survey which conducted a study on adult sexual behavior prevalent in the United States, it has been estimated that around 10â€“52% of men do experience various kinds of sexual dysfunction.
1.1 Erectile Dysfunction
It is a sexual dysfunction in males, wherein, there is an inability to attain and maintain a penile erection sufficient to allow satisfactory sexual intercourse, is known as Erectile Dysfunction.
According to an estimate, around 20 million to 30 million men in the US are affected by this inability.
It can be a consequence which can rise due to any neurologic, psychological, cavernosal, hormonal, or arterial impairment or can rise due to a combination of these factors.
Etiologyof Penile Erection
Penile erection is basically a neurovascular event that is modulated by various psychological and hormonal factors.
Due to sexual stimulation, nerve impulses lead to the release of certain neurotransmitters from the cavernous nerve terminals and penile endothelial cells relaxing factors, which results in the smooth muscle relaxation in the arteries and arterioles which increases the blood supply to the erectile tissue.
Also, relaxing the trabecular smooth muscle can also increase the sinusoids compliance which can facilitate the rapid filling along with the expansion of the sinusoidal system. Due to this, the subtunical venular plexuses are then compressed between the tunica albuginea and the trabeculae which can result in total occlusion of venous outflow. Due to these, blood is trapped within the corpora cavernosa and the penis is raised from a dependent to an erect position, having an intracavernous pressure of approx 100 mm Hg.
Pathophysiology of Erectile Dysfunction
Psychogenic Erectile Dysfunction
Certain usual causes of psychogenic related erectile dysfunction may include lack of sexual arousability, performance anxiety, a stressed relationship, and certain psychiatric disorders such asÂ depression andÂ schizophrenia
Neurogenic Erectile Dysfunction
Hormonal Causes of Erectile Dysfunction
Deficiency of androgens can decrease the nocturnal erections and libido.
Vascular Causes of Erectile Dysfunction
Common causes that can be associated with penile arterial insufficiency generally include hyperlipidemia, hypertension, cigarette smoking along with diabetes mellitus and pelvic irradiation.
Drug-Induced Erectile Dysfunction
Certain drugs have been found to cause erectile dysfunction.
Neurotransmitter pathways involved in penile erection which include dopaminergic, serotonergic, and noradrenergic, and also the pathways which are involved in sexual function can be disturbed due to the certain antipsychotic, antidepressant, and centrally acting antihypertensive drugs.
Certain beta-Adrenergicâ€“blocking drugs also cause erectile dysfunction by potentiating penile alpha-adrenergic activity.
Thiazide diuretics and Spironolactone are also associated with erectile dysfunction.
Hormonal Causes of Erectile Dysfunction
Androgen deficiency can decrease nocturnal erections and libido. However, erection in response to visual sexual stimulation is preserved in men with hypogonadism, demonstrating that androgen is not essential for erection.
Hyperprolactinemia from any cause can result in reproductive and sexual dysfunction because prolactin can inhibit central dopaminergic activity and therefore it results in hypogonadotropic hypogonadism due to the secretion of gonadotropin-releasing hormone.Â
Erectile Dysfunction Due to Other Systemic Diseases and Aging
- Due to aging, sexual functioning also decreases.
- Also, it has been found out that around 50 percent of men who have chronicÂ diabetes mellitus may have erectile dysfunction.
The word ‘yoga’ is a derivative of a Sanskrit root Yujwhich means ” to bind, to yoke, to attach, to join, to direct and concentrate one’s attention on, or to use and apply”.
YogaÂ is among the six systems of Indian philosophy. It was devised by Patanjali in his text, The Yoga Sutras.
In this text, yoga is said to be a sacred science that involves evolution through eight components, which are said to be the eight limbs of yoga. The first step is called Yama that is the attitudes towards the environment, and the other being Sama Ì„dhii.e complete integration with the object which has to be understood. Some other limbs are Niyama that are attitudes towards the self. These limbs give an individual the tools which help him/her connect with the higher being (whichever belief system one chooses) and therefore get liberated that is free from mental suffering, physical stress, emotionally, or spiritually.
Yoga involves various :
- Asana that is the practice of body exercise,
- Pranayama which is the practice of breathing exercises,
- Dharana that is the ability to direct the mind),
- Pratyahara i.e restraint of the senses
- Dhyana that is the ability to develop interactions with what one seeks to understand
These asanas and pranayama exercises may prepare an individual for meditation; Also, provide one with the ability to focus along with concentrating on the present moment, with the least resistance, in order to reach liberation goal.
In this article, we will find out how yoga proves to be essential for male sexual disorders such as erectile dysfunction.
Section 2: Yoga And Sexual Health
There is an extensive body of non-empirical literature focused on yoga,in which there is a huge amount of knowledge linking yoga with improved sexual health and also as presenting yoga as an efficient treatment for nearly every sexual ailment.
Yoga theory says that certain diseases that are related to sexuality may be due to blocked or stagnant energy in the chakra root that is Mooladhara chakra or the second chakra that is Swadhisthana chakra. One way to release such energy is to raise or move an individual’s KundalinÌ„ithrough the spine and up to the brain through the various NÄdisthat are the channels through which these energies pass through the chakras.
In Tantric and ancient practices and Kundalini yoga, it is said that yoga is an efficient tool to prepare the movement of kundalinÄ«ienergy. Kundalini energy is related to increase the sexual delight and by facilitating male orgasms without ejaculation, it extends the longevity of sex.
2.1 Need for Yoga for Erectile Dysfunction
There are various Pharmacotherapies that are present for male sexual disorders like erectile dysfunction like sildenafil, etc.
However, only 10â€“20% of people who are undergoing male sexual disorders are likely to seek medical consultations
Therefore, self-help and natural therapies like yoga may potentially be vital for men who cannot visit a doctor but are motivated to stick to advice and prescription for the cure of their ailment.
2.2 Yoga and Erectile Dysfunction
There has been an extensive literature present which relates yoga to various male sexual disorders like erectile dysfunction, etc.
Various yoga books mention male sexual disorders and suggest yoga as a means of treatment.
Claire (2003) says that yoga increases strength, keeps people centered. It also helps in relaxation, lowers stress and performance anxiety, and helps the practitioner to maintain attention in sex, through meditation and breathing exercises. The author also states that it can relieve an individual from premature ejaculation, erectile dysfunction, and orgasm difficulties (Claire, 2003, p. 185).
An author, Thomas says that yoga is said to strengthen and tone the urogenital area. Also, it is said to strengthen pelvic floor muscles, massage the prostate gland, increases the genital blood flow, strengthens genital muscles, and builds stamina along with control, and that specific yoga poses are recommended for this purpose.
It is also said that for Indian men who practice brahmacharya also called celibacy, certain yoga poses are said to control or reduce erection and desire according to Alter.
For example, there is a central pose called Siddhasanain which an individual’s legs are crossed while seated, during which a celibate man can pinch his scrotum and penis with the help of his heels to control his desire. This type of control is considered a highly desirable state to attain for these men who chose celibacy.
Various popular websites also make claims of yoga’s outcomes on sexual dysfunction. For example, a website called “Health and Yoga Infoplace” contains one entire section on yoga as a treatment for erectile dysfunction, where a series of yoga positions are described to be an effective treatment for erectile dysfunction.
Section 3: A Non Comparative Study; Yoga In Male Sexual Functioning
A study was conducted by various reputed researchers from various research institutions to identify the effect of yoga in male sexual functioning.
They studied 65 males who attended a yoga camp in the city of Mumbai located in India. The participants were first briefed about the yoga protocol and they were supposed to follow the protocol; over the period throughout the upcoming 12 weeks.
Participants were asked to perform various Asanas as described below. These asanas believed to have certain effects on the endocrines, digestion,abdomino-pelvic muscle tone; gonads, also on joint movements, and mood, and therefore they were specifically chosen for the present study. A general physical examination of all individuals was performed.
The participants undergoing the study were required to take the Male Sexual Quotient (MSQ) assessment before and after yoga sessions. Also, their scores were noted before as well as after the study.
MSQ i.e Male Sexual Quotient is a valid, brief, and reliable self-report measure of male sexual function, which can be easily administered to a wide age range of men.
MSQ is essentially a user-friendly type of questionnaire which is designed to measure sexual functions and satisfaction levels with various factors of male sexuality.
Various Poses used for the study were :
- Kapalbhati (Figure 1A, kapal = skull, bhati = bright; “forehead brightener”)â€”One should Sit straight in squatting posture with eyes closed. Also, put hands on the knees. Fix the chest and consciously contract abdominal muscles.
- Vajarasana(Figure 1B, vajra = diamond)â€”Fold your legs at knee joints and sit on the legs, and touch the knee caps as shown.
- Yog mudra (Figure 1C, Yog = after yogis, mudra = posture; “symbol of yoga”)â€”Take your hands to the lower back. Then one should catch his/her right wrist with the left palm and then bend forward.
- Marjarasan = (Figure 1D, Cat’s posture)â€”Sit in vajarasana and after that be in the cat’s posture and move one’s spine and neck.
- Pavanmukatasanâ€”(Figure 1E, hanging in the air)â€”Lie down on your back, bend the legs, bring them inside; clasp them with hands. Now, the person should bring the head up to touch the knee as shown.
- Viparitakarani mudraâ€”(Figure 1F, viparit = opposite, mudra = posture); “legs-up-the-wall pose”
- Matsyasanaâ€”(Figure 1G, Fish’s posture)â€”Lie down flat on the back and bend the neck backward.
- Halasanâ€”(Figure 1H, Hala = plough)â€”Lie down flat; then, turn legs overhead while maintaining hands on the ground firmly.
- Ardhmatsyendra mudraâ€”(Figure 1I, Half-spinal twist)â€”Sit straight, bend right knee, and put it below buttocks. Now one should cross his/her left leg and bring it in front of the right knee.
- Paschimottoasanaâ€”(Figure 1J, Back stretching pose)â€”Sit with legs straight, touch toes, and try to bend the head forward and kiss the toes.
- Paravatasanâ€”(Figure 1K, Parvata = mountain; mountain pose)â€” One should sit with head and spine intact and with hands stretched overhead such as a mountain.
- Bhujangasan (Figure 1L, Bhujang = Snake)â€”Lie down in prone position and transfer weight on palms. Attempts can be made to stretch the back muscles.
- Shalabhasanâ€”( Figure 1M, Locust pose)â€”Lie down on your chest and rest the head on the ground. Lift the legs to the extent that the entire body rests on the chest and abdomen. Keep hands firm on the ground.
- Naukasana (Figure 1N, Nauka = boat; Boat posture)â€”Lying prone and lifting hands and legs in the air.
- Dhanurasan(Figure 1O, Dhanu = Bow)â€”The body gets a “bow-like shape.”
- Bhushirasanaâ€”(Figure 1P, Preliminary posture of Shirshashan)â€”Sit in Vajarasan and touch head on the floor with the help of the wall.
- Hansasanaâ€”(Figure 1Q, swan pose; the preliminary posture of Mayurasan)â€” One should sit in Vajarasan and then transfer your weight on both the palms. The body will hang in the air, but the feet should be supported by the ground. It will give all the benefits that comes from Mayurasan without difficulty. Particularly suited for overweight or old people.
- Chakrasâ€”(Figure 1R, wheal pose)â€”This asana is named such because the body takes the form of a circle or semicircle.
- Trikonasanaâ€”(Figure 1S, Triangle pose). Stand up, open the legs, and touch the right leg with the right hand and move the left arm in the air. Look toward the fingertips of the left hand.
- Uddiyana bandha/agnisaraâ€”(Figure 1T, Rapid abdominal lifts)â€”Exhale out all air and then draw abdominal muscles under the rib cage.
- Pranayamaâ€”(Figure 1U, Breath-control)â€”Sit comfortably with eyes closed in squatting posture. Do Deep breathing via alternating nostrils as shown in the figure.
- Shava Asanaâ€”(Figure 1V, Dead posture)â€”It involves lying relaxed, eyes closed with arms placed on both sides of the body. 
They studied 65 males who were aged between 24 to 60 years and their mean was 40.57 ô°€ 8.26 years) who were enrolled in a yoga camp. They were offered MSQ before as well as after a 12 weeks session of yoga.
The overall changed MSQ score was 4,314 before the start of the study that is called the baseline score and 5,082 after the full completion of the study. A statistically significant result is an overall improvement of 11.81% in which P-value< 0.0001 in scores of sexual functions was found, as tested by MSQ.
As per the MSQ scores, the order of improvement among various domains was :
Intercourse satisfaction (24.6%) > ejaculation control (20.6%) > erection quality (14.15%) > performance (13.23%) > confidence(11.3%) > orgasm (8.3%) > desire (8%) > partner synchronization (4.9%).
In MSQ, THE erection quality is checked in three subdomains according to the order of improvement as it took place :
Maintenance of erection during intercourse (16.9%; P value < 0.0001) > on-demand erection (13.2%; P value < 0.0001) > hardness (12.6%; P value < 0.0001).
Limitations of Yoga as a Therapy
- The time of onset of improvement is not known.
- No prediction can be done as to how long the improvement due to yoga will last.
- There is some sort of selection bias in the study as well; as only those people who voluntarily chose to participate in the study were taken.
In the present study, it is a noncomparative trial and the test of yoga has not been compared with any placebo or any other known modality that improves erectile disorder.
Section 4: Conclusion
Yoga is thought to be one of the efficient tools to eradicate but it can not be the only tool used to eradicate the disease completely.
A journey for modalities to protect or improve male sexual capacity is everlasting. Yoga has all the earmarks of being a nonpharmacological technique for improving sexual capacities in men.
Considering across the board acknowledge the capacity of yoga, non pharmacological nature, and obvious helpful impacts in the current investigation, this methodology merits further examination.
It could be beneficial for those patients who do not want to seek medical help and want to rely on natural pathways. Nevertheless, yoga has various benefits and can improve overall health in the long run.
- Lue, T. F. (2000). Erectile dysfunction. New England journal of medicine, 342(24), 1802-1813.
- Brotto, L. A., Mehak, L.,& Kit, C. (2009). Yoga and sexual functioning: a review. Journal of sex & marital therapy, 35(5), 378-390.
- Dhikav, V., Karmarkar, G., Verma, M., Gupta, R., Gupta, S., Mittal, D., & Anand, K. (2010). Yoga in male sexual functioning: a noncomparative pilot study. The journal of sexual medicine, 7(10), 3460-3466.