In the meta-analysis, we identified 89 cohort studies (452 effect sizes) that had reported an association between at least one sexual dysfunction outcome (erectile dysfunction, premature ejaculation, female sexual dysfunction) and at least one health-related lifestyle factor (cigarette smoking, alcohol consumption, physical activity, diet, caffeine, or cannabis use).
Pooled mean effects from 69 studies (223 effect sizes) showed that past and current cigarette smoking had dose-response associations with erectile dysfunction. Higher levels of past and current cigarette smoking were associated with greater risk. Female sexual dysfunction and premature ejaculation were unrelated to cigarette smoking.
Pooled mean effects from 52 studies (114 effect sizes) showed that alcohol intake had a dose-response curvilinear association with erectile dysfunction. Moderate levels of alcohol intake were associated with a reduced risk, but high alcohol consumption was associated with an increased risk. Female sexual dysfunction and premature ejaculation were unrelated to alcohol intake.
Pooled mean effects from 38 studies (79 effect sizes) showed that physical activity had a dose-repose association with erectile dysfunction, with higher levels physical activity associated with reduced risk. Greater physical activity was also associated with a reduced risk of female sexual dysfunction.
Less robust conclusion could be formed for diet, caffeine and cannabis use as risk factors, as less than 10 studies were available in each instance. There was some evidence that a healthy diet (e.g., greater fruit and vegetable intake) was associated with reduced risk of female sexual dysfunction and erectile dysfunction. Despite much media interest in caffeine as a psychoactive stimulant there was no evidence of an association between caffeine and any sexual dysfunction.
Many media outlets, including the International Society for Sexual Medicine have reported that cannabis use is a risk factor for erectile dysfunction. We were able to locate only 2 studies that had explored this association with the pooled mean effect showing no association.
Insufficient research was available to draw conclusions regarding lifestyle as a potential risk factor for premature ejaculation. Based on effect sizes, low physical activity was the more important risk factor for both erectile dysfunction and female sexual dysfunction.
Written by: Mark S Allen, University of Wollongong, Wollongong, NSW, Australia, @DrMarkAllen0
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