I want to improve my sexual energy without using Viagra

Q. I am 55 and have recently noticed a slowing down in my libido and performance.

I don’t want to resort to Viagra, but would like to do something. Would any exercises help? Or is there anything homeopathic I could try?

A. In a world where most problems can be solved with a pill or a purchase, long-term, energy intensive solutions hold very little appeal. However, if you are not suffering from an underlying medical condition and you don’t need pharmaceutical assistance, plain old diet and exercise are more often than not the best ways to sustain and improve matters. There is a mountain of research which suggests that sexual function is undermined by lifestyle choices, such as overeating, smoking, alcohol abuse and lack of exercise.

Two major studies have shown that men who have a sedentary lifestyle are more at risk, and a 2007 study from the John Hopkins University School of Medicine has shown that men who watched television for more than five hours a day are four times more likely to have a problem.

The good news is that the risk is modifiable. By switching to a lower-calorie Mediterranean-style diet, rich in whole grains, fruits, oily fish and vegetables, pulses, walnuts, and olive oil, and burning more than 200 calories a day doing exercise, you can improve your erectile function by up to 70%.

There are specific exercises you can do, too. Professor Grace Dorey, author of several snappily titled books, including Use it or Lose it! is a staunch promoter of the link between Kegel exercises and improved erectile function. In her research, 40% of men who had experienced difficulties for six months or more regained normal erections after strengthening their pubococcygeal (PC) muscle for three to six months. Your PC muscle is the one you use to stop yourself peeing midstream. If you clench the same muscle (without peeing) you’ll feel the muscle contract.

Once you’ve mastered this contraction, lie on your back with your knees bent and slightly apart. Breathe normally, tighten your pelvic floor for three seconds, relax for three seconds and repeat. Work your way up to three sets of 10 repetitions a day.

I’m not sure the same can be said for so-called “natural sex remedies” advertised all over the internet. Avena sativa, damiana, ginseng, ginkgo biloba, maca, muira puama and zinc are all promoted as sex aids for men, but there is no credible scientific evidence to show that any of them improve libido or sexual function.

Some people point to evidence that the supplement yohimbine works. However, an American Urological Association review of 208 studies concluded it was no better than a placebo. The side-effects include rapid heart rate, high blood pressure, panic attacks, dizziness, seizures and renal failure. There is a very narrow margin between an effective dose and an overdose.

Another supposed alternative is arginine. However, the side-effects — abdominal pain, gout and aggravation of pre-existing asthma — are serious. In 2006, a clinical trial of L-arginine was abandoned after six cardiac patients taking the over-the-counter supplement died. No patients in the placebo group died.

The thing about Viagra is it does work and its closest rival Cialis works for 36 hours. However, both pills have side-effects. You can’t use them if you have angina, and they can be fatal if they are combined with nitrates. Frankly, as solutions to your problem go, exercise and healthy eating sound a lot more appealing.

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