Associations between Self-Reported Physical Activity, Autonomic Reactivity, Interoception, and Sexual Dysfunctions in Men

Abstract Premature ejaculation and erectile dysfunction are prevalent male sexual dysfunctions worldwide, causing significant distress for men and their partners, as well as resulting in reduced quality and stability of romantic relationships. We aimed to investigate how physical activity in free time was associated with self-reported interoceptive awareness and autonomic nervous system reactivity during sex as well as with premature ejaculation and erectile dysfunction. The sample of 1976 Chinese urban men aged 18 to 50 (M = 31.5 years, SD = 5.3), responded to a questionnaire on two online survey platforms. Participants reported their age, height, and weight, and filled out the Physical Activity Questionnaire, the Body Perception Questionnaire Short Form adapted for sexual events, the Multidimensional Assessment of Interoceptive Awareness, the International Index of Erectile Function-5, and the Checklist for Early Ejaculation Symptoms. Results indicated that more physical activity was associated with more self-reported parasympathetic activity during sex, better interoceptive awareness, and fewer premature ejaculation and erectile problems. The associations between more physical activity and fewer premature ejaculation and erectile problems were mediated by more parasympathetic reactivity during sex and more interoceptive awareness. The present study was the first to investigate the associations between physical activity, autonomic activity, interoceptive awareness, and sexual dysfunction. More physical activity was associated with better erectile function and ejaculation control through heightened interoceptive awareness and better sympathovagal balance during sexual activity. This suggests that physical exercise may enhance sexual function through both psychological and physiological pathways.