150 Minutes of Weekly Cardio Improves Erections as Much as Viagra

Source: Diary of a CEO | Published: 2026-04-27T07:00:18Z

Sexual frequency among 18-to-30-year-olds has plummeted, yet 60% of college-age women report being choked during sex — urologist Rena Malik argues smartphones have shredded our attention spans so thoroughly that desire can never find a runway to land.

Fifty Years Ago There Were No Phones, So People Had Sex

Life moved at a completely different pace fifty years ago. No smartphones, no email, a handful of TV channels with commercial breaks in between. People came home from work, ate dinner, watched a show or two, then got into bed — right next to their partner, with nothing to scroll through. So they talked, cuddled, and sex just happened naturally.

The problem now is that attention has been sliced into infinite fragments. Fifteen to twenty percent of young people describe their phone use as "nearly constant" — scrolling while eating, on the toilet, before bed. A new video every 60 seconds, the brain perpetually processing the next bit of information. This carries directly into the bedroom: the body is having sex while the mind is replaying something it just saw, tomorrow's to-do list, something it wanted to look up. As Malik puts it, you need to be in a parasympathetic-dominant state to become aroused — "rest and digest" mode. If you're stuck in a hyper-stimulated sympathetic state, desire has no runway to land on.

Young People's Sex Education Comes from Porn, and It Shows

Dating apps have turned first sexual encounters into something that happens with strangers. You don't know the other person, don't know what they like, and nobody ever taught you how to say "I like this." The result is a bad or mediocre experience, and both parties walk away thinking "I guess that's all there is."

The only "sex education" source is often pornography — meticulously staged, deeply unrealistic sex. Young people try to replicate these scenes, and rough sex becomes increasingly common. Sex researcher Debby Herbenick conducted qualitative research asking women how being choked felt. The answers were nuanced: some said it was fine, some said they were scared because the other person was much bigger with large hands, some said they didn't mind but didn't particularly enjoy it either — "it's just part of sex, like kissing." When people do what they think the other person wants instead of what they actually enjoy, sex becomes a performance.

An Erection Is the Result of a "Story"

A common misconception is that men are always ready to go. Malik considers this unfair to men — everyone needs time to get aroused, especially after a high-pressure day at work or a long trip. Erections require a parasympathetic state, which requires some kind of stimulus — visual, psychological, olfactory, or tactile.

Some people can shift into that state quickly. Others need specific conditions: a certain scent, a hot shower, a mental "warm-up." This is especially true in long-term relationships, where spontaneous desire fades and is replaced by responsive desire triggered by specific cues. If you don't know what cues your partner needs, you're missing a major piece of the intimacy puzzle.

Performance Anxiety Is a Self-Reinforcing Spiral

Malik sees the same pattern over and over in her practice: an erection fails once, and the man starts worrying it'll fail again. Next time, instead of feeling pleasure, he's "spectating" himself — the anxiety activates the sympathetic nervous system, making erections even harder to maintain, which deepens the anxiety.

"Any time you have a problem in the bedroom, it follows you."

Her advice is to take the pressure off penetrative sex. Start by exploring each other's bodies, doing "sensate focus" exercises — finding sensitive zones beyond the genitals, enjoying the process of play. When you stop fixating on erections, they tend to show up on their own. Then gradually reintroduce genital contact, and only then return to penetrative sex. It's a gradual, low-pressure process.

150 Minutes of Weekly Cardio Works as Well as Viagra

Malik compares sexual health to a house with four foundational pillars: fuel (diet), strength (exercise), environment (stress and sleep), and confidence (knowledge and communication).

On the diet front, the Health Professionals Follow-Up Study, which tracked 20,000 men, found that those following a Mediterranean diet had a 22% lower risk of erectile dysfunction. Getting specific: men who ate 100 grams of pistachios daily saw improved erectile function; regular blueberry consumers experienced roughly a 20% improvement; and consuming 38 grams of dietary fiber per day (the recommended amount for men) protects the vascular endothelium through short-chain fatty acids, improving overall metabolic health.

The most striking exercise data: 150 minutes of moderate-intensity aerobic exercise per week produces erectile function improvements comparable to taking Viagra. Even men with heart disease who couldn't handle moderate-intensity exercise saw 70% improvement in erectile function through a simple protocol of a 5-minute warm-up, 20-minute walk, and 5-minute cool-down. Resistance training is equally critical — men who maintain muscle mass are only one-third as likely to develop erectile dysfunction. Muscle naturally declines about 7% per decade after 40, and resistance training is the primary defense against that loss.

Your Pelvic Floor May Be the Sexual Bottleneck You Never Considered

The pelvic floor is a bowl-shaped group of muscles supporting the bladder, rectum, and reproductive organs. During orgasm, they contract and relax in a rhythm of once every 0.8 seconds; during male ejaculation, these same muscles propel semen outward.

The problem is that these muscles respond to stress — just as some people unconsciously clench their jaw under pressure, the pelvic floor can become chronically tight. This can cause back pain, constipation, urinary urgency and frequency, pain during sex, erectile dysfunction, and even premature ejaculation. Most people have only heard of Kegel exercises (tightening the pelvic floor), but if the muscles are already in a tense state, Kegels can make things worse.

The right approach starts with learning to relax: diaphragmatic breathing, the "figure four" stretch, yoga's happy baby pose or child's pose. Severe cases require a pelvic floor physical therapist.

Erectile Dysfunction Is an Early Warning Sign for Heart Disease

Among men over 50, 52% have erectile dysfunction, rising 10% per decade — 60% at 60, 70% at 70. But the real significance lies in what it signals: erectile problems typically appear 3 to 5 years before cardiovascular disease. After developing erectile dysfunction, 14% of men will have a heart attack within 7 years.

"We call it the 'canary in the coal mine.' It's telling you bad things are coming."

The spongy tissue of the penis and clitoris requires a constant supply of fresh blood to stay healthy. Without regular erections (nocturnal or during sex), this tissue develops fibrosis and eventually atrophies. Young men have 3 to 5 erections per night, each lasting up to 40 minutes; by their 40s, duration decreases but frequency should remain the same. If you've stopped getting morning erections, that's a signal worth paying attention to.

One Week of Sleep Deprivation Drops Testosterone as Much as a Decade of Aging

Among the environmental pillars, sleep may be the most underestimated. Take the same man, switch him from 8 hours of sleep per night to 5, and after just one week, his testosterone drops 15% — equivalent to ten years of natural aging. Sleep apnea is another hidden culprit: if your partner says you gasp awake during the night, or your neck circumference exceeds 17 inches (men) or 16 inches (women), sleep apnea is likely. After treatment, some men see testosterone increases of 200 ng/dL.

Microplastics and endocrine disruptors are also part of the environmental picture. Phthalates and BPA in plastic bottles can mimic estrogen and suppress testosterone production. Malik's practical advice: don't drink warm water from plastic bottles, transfer takeout to a plate before reheating, and store food in glass or metal containers. But she also emphasizes — don't let anxiety about these chemicals become yet another source of stress.

Testosterone Is Declining, but Most People Don't Need Replacement Therapy

From the 1990s to around 2015, average male testosterone levels dropped from roughly 600 to 450 — a decline of about 25%. Obesity is a major driver: the aromatase enzyme in fat tissue converts testosterone to estrogen, and more fat means more conversion.

But Malik pushes back against the popular notion that "all men over 50 should be on testosterone." Everyone's androgen receptor sensitivity is different — 500 might be perfectly fine for one person and low for another. Once receptors are saturated, more testosterone won't improve cognition, mood, or sexual function — it'll just keep adding muscle mass (which is exactly what steroid abusers are chasing). And supraphysiological testosterone doses carry real risks: blood thickening (raising stroke and heart attack risk), cardiac fibrosis, acne, and mood disturbances. People who use anabolic steroids for muscle building have a 15-fold higher risk of premature heart failure and a 122-fold higher risk of sudden cardiac death.

Testosterone replacement therapy also comes with a critical cost: within 18 months of starting, 70% of men become infertile. Some see sperm counts decline as early as 10 weeks after beginning treatment.

Penis Anxiety Is More Common Than Height Anxiety

A Malik video about penis enlargement racked up 31 million views — even she didn't anticipate how much the topic would resonate. The data shows that more men want a longer penis than want to be taller. Average erect penis length is 5.2 to 5.5 inches, but men generally believe the average is 6 to 7 inches — porn performers are deliberately selected outliers who have become the benchmark.

Surgical enlargement has a high complication rate, and Malik doesn't recommend it. She mentions a traction device that clinical studies show can add about 2 centimeters in length with twice-daily 30-minute sessions over 3 to 6 months, though whether the gains persist after stopping is unclear. She specifically warns against "jelqing" (hand-stretching the penis), popular on TikTok, which has caused permanent erectile dysfunction in multiple patients.

"I had a patient seriously ask me if he should drink hydrogen peroxide to improve his erections because he saw an ad."

Her most heartbreaking cases are men whose penises were already above average, who opted for enlargement surgery, and ended up with permanent disfigurement.

85% of Women Can't Orgasm from Penetration Alone

The clitoris is the homologous structure to the penis — the visible part is just the tip of the iceberg, with its "legs" and "bulbs" extending internally along the anterior vaginal wall. The so-called G-spot is located about 2 centimeters inside on the front wall, where nerve endings are dense, and the presence of the internal clitoral structure and Skene's glands (the female homologue of the prostate) makes this area particularly sensitive to stimulation.

But 85% of women cannot orgasm from vaginal penetration alone and need direct clitoral stimulation. Malik uses an analogy: penetration feels to a woman like someone rubbing your testicles or perineum — it feels nice, but it won't get you there. Understanding this is crucial for both partners. Women in the on-top position typically orgasm more easily because they can control the angle of clitoral stimulation. Another research-backed technique is the "coital alignment technique" — using a rocking motion rather than thrusting to maintain continuous pubic contact with the clitoris.

People Who Have Sex Weekly Live 49% Longer Than Those Who Have It Yearly

Sex isn't just about pleasure. People who have sex weekly have a 49% lower all-cause mortality rate than those who only have it once a year. A 1997 study found that for every additional 100 orgasms, men's life expectancy increased by about 13%. Of course, these findings can't fully eliminate confounding factors — being able to have regular sex already says something about physical fitness and cardiovascular health. But sex is genuinely aerobic exercise: it elevates heart rate and maintains physical function.

The WHO has classified loneliness as an epidemic, equating its health impact to smoking 15 cigarettes a day. Sex is one of the deepest forms of human connection, and its absence means more than just missing out on pleasure.

Ozempic May Be Quietly Killing Your Libido

GLP-1 drugs deliver metabolic benefits that indirectly improve sexual function: healthier blood vessels, weight loss, and reduced suprapubic fat (the so-called "Ozempic penis" is really just less fat making the penis appear longer). But these drugs act on the brain's reward pathways — and early data already shows they reduce cravings for food, gambling, shopping, alcohol, and tobacco.

In theory, the same mechanism could suppress libido. Malik's concern is that many people may not even notice their desire declining because everything else feels so good. There's no definitive clinical data yet, but if you've noticed a marked drop in sexual interest after starting a GLP-1 drug, it's worth discussing a dose adjustment with your doctor.

The Best Place to Talk About Sex Isn't the Bedroom

A point Malik returns to repeatedly: nobody is naturally good at talking about sex, regardless of gender. Her advice is to pick a moment when both partners are calm and relaxed — during a walk, in the car, side by side rather than face to face. Lead with something positive, express curiosity rather than criticism, and give the other person the option to choose when to have the conversation.

Men often treat sex as their only form of intimacy — this isn't "just wanting sex," it's their way of connecting with a partner. Women, meanwhile, tend to view sex as "one more thing on the list" when they're stressed. Understanding this difference is itself a starting point for communication. A 20-second hug during the day, a 6-second kiss, a text sharing a funny video — these seemingly small gestures are all laying the groundwork for intimacy later that night.

Your Social Circle Is Also Shaping Your Sex Life

Malik's husband is part of a male physicians' group where the conversation often turns to "none of us are really having sex anymore" — this kind of talk normalizes sexual absence. A study of roughly 50,000 people found that when individuals were encouraged to build social circles around positive sexual-behavior role models, positive behaviors like safe sex increased by 46%.

If your friends are all complaining about their sex lives, treating their partners as sources of stress, and living parallel rather than intersecting lives, that attitude is contagious. Conversely, if the people around you value their partnerships and talk about intimacy in a positive way, you're far more likely to make it a priority yourself.