Howev er, no trial has yet
explored whether diaphragm breathing exercises might be beneficial when
it comes to sexual arousal. Nevertheless, a new approach to the treatment of
premature ejacu lation was devised in 2006.12 Functional sex therapy , which
incorporates aspects of functional movement and breathing, was shown to
be more ef fective than traditional masturbation-based techniques. While Viagra or equivalent drugs may seem like the perfect solution for
men with erectile dysfunction,  there are strong arguments for exploring
more natural alternatives. A 2003 study that importantly but rather
unusually exam ined the impact of Viagra on men’ s sexual partners found
many problems. Not only were women experiencing physical symptoms
such as cystitis from prolonged  penile-vaginal sex, often in the absence of
other sexual stimulation and foreplay , the “blue pill” put a heavy weight of
expectation on the partner , sometimes leaving little room for the respectful,
engaging interaction essential to healthy sex.13 Rather as an afterthought,
researchers asked the question:
Will the sexual script of Viagra lovemaking actually be flexible and
worry‐free, or will Viagra‐sex be all about worshipping the penis,
since no one spending upwards of $10 to have an erection will
ignore it?14
The implication s behind this question are not insignificant. Popping a blue
pill is quick and easy, but with the focus purely on a rather penis-centric
idea of performance, it cannot be without problems and may actually prove
damaging to vulnerable partners.13 In fact, in homosexual men, the drug has
been linked with increased sexual risk-taking.15
Fortunately , a growing weight of scientific evidence indicates that
functional breathing practice can provide long-term benefits for sexualfunction through better oxygen ation and improved diaphrag m function. Unlike quick-fix pharmacological solutions, this has the bonus of overall
improved health, physically , mentally , and relationshipwise. Nasal breathing is also important in our sexuality through its connection
to our sense of smell. Research has confirmed that the olfactory system
plays a significant role in choos ing a partner and in empathic functioning. Scientists examining people with impaired olfactory function found that the
sense of smell influences various aspects of our sexuality .16 A 2018 study
explored the link between odor sensitivity and sexual desire, experience,
and performance in 28 men and 42 women. Researchers found that the
enjoyment of sex was enriched by olfactory input, and women  who were
more sensitive to smell reporte d a higher number of orgasms during sex. Odor sensitivity correlated with pleasure experienced during sex, perhaps
because the perception of certa in body odors enhances the recruitment of
reward areas in the brain.16
This connection  between our sense of smell and the way we interact
with others, including our sexual partners, was also examined in a study
from 2017. Scientists assessed the reliability of social judgments made via
olfactory cues to discover the difference between responses to natural body
odor and perfumes/deodorants, and between whole-body olfactory
impressions and armpit odor presented on a t-shirt. Participants wore ear
plugs and an eye mask to ensure that their impression of the person they
were “meeting” was confined to their sense of smell. The results showed
that people make consistent social judgments about others based on body-
odor alone.”17
We don’t yet know the full function of human body odor or the role it
plays in sex, but it is known that nasal breathing activates the olfactory
nerve.18 According to another 2017 paper , “airflow rhythm in the olfac tory
system can regulate the phys iological and brain states, providing an
explanation for the ef fects of breath control in meditation, yoga, and T aoism
practices.”
On the other hand, smell can also be a big turn-of f. Kissing, which
should be a delightfully pleasurable experience, can be rendered unbearable
by bad mouth odor. However , bad breath is not always the result of poor
oral hygiene. It is also a symptom of mouth breathing. Bad breath in themorning can be the result of mouth breathing during sleep. When we sleep
with the mouth open, saliva dries up and bacteria proliferates, producing the
dreaded “morning breath,” even  in people with otherwise meticulous oral
hygiene. If you have a dry mouth when you wake, it is likely that you
mouth breathe during your sleep. It is also likely that you have a buildup of
plaque on your teeth and tongu e.19 Fortunately , it is easy to restore nasal
breathing durin g sleep simply by taping your mouth with MyoT ape—
though you may want to wait until after you’ve had a cuddle to apply the
tape. WHY STRESS IS A BIG TURN “OFF”
While nasal breathing directly enhances sex drive and performance due to
increased blood flow to the penis and clitoris, functional breathing also
helps reduce stress and promote better sleep, which, of course, impacts
sexual function. Despite the once widely held belief that most sexual
dysfunction has its roots in mental health, it’s now known that sexual
problems such as erectile dysfunction are caused by physiological factors in
more than 80% of cases.20 Nevertheless, chronic stress can and does create
emotional and cognitive changes that prevent us from responding to sexual
cues.21 Stress has a powerful negative  impact on all of the body’ s systems
and can cause many problems that show up as physical or biochemical
imbalances. If you are exhauste d, stressed out, depressed, or have a poor
body image, you will find yourself in the mood for sex much less often, and
this can impact your relationships and further undermine self-esteem.22
To understand the impact that stress can have on sex, we need to look
back to the autonomic nervous  system (ANS). Remember that breathing,
stress, and the ANS are interconnected, as we have already discussed
(Chapter Four ). The ANS controls functions that include heart rate,
respiratory rate, and sexual arousal. It consists of the two main branches,
the sympathetic and parasympathetic nervous systems, commonly known as
fight, flight or freeze, and rest and digest (or “feed and breed”). Ideally ,
those two branches function in balance. However , when sympathetic
activation is too high or too constant, we experience chronic stress. In thatstate, the body’ s evolutionary mechanisms prioritize survival over sex and
sexual desire. Under normal circumstances, sex can be a great way to relieve stress. It
causes the release of mood-enhancing hormones, including endorphins. It
can be great exercise, which is uplifting, in itself. However , stress can
create a vicious cycle. Imagine this scenario. You’ve been working hard all
week and want to enjoy some quality intimate time with your partner . Your
mind is elsewhere, still going over a problem you didn’ t manage to fix. You’re too stressed and can’t get aroused or can’t get an erection. Your
partner asks what’ s wrong, but because you haven’ t realized how stressed
you are, you brush the question aside and push yourself to perform. You
can’t or it’s unsatisfying. The next time you want to be intimate,  the episode
replays in the back of your mind. Anxious not to repeat the embarrassment
and discomfort, the inevitable happens. The more you try, the worse things
get. Anxiety about your ability to perform in bed quickly becom es habitual,
causing erectile dysfunction, lack of arousal, or even aversion when you
think about having sex. This is one of the main reasons some men and
women begin to avoid intimacy altogether . While many of the situations we discuss in this book are primarily
health-related, sex is more than just a physical experience. Any health
concern can impact quality of life, but sex has a unique place in our closest
relationships, as an emotional outlet and as a marker of personal identity . It
is hardly  surprising that we can form negative feelings around sex that
trigger automatic physical responses that prevent sexual function. For many men, erectile dysfunction begins as a stress response. Stress
on top of stress triggers a vicious cycle of events. Unfortunate ly, because
sexual arousal is controlled by the ANS, it doesn’ t respond to attempts at
conscious contro l. However , there are ways to mediate the ANS to address
the issue  from a body-to-brain perspective. These include slow diaphragm
breathing exercises at six breaths a minute and mindful breathing—the
simple practice of paying attention to the breath. It may be helpful to understand  what the ANS does when it comes to
sex and why it’s such a problem when things are out of whack or when the
ANS is affected by stress. First, the ANS is responsible for the dilation of
the blood vessels that cause erection of the penis or clitoris. In men, thisdilation is largely facilitated by nitric oxide.23 Erection depends on nerve
impulses from the ANS directin g blood flow to the penis. It also requires
the autonomic constriction of a circular muscle called a sphin cter, which
ensures that blood doesn’ t flow back out of the penis. The ANS also
controls stimula tion of secretions from the vagina or prostate. It mediates
smooth muscle contractions of the vas deferens during ejaculation, or
rhythmic contra ctions of the vagina during orgasm, and contractions of
other pelvic muscles that accompany or gasm in both sexes.23
The processes differ between men and women. The female sex hormone
estrogen  is associated with increased synthesis and release of
acetylcholine,24 the neurotransmitter produced by the vagus nerve. In
women, acetylcholine floods into the pudendal artery during vasodilation. Relaxing this artery , which supplies blood to the genitals, is essential to
engor ge the clitoris and vagina during sexual stimulation. Researchers
believe that when relaxation of this artery is compromised, it can contribute
to female sexual dysfunction.25 Women who are stressed experience lower
levels of genital arousal, even when psychological arousal is high. Women
are reputed to be gifted with the ability to multitask, but researc h has found
that arousal decreases in wome n who are distracted due to stress.21 The
practice of mindful breathing can help with the ability to stay present during
sex and attend to physical and emotional sensations. Research has shown
that mindfulness enhances sexual arousal.26
When the ANS is out of balance and sympathetic activation is high, the
body is not able to function normally . Stress floods the body with cortisol
and disrupts other hormones. Cortisol is needed for the regulation of blood
pressure and the normal functioning of the body’ s systems, but too much of
it can affect the normal biochemical functioning of the male sex organs.27
Stress can affect testosterone production,28 resulting in lower sex drive,
erectile dysfunction, and impo tence. It can also negatively affect sperm
production, maturation, and make the body more vulnerable to infection. Infection in the prostate, urethr a, and testes can all prevent normal sexual
function in men.27
In women, stress can affect menstruation, increase symptoms of PMS,
reduce sexual desire, negatively impact pregnancy health and postpartum
adjustment, and worsen symptoms of menopause. It contributes to theexacerbation of diseases such as polycystic ovarian syndrome and can
disrupt estrogen and progesterone levels, along with other hormones that
support fertility . Sexual arousal relies on a variety of functions, including
vaginal blood flow and engor gement of the labia, clitoris, and vestibular
bulbs. These physiological responses are triggered by neurons that are
controlled by the parasympa thetic nervous system,29 which can be
suppressed by stress. Research, parad oxically , shows  that moderate sympathetic activation
may boost sexual arousal in women.30 The genitals are largely innervated
by a nerve that, rather unusually , contains both sympa thetic and
parasympathetic neurons31 (if you’re dying to know , it’s called the major
pelvic ganglion ). Scientists believe that this sympathetic activity may
increase arousal  by enhancing focus and attention on erotic cues, increasing
blood flow, decreasing digestio n, and directing more blood to flow to the
genitals. Alessandro Romagnoli is an Oxygen Advantage Master Instructor in
Italy and France. He works as a psychologist, specializing in cognitive
neuroscience. He has a wealth of clinical and scientific experience that
allows him to help a broad range of clients, from people with severe
psychiatric conditions to high-level professional athletes. I asked him to
bring some insight to the topic of breathing and sex. He explained:
Breathing techniques can be helpful in the treatment of sexual
dysfunction because the breath can influence not only the
physiological aspect but also the state of mind, and even the quality
of the relationship. For example , slowing down the respiratory rate
before intercourse would be tremendously beneficial, reducing any
feelings of inadequacy and stress. Ultimately , the ANS must be in balance to function optimally . Despite
the relationship between sympathetic activation and stress, both the
parasympathetic and sympathetic branches of the ANS contribute to sexual
arousal. The male sexual response, in particular , reflects a dynamic balance
between exciting and inhibiting  influences of the ANS.32 Interestingly , a
2002 study in Cardiovascular Resear ch found that the human heart is moregeared toward sympathetic mediated responses in men and parasympathetic
responses in women.24
VAGUS NER VE—SECRET T O DEEPER ORGASMS? The parasympat hetic nervous system (PNS) plays a significan t role in in
sexual function, as it does in general health. Elevated heart rate variability
(HRV) has been  linked to bette r erectile function in men.33 HRV, which is
used as a measure of parasympathetic or vagal tone, can also be used to
predict female sexual dysfunctio n. In a study of 84 women aged  between 18
and 47 years, low HRV was identified as a risk factor for sexual
dysfunction. The study recor ded measurements of respir atory sinus
arrhythmia (RSA) before, during, and after sexual arousal. Researchers
found significant differences in vagal activity between women  who were
sexually functional and women  who experienced dysfunction,  suggesting
that vagal tone could provide a potential mechanism through which to treat
sexual dysfunction.34 This implies that sexual dysfunction could be
alleviated by stimulating the vagus nerve—which can be done by practicing
slow breathing at six breaths per minute. Research from 2015 reached a similar conclusion from a different
starting point. In a study of women who had survived childhood sexual
abuse, their HRV was compare d against women who had no history of
trauma. It was found that when  women were treated to reduce autonomic
imbalance, their sexual well-being improved. Over time, as HRV became
better regulated, the women showed increasing improvements in sexual
arousal and or gasmic function.35
The vagus nerve is implicated in female orgasm and in ejaculation for
both men and women. In women, vaginal orgasm is physiologically
different from clitoral orgasm.36 While sensory input from the clitoris
travels to the brain via the puden dal nerve, information from the vagina and
cervix travels via the pudendal,  pelvic, hypogastric, and vagus nerves. The
vagus nerve is stimulated durin g heterosexual sex as the penis connects
with the cervix. This stimulation appears to be linked to better
cardiovascular and psychological function and increased vagal tone.36
Research by Beverly Whipple and Barry Komisaruk, authors of The Scienceof Orgasm , demon strates that the vagus nerve plays a role in deep orgasm s
in women.37 So much so that it is possible for a woman who has a
completely severed spinal cord and no feeling in her lower extremities to
experience orgasms, even in the absence of any connection between the
external clitoris and the brain.36
More recent research has shown that much of the clitoris is internal,
with four-inch roots reaching into the vagina.38 This would indicate that
vaginal and G-spot orgasms are, in fact, also clitoral and come from
stimulating the internal parts of the clitoris. It is certainly the case that if the
vaginal walls had as much sensation as the clitoris, childbirt h would be
impossibly painful. Just the tip of the clitoris has over 8,000 nerve endings,
double the number found in the penis.39 However , it is hardly surprising
that understanding of female orgasm is limited and conflicting, because it
wasn’ t until 2009 that the first sonographic mapping of an erect  clitoris was
carried out. Without this knowle dge, much study of the female anatomy and
female sexual satisfaction has assumed that penile stimulation is necessary
to orgasm—only adding to an unhealthy culture around female sexuality
that may help explain why 1 in 10 women has never had an or gasm. Looking at it from a different direction, the ancient Tantric idea that
restricted breathing creates a type of internal contraction, blocking feeling
and emotions, was confirmed in 2008 by scientists who made a link
between the way a woman walks and her experience of, or potential for,
vaginal orgasm. The researchers speculated that chronic muscle tension
impacts sexual function by impairing feeling and functional movement,
possibly representing mental or emotional blocks. The paper cites a study of
men in which it was found that a method of therapeutic manual tissue
manipulation known as Rolfing  decreased postural problems in the pelvis
and increased cardiac vagal tone, which indicated better parasympathetic
function. Research from 2004 similarly linked physical therapy with better
orgasmic function in women,40 and another review from 2007 indicated that
problems in the muscles of the pelvic floor are closely related to sexual
dysfunction.41 The 2008 paper concludes,
The discerning observer may infer women’ s experience of vaginal
orgasm from a gait that comprises fluidity , energy, sensuality ,freedom, and absence of both flaccid and locked muscles.36
This raises the question, could the diaphragm—which is central to
breathing, integr al to the core, vital for stability of the spine and pelvis, and
connected to the vagus nerve— also play an important role in the ability to
achieve satisfying or gasms? Significantly , that all-important vagus nerve also innervates the voice
box and throat, and it is direc tly connected to the cervix and uterus.42
Research into this area is incredibly sparse, but one paper explores the
involuntary vocal noises we typically make during sex, linking the more
powerful sounds with hyperventilation. It is the first study to examine blood
sensitivity to CO 2 during intense sex. It suggests that the metabolic changes
occuring in the brain during hyperventilation may deepen states of sexual
trance.43 The researchers observe that changes in breathing patterns during
sex are similar in both men and women. However , accelerated breathing is
more accentuated in women. Anecdotal evidence also suggests that women
are more vocal during sexual intercourse.43
The Multi-Or gasmic Woman  describes the use of the breath to extend
female orgasm by contracting the pubococcygeus muscle and expressing
pleasure with the voice, explaining that, according to Taoist wisdom, the
throat and vagina are connected.44 As you gain better control of your sexual
energy, “you will be able to extend your orgasm through one long out-
breath, a quick intake of breath, and then another one or two breaths.” The
book states that if the throat  is open, the genitals will be “open to
pleasure.”44 In the book The Multi-Or gasmic Man by Mantak Chia and
Douglas Abrams, we learn that the ability for men to control ejaculation and
have more than one orgasm also begins with strengthening and deepening
the breath45. If you are interested in exploring the Taoist techniques for
sexual pleasure more deeply , those books, along with The Multi-Or gasmic
Couple , provide an approachable and informative resource. As we know , hyperventilation alters levels of blood CO2, and CO2
moderates the rate of blood flow in tissues, especially the brain. Hyperventilation also induces changes to the blood’ s acid-base balance,
which increases the affinity of blood hemoglobin for oxygen. This further
decreases the amount of oxygen available for the cells and tissues. Bloodflow to the brain can decrease by as much as 50% during
hyperventilation.43 At the same time, metaboli c activity in the brain
changes. Functional magnetic resonance imaging (fMRI) studies show that
oxygen consumption is predomi nantly reduced in the neocortex gray matter
and much less in the limbic structures. The limbic systems in the brain are
responsible for our emotional responses, while the gray matter influences
attention, memo ry, thought, and motor control. The study suggests that this
may explain the role of hyperv entilation in intensifying emot ional states
and changing behavioral control during sex. The study also suggests that changes within the nervous system induced
by hyperventila tion could lead to altered states of consciou sness. This
involves a shift in the pattern of activity between different structures within
the brain. The result is someth ing that scientists describe as an “arousal
dissociation,” which may result in a more primitive form of brain function. This brain “state,” which involves activation of pleasure responses, less
self-control, a decrease in abstract thinking, and an increase in emotionally
guided thinking is known to occur during dreams, hypnagogia (the state of
consciousness just before we fall asleep), and in states induced by
hallucinogenic drugs.43 Hyperventilation may be used instinctively in this
context to intensify experience s of sexual excitation, sexual trance, and
orgasm.43
Tantra.com founder, Suzie Heumann, speculates that for women,
opening the mouth and chest cavity with slow, deep breathing may connect
with the vagus nerve to greatly enhance orgasmic capacity .46 Heumann
writes,
When women emit deep, low sounds from their abdomens and with
their mouths wide open this can sometimes lead to longer lasting,
powerful or gasms and even female ejaculation.46
Since it has been found that people who are more suscep tible to
hypnotic trance have a higher autonomic responsiveness and higher levels
of brain  to body vagal activit y,47 Heuma nn’s suggestion that a highly
activated vagus nerve can produce “out of body pleasure” may not be far
from the truth.WHEN SEX IS DYSFUNCTIONAL
Sexual function is defined in Western medicine as a state of physical,
mental, and social well-being as it pertains to sexuality . It requires a
positive and respectful approach  to sexuality and sexual relation ships, and it
involves the possibility of pleasurable, safe sexual experiences. Sexual
function is about more than just frequency or duration of sex. It includes
sexual desire, arousal, satisfactio n, orgasm, lubrication, and the workings of
the sex hormones22—all of which can ultimately be af fected by breathing. While sexual problems can include lack of desire, pain, inability to
orgasm, erectile dysfunction, aversion, difficulty with vaginal penetration,
premature or delayed ejaculation, lack of arousal, or inappropriate,
unwanted arous al, there is no universally accepted definition of sexual
dysfunction. For women, it encompasses ongoing or recurring decrease in
sexual desire or arousal, the feeling of pain during sex, and an inability to
reach orgasm. For men, it’s generally the inability to “get it up” or early
ejaculation. Few men know (or take advantage of the fact) that orgasm and
ejaculation are two quite distinct functions.3
Hormonally speaking, there is plenty of evidence to indicate a
relationship between sexual function and testosterone production in men. On the other hand, the relationship with estrogen in women is less clear . What most of us know about female hormones and sex is limited to how it
relates to pregnancy (or trying not to get pregnant) and worries about
vaginal dryness, pain during sex, and changes after menopause. Lack of
knowledge and a paucity of research into female sexual function adds to the
pressure on women to stay “youthful” and the unhealthy prejudice that
postmenopausal women are sexually redundant. On the other side, lack of
understanding about the physiological aspects of sexual function leaves
men feeling emasculated. Neither of these common reactions reflect the
truth. Sexual dysfunction is a problem that can affect anyone, particularly as
we get older and when other health conditions are present. Global
prevalence of sexual dysfunctio n is high. Studies have identified that as
many of 57.8% of men and 41% of women suffer from lack of desire,
anxiety about sexual performance, and orgasmic dysfunction. A 2003 study
of 1,793 Australians reported sexual dysfunction in 55% of men and 60% ofwomen. Howeve r, while prevalence is high in both sexes, there has been no
breakthrough in the treatment of women equivalent to the PDE5 inhibitor
(Viagra) for men. Although PDE5 inhibitors can increase clitoral blood
flow in postmenopausal women, and some women report heightened
arousal, these drugs have not been found to be consistently ef fective.25
Overall, male sexual function has been extensively documented and is
well understood. In contrast, in women, the problem has been much
understudied.25 Ironically , sexual dysfunction  is also considered more
complicated in women due to the combination of anatomical,
psychological, physiological, and social-interpersonal factors that
contribute.25 Howeve r, it seems likely that this perception is colored by the
lack of research. In middle-aged and older men, factors such as high blood pressure,
diabetes, cardiovascular disease, and obesity (all affected by breathing
issues) clearly contribute to poor sexual performance. Substance use
(including smoking), thyroid conditions, anxiety , and depression can also
play a part. Erectile dysfunction  is normally caused by problems with blood
flow to the penis, hormones, or nerve supply . When the arteries harden due
to cardiovascular disease or hypertension, blood is less able to flow to the
penis, and it becomes dif ficult to achieve or maintain an erection.48
As with men, female sexual disorders are affected by health  and by
psychosocial factors. Several studies have made the connection with
cardiovascular disease in women, indicating that treatment of sexual
dysfunction purely as a matter of lifestyle may underestimate its importance
as an indicator of health. A 2008 study claimed that 87% of middle-aged
women with heart failure report ed some level of sexual dysfunc tion,49 76%
had problems with dryness, and 63% struggled to or gasm. Cardiovascular and respiratory health are important from a purely
physiological perspective too. One early study , published in 1966, recorded
a peak coital heart rate of betw een 140 and 180 beats per minute and a
mean increase in blood pressure during sex.50 Even earlier research, from
1956, found a similar outcome.51 Peak coital heart rates at orgasm
approached 170 beats per minute in both men and women. Respiratory rates and tidal volumes were also recorded in this early
trial. Both measurements increa sed significantly in all subjects, with someparticipants demonstrating a breathing rate of more than 60 breaths per
minute and a peak minute volum e comparable with that during moderately
intense physical exercise. A study of midd le-aged men from 1970 compared the increase  in heart
rate during sex with that seen after climbing two flights of stairs.52 Body
oxygen consumption was equivalent to 60% of the subject’ s VO 2 max. While the clinical implication is that sex imposes a modest
physiological cost, with maximal heart rates lasting around 15 seconds, this
cost is significant for anyone with heart or lung conditions. Diabetes (see Chapter Fourteen ) can affect the blood vessels and the
nerves that supply the penis. On average, men with diabetes experience
erectile dysfunct ion 15 years earlier and are four times more likely to suffer
from it than men without diabetes. Sexual dysfunction in diabetic women
has been less well studied,25 but recent research shows they are more prone
to sexual dysfunction than healthy women,25,53 suffering with lower sex
drive, vaginal dryness, little or no arousal, difficulty achieving orgasm, and
reduced sexual satisfaction. Obesity is linked to several types of sexual dysfunction in men and
women, both due to health reasons and to the poor body image that often
accompanies excess weight.23 For people with epilepsy (see Chapter
Fifteen ), hyperventilating during sex can directly cause seizures. The study of female sexual dysfunction is challenging, due to its
multifaceted nature and to preconceptions that labeled women as “frigid” or
“neurotic” until alarmingly recently . It is also more difficult to overtly
define arousal in women, and the understanding of the femal e orgasm is
limited. Even today , the problem  has largely been investigated in terms of
comorbid condi tions such as diabetes and high blood pressure, making it
necessary to interpret results in terms of those disorders. Traditionally ,
women with sexual problems were treated with psychological therapy ,
whether the underlying cause was mental or physical, and there have been
few medications available. Since  female sexual function was first addressed
in research only 50 or 60 years ago, it’s hardly surprising that treatment
options can, at best, be described  as inadequate,25 which makes the benefits
possible through ef fective breathing all the more important.For both men and women, sex changes as we age. Scientists directly
compared the effects of aging on erectile dysfunction with the impact of
various comorbidities typically associated with aging and found that age
alone increased the risk of sexual dysfunction. Researchers reported that
poor health, diabetes, and urinary incontinence increased the risk of sexual
problems in all age groups.54 In women, too, aging can, of itself, cause
problems. As we get older , the likelihood of developing decre ased energy
and strength, cardiovascular disease, diabetes, arthritis, cancer , and other
health concerns is greater . Relationships can change if one or both partners
develop chronic medical problems, and the inevitable physica l decline of
the aging body must be accepted  and accommodated if we are to maintain a
satisfying sex life.55
Aside from the direct impact of poor physical and mental health,
hundreds of common medications also cause sexual dysfunction. These
include depression medications, particularly SSRIs (serotonin reuptake
inhibitors) such as citalopram, fluoxetine, and sertraline, and blood pressure
drugs including beta-blockers.48 One study found that while SSRIs caused
more incidence of sexual dysfunction in men, the dysfunction experienced
by women using the drugs was more intense.56
Many hormonal birth control methods can cause side effects, including
decreased sex drive and vaginal dryness. The Multi-Or gasmic W oman  offers
a detaile d overv iew of contraceptive methods and intimate problems such
as urina ry tract and yeast infec tions that may impede sexual function in
women.44 The book is a valuable resourc e for any woman wanting to gain
better understanding and control of her sexual health. Sexual function can be a useful  measure of how well other systems are
working. Throughout this book, we examine how dysfunctional breathing
impacts general  physical and mental health and longevity , as well as
specific conditions. By making  positive changes to health through better
breathing, your sex life can be improved. BREA THLESS: SEX AND RESPIRA TORY DISEASE
If you have a respiratory disease, the connection between it and sex is much
more obvious. If you suffer from asthma or another chronic respiratorycondition, sex can quite literally leave you breathless. A 2019 study
explored problems of sex and intimacy in patients with severe asthma,
revealing a huge number of constraints facing people with respiratory
symptoms.57 Some of these had to do with expectations, fear, and
embarrassment, while others directly related to physical exacerbations. This
study , which describes the experiences of nine patients in detail , is the first
to really address a problem that af fects millions of people worldwide. An earlier study had raised the issue of postcoital asthma and rhinitis.58
The paper descr ibes the case of one male patient whose acute severe asthma
after sex resulted in several emer gency department visits and
hospitalization. Patients with COPD also struggle with breathlessness
during sex, a feeling that may be worsened by hyperventilation .59 Erectile
dysfunction and low testostero ne levels have been reported in men with
respiratory diseases such as COPD,60 asthma and obstructive sleep apnea
syndrome (OSA). In patients with COPD, breathlessness, coughing, muscle
weakness, and diminished physical activity all contribute to decreased
sexual activity .61 In these situati ons, anxiety around respiratory symptoms
adds another burden on both the suf ferer and the spouse or lover . A study  of patients with rhinoconjunctivitis —an allergic condition
characterized by nasal congestio n, runny nose, sneezing, postnasal drip, red
eyes (conjunctivitis), and itchin g of the nose or eyes—found a significant
relationship with sexual dysfunction in women and erectile problems in
men. In both genders, sexual function was much better in patients who had
received treatment for nasal and conjunctival symptoms than in those
patients who were untreated.62
The 2019 asthma study gives the most detailed account of the problems
facing asthmatic s. Each of the nine people interviewed felt that a good
sexual experience required some physical effort,57 yet even moderate
exertion limited their performance due to worsening symptoms. Intimacy
was made difficult by asthma, even to the extent that kissing caused a flare-
up of breathlessness. One partic ipant described having to stop in “full flow”
because of feeling unable to breathe. They described feelings of exhaustion
that came from living with asthma and taking high-dose corticosteroids. Sleep deprivation caused marital strain in one case, as the participant’ s
partner interpreted attempts to get enough sleep as an evasion of intimacy .Patients felt they had to organize equipment or remember to use inhalers or
nebulizers, detracting from any spontaneity . While some could  accept this
as being part of their condition, others found it distressing and a barrier to
intimacy . One commented that her inhaler pump was almost like a third
person in the relationship because it was necessary to maneuv er around it
during sex. There was also a genuine fear that sexual climax might induce severe
bronchospasm requiring emer gency medical intervention. This added level
of anxiety reduced sexual satisfaction. The embarrassment caused by
having to explain the reason for the exacerbation to paramedics and
healthcare professionals was a major consideration. Some devised positive
coping mechanisms, including using pillows as props and finding positions
that didn’ t lead to exacerbations—the “Asthma Sutra.” Emotional intimacy
has more elements than the purely physical expression of sex, but all of the
participants found that the physical act of sex was restrict ed by their
asthma. Certain positions caused feelings of suffocation, especially for
women, and men perceived their sexual performance to be dampened by the
need for physical exertion. Emotionally , the patients experienced frustration and guilt, and felt
pressure to perform. Often part of the problem was feeling they couldn’ t
broach the subject with their partner. Five of the female participants (83%)
described givin g their partners permission to sleep with other women
because they felt so guilty over being unable to offer sexual satisfaction in
the relationship and feared losing their partner altogether . Many felt that
they should not impose their asthma-related concerns on their partners. Others reported an emotional weight being lifted when they did manage to
explain the situation and receive support. Insights into self-image
uncovered feelings of self-loathing in all participants and problems
balancing the dual role of the partner as a carer and a lover: “One minute
they’re wiping your bum and then the next minute you’re ripping each
other ’s clothes off. It does vary.” Two of the participants describ ed how this
conflict in roles had caused the breakdown of previous marriages. Weight gain due to long-term corticosteroid use and difficulty
exercising because of symptoms also had a negative impact on body image
and feelings of sexuality . Even things most people take for granted, such as
wearing sensual underwear , were problematic due to feelings of restrictionon the chest wall. All participants voiced some element of struggle on a
daily basis. Despite the significance of these  issues in the day-to-day lives of people
with severe asthma, no healthcare provider had ever initiated discussion of
sexual intimacy during medical appointments with any of the participants. Two even described negative reactions when they tried to raise their
concerns. One commented, “I actually brought it up, and I thought the
counsellor was going to run out of the room screaming!” Seven of the
participants felt that the topic was too intimate to raise but would welcome
the chance to talk about it with a specialist nurse if the opportunity were
offered.57
The study confirms that fatigu e has a significant impact on sexual
quality of life for people with severe asthma. The finding that the fear of
exacerbation was so present during sex is new, as is the discovery that
embarrassment about having to call an ambulance was generally worse than
anxiety about the asthma exacerbation itself. Intimacy , from kissing to full
sex, produced breathlessness and feelings of suffocation, and spontaneity
was difficult. All these factors added pressure to the sufferer ’s relationship,
presenting a huge emotional burden on top of the physical limitations. The
study concluded that it is essential for their quality of life that healthcare
professionals openly address sex and intimacy with asthma patients. The breathing exercises in this book have been shown, time and time
again, to reduce asthma symptoms and prevent asthma exacerbations. If
asthma is affecting your quality of life, relationships, and sexual pleasure,
it’s time to take back control. You can read much more about using
breathing exercises to control your asthma in Chapter T en. SLEEPING T OGETHER
Sex and sleep are interesting bedfellows—quite literally both are typically
done in bed—bu t the connection goes far deeper than this. We’ve already
discovered that sexual function  is indicative of health, and we also know
that sleep is fundamental to physical and mental well-being. A healthy sex
life will help decrease stress and improve sleep; conversely , quality sleep is
essential for sexual health.We’ve explored how stress can affect sex drive and sexual function for
physical and psychological reasons. Fatigue, sleep disturbance, and sleep
deprivation, by themselves, can simply make us too tired for sex. The
impact this can have on self-es teem, intimacy , and relationship s is all too
apparent in the study of patients with severe asthma. Accordin g to a 2002
paper , being “too tired” is the primary reason people lose interest in sex.63
Conversely , 2015 research from scientists at the University of Michigan
Medical School reported that the more sleep people had, the more likely
they were to feel like sex the following day.64 If all that you and your
partner are doing is actually sleeping together , it’s time to look at the quality
of your sleep. Whenever you can improve the quality and quantity of your sleep, you
are likely to improve the quali ty and quantity of your sex life. We have
already looked in detail (in Chapter Seven ) at sleep-disord ered breathing
and ways we can ensure better sleep and better health through improved
breathing. Howe ver, it is worth examining the statistics here. One research
paper found that about 50% of men aged between 18 and 70 years who
have moderate to severe sleep apnea also suffer from erectile dysfunction.65
Another study found that 69% of participants with sleep apnea also had
erectile problems.66 The link may be partly hormonal. Men with sleep
apnea have lower levels of testosterone.65 Since we already know an
overactive fight -or-flight respo nse inhibits testosterone production, this
makes a lot of sense. For men, it is absolutely norm al for erections to occur durin g sleep. Nighttime erections often go unnoticed, perhaps only becoming obvious
first thing in the morning as “morning wood,” but to use its medical name,
nocturnal penile tumescence (NPT) is actually an important marker of heart
health,67 vascular tone,68 and parasympathetic function.69 Medical science
frequently uses NPT as an indicator of sexual or hormonal well-being,70
especially when  diagnosing the causes of erectile dysfunction. If a man has
frequent nightly erections but is unable to achieve or maintain  an erection
during sex, it is likely that blood flow and nerve responses in the penis are
healthy . In this instance, erectile dysfunction may have a psychological
basis. If, however , he has no NPT and is unable to function sexually , it ismore likely that the root cause is physical. This differentiation allows
doctors to treat the problem ef fectively . Nocturnal erections usually occur during rapid eye movement (REM)
sleep.71 The reason that they are most apparent in the morning is that we
tend to wake up at the end of a REM sleep cycle. Equally , testosterone
levels tend to be higher in the morning. It is thought that erect ions of this
type may differ in some way physically from those caused by arousal. Research has reported cases of men who experience pain with NPT but
never with erections related to sexual arousal.72
It is common for a man to have three to five of these nocturnal
erections, each lasting 30 minut es or longer , during eight hours of sleep.73
Contrary to what many people believe, these are not the result of sexual
stimulation, thoughts, or dreams. Young men, who have higher testosterone
levels, tend to experience more NPT, and incidence declines in men during
their forties and fifties. This gradual decrease is normal too, but if these
erections stop altogether , this can be a sign of a hormonal imbalance, high
blood pressure, or other potentially serious health problem. We know , for
example, that the production and stability of sex hormones can be strongly
affected by dysfunction in the autonomic nervous system caused by stress. Research found that men with a condition called hypogonadism,74 which
causes diminished function of the gonads and testes (or the ovaries in
women), experienced more NPT after they were given testosterone therapy . Scientists have demonstrated that NPT can be affected by quality of
sleep.75 Poor or disturb ed sleep prevents us from entering the REM sleep
cycle when nocturnal erectio ns usually occur . We know that sleep-
disordered breathing results in less restful sleep. Men with sleep apnea and
erectile dysfunction experience more nocturnal erections when  they use a
CPAP machine to improve their sleep than those whose OSA is untreated.76
Mouth breathing  at night is a significant anatomical risk factor for OSA,
increasing the incidence and severity of upper airway collapse77 and
therefore contributing to erectile dysfunction. This underlines how
important it is to ensure nasal breathing during sleep—someth ing that can
be easily achieved by using MyoTape. (You can read more about CPAP
compliance in the chapter on sleep. )One of the hallmarks of sleep apnea is recurrent hypoxia throug hout the
night. In hypoxia, not enough oxygen makes it to the cells and tissues in the
body . This can happen even when blood flow is normal. It is related to
many factors, including heart and respiratory failure, sleep apnea, smoking,
COPD, diabetes , high blood pressure, and clogged arteries.78 Significantly ,
all of these disorders are characterized by erectile dysfunctio n and by a
reduction in sleep-related erections. In one study , scientists used high altitude to reproduce symptoms of
hypoxia in healthy men and assessed the results in terms of penile rigidity .78
The level of inspired oxygen decreases incrementally as altitude increases. Researchers followed three mountain climbers in their early thirties over a
26-day stay at altitudes ranging from 2,000 to 5,600 meters above sea level. At altitudes over 4,450 meters,  the rigidity of erections decre ased almost
completely , confirming that hypoxia negatively impacts erecti le function. We already know that slow, nasal breathing significantly improves
oxygenation due to the fact that more air reaches the small air sacs of the
lungs. This is yet another reason why nasal breathing during  sleep is so
important. Nitric oxide, which we harness by breathing through the nose, is also
essential both for vascular health and erectile function. In one study ,
scientists state that “maximal attention should be placed on measures
known to improve vascular NO production.”6 This includes the use of
PDE5 inhibitors and exercises to ensure normal functioning of the pelvic
floor muscles. These two approaches are complementary rather than
competing as they work on entirely different aspects of erectile function.6
As we’ve discussed, normal functioning of the pelvic floor relies on a fully
operational diaphragm, and it is nasal breathing during wakefulness and
sleep that promotes deep breathing from the diaphragm rather than fast,
upper chest breathing. For women, sleep apnea and insomnia have been linked to sexual
dysfunction and decreased sexual satisfaction. This is certainly the case
after menopause, but there are also a few studies of younger women that
examine this connection. A 2017 study of postmenopausal women found
that those with higher insomnia  scores were less satisfied sexually . Also,
women who slept less than seven or eight hours a night were less likely tohave sex with their partners at all.79 Researchers concluded that shorter
sleep and worse insomnia was associated with decreased sexual function in
these women. Despite the many decades of sexual revolution, studies of younger
women still often focus on fertility80 (or infertility) rather than on sexual
satisfaction in relation to common disorders such as poor sleep . One study
examined femal e sexual function in terms of sexual desire, sexual arousal,
lubrication, orgasm, sexual satisfaction, and intercourse pain in women
aged between 18 and 45 and found significant links with sleep quality .81
There was a marked inverse relationship between daytime sleepiness,
insomnia, poor sleep quality , and sexual function. Sexual desire was highly
dependent on good sleep, while  poor lubrication, orgasm, and satisfaction
were all associated with sleep  disorders. Pain during intercourse also
increased when  sleep was inadequate. Sexual function decreased
incrementally with each reduction in sleep quality and with each increase in
the time it took to fall asleep. Another study explored factor s in sexual function and infertility in
women with endometriosis82—a common condition where tissue similar to
the lining of the womb starts to grow outside the womb. The authors found
that sleep quality was a primary contributing factor in sexual dysfunction
for these women. As sleep quality, anxiety , depression, and pelvic pain
worsened, sexual function decreased. Again, as we have found in various chronic conditions, quality of sleep
can make a huge difference to how “in control” we feel. When sleep is
restorative, everything is a little bit easier . We feel mentally stronger , more
resilient, and less sensitive to pain. By making the switch to functional
breathing day and night, it is possible to experience significant
improvements in sleep, in quality of life, and in sexual function. LEARNING FROM ANCIENT WISDOM
It may sometimes seem like there is a constant focus on sex. As the old
marketing adag e says, “Sex sells.” Adverts on the statio n platform,
magazine article s, self-help books, films, talk shows, and gossip columns
are all obsessed with sex and sexuality . Even in a culture where  attitudes tosex and gender are changing, the sexual narrative, an almost competitive,
heteronormative view of sex is ever-present. Ironically , our fast-paced,
thrill-seeking, consumerist world paradoxically creates an environment
where it is difficult to fully enjoy a healthy , truly pleasurable sex life. As
with breathing and sleep, the real power of sex is in the quality , not the
quantity . Phallocentric attitudes have narrowed our view of sex to cente r on the
release of seminal fluid, an end goal which is largely irrelevant and leaves
men and women unsatisfied and disconnected. Sex has become functional. Despite all our advancements as a species, our relationship with sex is far
less healthy than it was thousands of years ago, and our understanding of it
is less assured. For instance, ancient T aoism teaches that men can control ejaculation by
using the breath. This makes no sense if you equate “coming” with orgasm. However , Taoism  also tells us that ejaculation and orgasm are two different
things. If this sounds far-fetched , research from 2015 confirms it to be true. Male orgasm and ejaculation are, in fact, two distinct physiological
processes.3 Orgasm is “an intense transient peak sensation of intens e
pleasure creating an altered state of consciousness associated with reported
physical changes.” Ejaculation is “a complex physiological process that is
composed of two phases (emission and expulsion)” and influenced by
complex hormonal and neurological pathways. Although male sexuality is
very well studied, much about this topic is still unknown. However , even
less is known about the “mythical” female or gasm. Taoism and yogic cultures embrace sexual function and orgasm in a
way that many people never experience. They view sex as wholesome and
life-preserving, not a taboo laden with concepts of guilt, sin, voyeurism, and
exploitation. By using the breath to guide and build sexual energy, they
access a health-giving resource. In this mindset, where sex is part of the
human experience and not separate from it, erotic ecstasy is a tool for
spiritual develo pment and physical and mental well-being . Although
research is limited, these conce pts are to some extent being examined and
contextualized in scientific literature. Increasing credence is being given to
the idea that the ancient sages may have been onto something.For exam ple, a 2019 paper in The World Journal of Men’ s Health looks
at yoga for managing prematu re ejaculation.83 The study describes the
connection between health and sexual function, including the links with
diabetes, heart disease, and chronic illness. It mentions that while
psychological disorders such as anxiety , depression, and stress are often
associated with premature ejaculation, medications used to treat these
conditions can come at a significant cost to sexual function.83 The
integrated appro ach of yoga therapy has been found to be effective in the
management of many of these diseases. At its core, yoga involves a deep
integration of mind and body , without which it is difficult to enjoy a
fulfilling sex life. This study examines yoga in relation to breath control and
pelvic floor muscle strength, which we know are vital to mental and
physical health and to functional movement, something many other papers
have touched on concerning sexual dysfunction. There are many forms of yoga. Of the better -known types, Tantra yoga
is gener ally perceived to focus on sex, although, in fact, Tantra is more
accurately abou t connection, either with the self, a partner , or the divine. Scientists have supported the potential applications of Tantric practices as a
holistic, accessible way to treat aspects of sexual dysfunction, such as
mental blocks, premature ejaculation, erectile dysfunction, and intimacy
issues.84 Anothe r branch  of yoga called Kundalini can be used to inten sify
sexual pleasure85 and to produce orgasms without ejaculation in men,
resulting in sex that can last longer and involve multiple orgasms. A
specific concept for conservation of semen, known as Bindu Samrakshana ,
was described in a fifteenth-century yogic treatise, Hatha Yoga
Pradeepika .86
Unfortunately , modern perceptions concerning these practices have
limited their therapeutic use. For instance, you may have heard of Tantric
sex in associatio n with the musician Sting. If you mention his name, the
question of marathon sex is likely to come up. It turns out that claims he
enjoyed seven-hour lovemaking sessions with his wife Trudie Styler were
originally a joke. However , in an interview for Inside the Actor ’s Studio , he
told host James Lipton that the concept of Tantric sex has its roots in a very
serious belief system:The idea of tantric sex is a spiritual act. I don’t know any purer and
better way of expressing a love for another individual than sharing
that wonderful, I call it, “sacram ent.” I would stand by it. Not seven
hours, but the idea.87
A 2011 article in the South African information website, Independent
Online  describ ed the prevailing male attitude to yoga as akin to “declaring
yourself a New Age hippy and wearing crystals.”88 Nevertheless, between
2012 and 2016, the number of men practicing yoga in the United States rose
from 4 million to 10 million.89 Yoga was long believed to be a traditionally
male-only pract ice, although historians now argue that women played a
central role in its development.90 Now , in W estern society , yoga for men is a
rapidly growing trend with some classes being marketed as “Broga.”91
Yoga has many benefits for everyone. Most yoga practices focus on the
breath and have some element of pelvic floor muscle activation. Yoga
improves nervous system functi on and hormonal balance and reduces age-
related decreases in testosterone. It eases stress, suppresses the sympathetic
nervous system,  and promotes parasympathetic activation. Stimulation of
the parasympathetic nervous system through yoga practice is believed to
improve ejacula tory control, providing a nonpharmacological alternative to
treatments such as fluoxetine for premature ejaculation.92
Yoga builds strength, stamina, flexibility , and muscle tone. It increases
stability in the core muscles, improves control of pelvic and perineal
muscles, and requires a focused interaction of breathing and movement. It is
thought that the deep breathing, better cardiopulmonary efficiency , and
mindfulness that develop through regular yoga practice may also improve
ejaculation control due to better awareness that ejaculation is about to
occur . The 2019 study from The World Journal of Men’ s Health also reports
that focused attention on abdominal breathing is associated with a marked
increase in whole blood serotonin. A heightened level of serotonin is
believed to improve ejaculatory control—SSRI antidepressant s can cause
delayed ejaculation in some men.93
The researchers suggest that yoga can provide the following benefits for
men who experience premature ejaculation:• Seated postures, in particular , relax the muscles of the pelvic region. Poor control of
the pelvic floor muscles is implicated in premature ejaculation, urinary incontinence,
and erectile dysfunction. • Inverted postures improve the circulation to veins in the pelvis and perineum,
enhancing the flow of blood to the sexual organs. (Recall that one value of nitric
oxide is in increasing blood flow to the erectile tissues. This is the function that is
enhanced by sexual performance drugs like V iagra.) • Controlled breathing practice ( Pranayama ) is very ef fective in reducing heart rate
and improving cardiovascular health. Specifically , diaphragmatic breathing reduces
sympathetic activation and stimulates the vagus nerve, reducing anxiety . The study
observed that after a five-minute practice of a Pranayama  breathing technique,
involving a respiratory rate of six breaths per minute, systolic and diastolic blood
pressure markedly decreased. • A yogic cleansing practice called a Kriya , which is done by exhaling forcefully and
inhaling passively , both through the nose, may help delay ejaculation. A similar
Tantric breathing technique, involving rapid exhalations through the mouth, can be
practiced as orgasm approaches to trigger changes in blood chemistry that are
believed to delay ejaculation. • Meditation and mindfulness improve sexual well-being by increasing relaxation, body
awareness, and autonomic nervous system balance. Many treatment options are available for men who are confident enough
to approach their doctor about premature ejaculation. Unfortunately , those
treatments can cause side effects and affect sexual satisfaction. However , a
lot of men never seek help at all due to the perceived stigmas around sexual
dysfunction.83 Yoga, as a nonpharmacological intervention or as a
compliment to standard medical treatments, has been established in
empirical studies as effective, although there is scant research into which
techniques or postures may be most helpful. Even so, it is widely
recognized that alternative methods, such as functional breath training and
yoga, provide low cost, accessi ble alternatives that may benefit men who
are uncomfortable discussing sexual problems with a healthcare
professional. Breathing techniques also help bring focus onto the mind-
body connection—an aspect missing in standard sex therapy—enriching the
sex life. The 2019 study concludes that integration of these techniques into
contemporary sex therapy could have a positive influence on different
facets of human sexuality .83
REACHING YOUR PEAKOrgasm is characterized by certain physiological features  including
hyperventilation up to 40 breaths a minute, tachycardia (a very fast heart
rate), and high blood pressure. A faster heart rate was found to be indicative
of “real ” (as opposed to fake) orgasm in men during heterosexual
intercourse.3 Orgasm also produces powerful, highly pleasurable
contractions of the pelvic muscle s. Intense sexual pleasure has been equated
with trance states94 and can even result in synesthesia—a light show akin to
your very own fireworks.95
It is possible to train the breath to experience powerful orgasm s. While
orgasm is often associated with losing control, ancient practices  like Tantra
emphasize that control is of the utmost importance. If your goal is sexual
ecstasy , you must first learn to master your sexual desire. For men, this
involves a practice of forceful exhalation called Kapalbhati  as orgasm
approaches,96 changing the blood biochemistry , and delaying ejaculation by
reducing blood flow to the genitals. But there’ s more to it than prolonging
sex. These techniques are part of a spiritual practice that may seem at odds
with the Western idea of sex. In discussions of spirituality , some writers
avoid the topic of sex altogether , but across a number of spiritual traditions,
the concept of sexual ener gy is considered fundamental to spiritual growth. In Tantra and Taoism, sexual energy is no less than the manifes tation of
our vital life force. The erotic sculptures in ancient Hindu temples display
rapture rather than lust in the upturned faces of the lovers.97 Descriptions of
spiritualized sex involve extended intercourse and a sense of timelessness
that makes them very different from everyday sex. Normally , we follow an
automatic series  of behaviors, movements, and fast breath patterns in which
the desire to express love becomes sidelined in the search for physical
pleasure.97 These ancient practices teach us to take time and to reach new
peaks. In his book Natur e, Man and W oman , Alan Watts describes how sex can
give rise to extraordinary spiritual experiences.98 He explains that, at its
height, sexual love is one of the most complete experience s of which
humans are capable, but that “prejudice and insensitivity have prevented us
from seeing that in any other circumstances such delight would be called
mystical ecstas y.” The whole purpose of Tantra is to generate a
transcendental state. In a 1981 edition of Yoga Journal , Dio Urmila Neffconcludes that “Generating spiritual ecstasy may have been . . . [along with
procreation] . . . the original purpose for sexual delight. It may indeed be
our most precious grace.”97
Whether you are interested in exploring the more esoteric concepts at
play here or just want to enjoy a better , healthier sex life, for yourself or as
a couple, these techniques all begin with the breath. Prana  is the ancient
word for breath—or life force. As the ancient yogic text Shiva Samhita ,
says,
The wise man does not talk about the capacity of uttering words,
about sight, hearing, or meditation; he speaks only of the different
types of prana that makes all these things possible. Because
everything else is nothing but manifestations of prana.99,100
WOR TH W AITING FOR
Consciously controlled breathing has considerable benefits. Better
oxygenation gives you more energy, so tiredness doesn’ t curtail your
enjoyment or arousal. Sex that lasts longer before orgasm generally results
in a more intense orgasm and greater satisfaction. Awareness of the breath
can help you to overcome resistance, relax the muscles, and ease difficulty ,
for example during anal sex.101
According to Urmila Neff, the way you breathe during sex has
“everything to do with its duration.” Both Tantra and Taoism recommend
deep nasal breathing from the diaphragm rather than fast, upper -chest
mouth breathing. In discovering  the functions of the vagus nerve and the
diaphragm, we have learned that there is a direct relationship between the
emotions and the breath, and this is thought to extend to sexual arousal too. While the breath is constant and normally unconscious, we can choose to
change its depth and rhythm. By deliberately directing the breath, it is
possible to modulate the emotions and temper sexual excitement. Another connection lies in the idea that the breath is a rhythmic
extension of the nervous and glandular systems. This idea of rhythm
throughout the systems and its place in the sexual experience has recently
been studied in the context of sexual trance.94There are various methods that can be used to stop ejaculation, but the
consensus is that fast breathing contributes to orgasm while slow breathing
helps delay (and intensify) it. The first and most basic way in which
breathwork can contribute is that it makes us more aware of the breath and
more attuned to the body . This is significant because unless you have a
certain awareness of your body , you are likely to employ any method of
delaying orgasm too late. Also, until you become accustomed to working
with the breath during rest, you will find it very difficult to adjust your
breathing during sex. For men, tantric breathing for “sexual continence” has two basic
principles: first, rhythmic breathing through the nose to slow the
metabolism and activate the parasympathetic nervous system, and second,
breathing explosively through the mouth, which is import ant for the
expression of feelings.102 In yoga  and Tantra, slow nasal breathing is used
to contro l sexual energy. The fast breathing generates an explosive external
orgasm—the faster the breath, the more effectively it works. When
breathing is slower , we receive  more vital energy. When it speeds up, we
emit more energy. A daily practice of diaphragm breathing is essential to
controlling ejaculation and increasing erotic sensation in the body . In the book The Multi-Or gasmic Man, authors Mantak Chia and
Douglas Abrams explain that because quick, shallow breathing increases
the heart rate, and a fast heart rate is synonymous with orgasm, deep, slow
breathing to slow the heart will control arousal and delay ejaculation.45 The
book describes how some men breathe quick, shallow breaths (the yogic
breath of fire) while others find that holding the breath for a few moments
on a deep inhalation lessens the ur ge to ejaculate. In Tantra, once you have reached the goal to no longer ejacul ate, you
need to continue with the breathing exercises to learn how to channel your
sexual energy into conscious mental energy. Diaphragm breathing massages
the prostate and other internal organs, and it relieves the sense of pressure
many men experience when they don’t ejaculate. This tension in the genital
area is common for men who are new to sexual continence practice. It is
caused by a buildup of sexual energy in the pelvis. If this energy is not
diverted, it causes irritability , anxiety , and confusion. At this stage,
diaphragm breathing is used to guide the sexual energy up through thespine. Retaining sperm is not the only aspect to developing the ability to
experience multiple whole-body orgasms: sexual energy must be
transformed, and that is done with the breath.
_OceanofPDF.com_The_Breathing_Cure_-_Patrick_McKeown.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        Howev er, no trial has yet
explored whether diaphragm breathing exercises might be beneficial when
it comes to sexual arousal. Nevertheless, a new approach to the treatment of
premature ejacu lation was devised in 2006. 12 Functional sex therapy, which
incorporates aspects of functional movement and breathing, was shown to
be more ef fective than traditional masturbation-based techniques. While Viagra or equivalent drugs may seem like the perfect solution for
men with erectile dysfunction,  there are strong arguments for exploring
more natural alternatives. A 2003 study that importantly but rather
unusually exam ined the impact of Viagra on men’ s sexual partners found
many problems. Not only were women experiencing physical symptoms
such as cystitis from prolonged  penile-vaginal sex, often in the absence of
other sexual stimulation and foreplay, the “blue pill” put a heavy weight of
expectation on the partner, sometimes leaving little room for the respectful,
engaging interaction essential to healthy sex. 13 Rather as an afterthought,
researchers asked the question:
Will the sexual script of Viagra lovemaking actually be flexible and
worry‐free, or will Viagra‐sex be all about worshipping the penis,
since no one spending upwards of $10 to have an erection will
ignore it. 14
The implication s behind this question are not insignificant. Popping a blue
pill is quick and easy, but with the focus purely on a rather penis-centric
idea of performance, it cannot be without problems and may actually prove
damaging to vulnerable partners. 13 In fact, in homosexual men, the drug has
been linked with increased sexual risk-taking. 15
Fortunately, a growing weight of scientific evidence indicates that
functional breathing practice can provide long-term benefits for sexualfunction through better oxygen ation and improved diaphrag m function. Unlike quick-fix pharmacological solutions, this has the bonus of overall
improved health, physically, mentally, and relationshipwise. Nasal breathing is also important in our sexuality through its connection
to our sense of smell. Research has confirmed that the olfactory system
plays a significant role in choos ing a partner and in empathic functioning. Scientists examining people with impaired olfactory function found that the
sense of smell influences various aspects of our sexuality. 16 A 2018 study
explored the link between odor sensitivity and sexual desire, experience,
and performance in 28 men and 42 women. Researchers found that the
enjoyment of sex was enriched by olfactory input, and women  who were
more sensitive to smell reporte d a higher number of orgasms during sex. Odor sensitivity correlated with pleasure experienced during sex, perhaps
because the perception of certa in body odors enhances the recruitment of
reward areas in the brain. 16
This connection  between our sense of smell and the way we interact
with others, including our sexual partners, was also examined in a study
from 2017. Scientists assessed the reliability of social judgments made via
olfactory cues to discover the difference between responses to natural body
odor and perfumes/deodorants, and between whole-body olfactory
impressions and armpit odor presented on a t-shirt. Participants wore ear
plugs and an eye mask to ensure that their impression of the person they
were “meeting” was confined to their sense of smell. The results showed
that people make consistent social judgments about others based on body-
odor alone. ”17
We don’t yet know the full function of human body odor or the role it
plays in sex, but it is known that nasal breathing activates the olfactory
nerve. 18 According to another 2017 paper, “airflow rhythm in the olfac tory
system can regulate the phys iological and brain states, providing an
explanation for the ef fects of breath control in meditation, yoga, and T aoism
practices. ”
On the other hand, smell can also be a big turn-of f. Kissing, which
should be a delightfully pleasurable experience, can be rendered unbearable
by bad mouth odor. However, bad breath is not always the result of poor
oral hygiene. It is also a symptom of mouth breathing. Bad breath in themorning can be the result of mouth breathing during sleep. When we sleep
with the mouth open, saliva dries up and bacteria proliferates, producing the
dreaded “morning breath,” even  in people with otherwise meticulous oral
hygiene. If you have a dry mouth when you wake, it is likely that you
mouth breathe during your sleep. It is also likely that you have a buildup of
plaque on your teeth and tongu e. 19 Fortunately, it is easy to restore nasal
breathing durin g sleep simply by taping your mouth with MyoT ape—
though you may want to wait until after you’ve had a cuddle to apply the
tape. WHY STRESS IS A BIG TURN “OFF”
While nasal breathing directly enhances sex drive and performance due to
increased blood flow to the penis and clitoris, functional breathing also
helps reduce stress and promote better sleep, which, of course, impacts
sexual function. Despite the once widely held belief that most sexual
dysfunction has its roots in mental health, it’s now known that sexual
problems such as erectile dysfunction are caused by physiological factors in
more than 80% of cases. 20 Nevertheless, chronic stress can and does create
emotional and cognitive changes that prevent us from responding to sexual
cues. 21 Stress has a powerful negative  impact on all of the body’ s systems
and can cause many problems that show up as physical or biochemical
imbalances. If you are exhauste d, stressed out, depressed, or have a poor
body image, you will find yourself in the mood for sex much less often, and
this can impact your relationships and further undermine self-esteem. 22
To understand the impact that stress can have on sex, we need to look
back to the autonomic nervous  system (ANS). Remember that breathing,
stress, and the ANS are interconnected, as we have already discussed
(Chapter Four ). The ANS controls functions that include heart rate,
respiratory rate, and sexual arousal. It consists of the two main branches,
the sympathetic and parasympathetic nervous systems, commonly known as
fight, flight or freeze, and rest and digest (or “feed and breed”). Ideally,
those two branches function in balance. However, when sympathetic
activation is too high or too constant, we experience chronic stress. In thatstate, the body’ s evolutionary mechanisms prioritize survival over sex and
sexual desire. Under normal circumstances, sex can be a great way to relieve stress. It
causes the release of mood-enhancing hormones, including endorphins. It
can be great exercise, which is uplifting, in itself. However, stress can
create a vicious cycle. Imagine this scenario. You’ve been working hard all
week and want to enjoy some quality intimate time with your partner. Your
mind is elsewhere, still going over a problem you didn’ t manage to fix. You’re too stressed and can’t get aroused or can’t get an erection. Your
partner asks what’ s wrong, but because you haven’ t realized how stressed
you are, you brush the question aside and push yourself to perform. You
can’t or it’s unsatisfying. The next time you want to be intimate,  the episode
replays in the back of your mind. Anxious not to repeat the embarrassment
and discomfort, the inevitable happens. The more you try, the worse things
get. Anxiety about your ability to perform in bed quickly becom es habitual,
causing erectile dysfunction, lack of arousal, or even aversion when you
think about having sex. This is one of the main reasons some men and
women begin to avoid intimacy altogether. While many of the situations we discuss in this book are primarily
health-related, sex is more than just a physical experience. Any health
concern can impact quality of life, but sex has a unique place in our closest
relationships, as an emotional outlet and as a marker of personal identity. It
is hardly  surprising that we can form negative feelings around sex that
trigger automatic physical responses that prevent sexual function. For many men, erectile dysfunction begins as a stress response. Stress
on top of stress triggers a vicious cycle of events. Unfortunate ly, because
sexual arousal is controlled by the ANS, it doesn’ t respond to attempts at
conscious contro l. However, there are ways to mediate the ANS to address
the issue  from a body-to-brain perspective. These include slow diaphragm
breathing exercises at six breaths a minute and mindful breathing—the
simple practice of paying attention to the breath. It may be helpful to understand  what the ANS does when it comes to
sex and why it’s such a problem when things are out of whack or when the
ANS is affected by stress. First, the ANS is responsible for the dilation of
the blood vessels that cause erection of the penis or clitoris. In men, thisdilation is largely facilitated by nitric oxide. 23 Erection depends on nerve
impulses from the ANS directin g blood flow to the penis. It also requires
the autonomic constriction of a circular muscle called a sphin cter, which
ensures that blood doesn’ t flow back out of the penis. The ANS also
controls stimula tion of secretions from the vagina or prostate. It mediates
smooth muscle contractions of the vas deferens during ejaculation, or
rhythmic contra ctions of the vagina during orgasm, and contractions of
other pelvic muscles that accompany or gasm in both sexes. 23
The processes differ between men and women. The female sex hormone
estrogen  is associated with increased synthesis and release of
acetylcholine,24 the neurotransmitter produced by the vagus nerve. In
women, acetylcholine floods into the pudendal artery during vasodilation. Relaxing this artery, which supplies blood to the genitals, is essential to
engor ge the clitoris and vagina during sexual stimulation. Researchers
believe that when relaxation of this artery is compromised, it can contribute
to female sexual dysfunction. 25 Women who are stressed experience lower
levels of genital arousal, even when psychological arousal is high. Women
are reputed to be gifted with the ability to multitask, but researc h has found
that arousal decreases in wome n who are distracted due to stress. 21 The
practice of mindful breathing can help with the ability to stay present during
sex and attend to physical and emotional sensations. Research has shown
that mindfulness enhances sexual arousal. 26
When the ANS is out of balance and sympathetic activation is high, the
body is not able to function normally. Stress floods the body with cortisol
and disrupts other hormones. Cortisol is needed for the regulation of blood
pressure and the normal functioning of the body’ s systems, but too much of
it can affect the normal biochemical functioning of the male sex organs. 27
Stress can affect testosterone production,28 resulting in lower sex drive,
erectile dysfunction, and impo tence. It can also negatively affect sperm
production, maturation, and make the body more vulnerable to infection. Infection in the prostate, urethr a, and testes can all prevent normal sexual
function in men. 27
In women, stress can affect menstruation, increase symptoms of PMS,
reduce sexual desire, negatively impact pregnancy health and postpartum
adjustment, and worsen symptoms of menopause. It contributes to theexacerbation of diseases such as polycystic ovarian syndrome and can
disrupt estrogen and progesterone levels, along with other hormones that
support fertility. Sexual arousal relies on a variety of functions, including
vaginal blood flow and engor gement of the labia, clitoris, and vestibular
bulbs. These physiological responses are triggered by neurons that are
controlled by the parasympa thetic nervous system,29 which can be
suppressed by stress. Research, parad oxically, shows  that moderate sympathetic activation
may boost sexual arousal in women. 30 The genitals are largely innervated
by a nerve that, rather unusually, contains both sympa thetic and
parasympathetic neurons31 (if you’re dying to know, it’s called the major
pelvic ganglion ). Scientists believe that this sympathetic activity may
increase arousal  by enhancing focus and attention on erotic cues, increasing
blood flow, decreasing digestio n, and directing more blood to flow to the
genitals. Alessandro Romagnoli is an Oxygen Advantage Master Instructor in
Italy and France. He works as a psychologist, specializing in cognitive
neuroscience. He has a wealth of clinical and scientific experience that
allows him to help a broad range of clients, from people with severe
psychiatric conditions to high-level professional athletes. I asked him to
bring some insight to the topic of breathing and sex. He explained:
Breathing techniques can be helpful in the treatment of sexual
dysfunction because the breath can influence not only the
physiological aspect but also the state of mind, and even the quality
of the relationship. For example, slowing down the respiratory rate
before intercourse would be tremendously beneficial, reducing any
feelings of inadequacy and stress. Ultimately, the ANS must be in balance to function optimally. Despite
the relationship between sympathetic activation and stress, both the
parasympathetic and sympathetic branches of the ANS contribute to sexual
arousal. The male sexual response, in particular, reflects a dynamic balance
between exciting and inhibiting  influences of the ANS. 32 Interestingly, a
2002 study in Cardiovascular Resear ch found that the human heart is moregeared toward sympathetic mediated responses in men and parasympathetic
responses in women. 24
VAGUS NER VE—SECRET T O DEEPER ORGASMS. The parasympat hetic nervous system (PNS) plays a significan t role in in
sexual function, as it does in general health. Elevated heart rate variability
(HRV) has been  linked to bette r erectile function in men. 33 HRV, which is
used as a measure of parasympathetic or vagal tone, can also be used to
predict female sexual dysfunctio n. In a study of 84 women aged  between 18
and 47 years, low HRV was identified as a risk factor for sexual
dysfunction. The study recor ded measurements of respir atory sinus
arrhythmia (RSA) before, during, and after sexual arousal. Researchers
found significant differences in vagal activity between women  who were
sexually functional and women  who experienced dysfunction,  suggesting
that vagal tone could provide a potential mechanism through which to treat
sexual dysfunction. 34 This implies that sexual dysfunction could be
alleviated by stimulating the vagus nerve—which can be done by practicing
slow breathing at six breaths per minute. Research from 2015 reached a similar conclusion from a different
starting point. In a study of women who had survived childhood sexual
abuse, their HRV was compare d against women who had no history of
trauma. It was found that when  women were treated to reduce autonomic
imbalance, their sexual well-being improved. Over time, as HRV became
better regulated, the women showed increasing improvements in sexual
arousal and or gasmic function. 35
The vagus nerve is implicated in female orgasm and in ejaculation for
both men and women. In women, vaginal orgasm is physiologically
different from clitoral orgasm. 36 While sensory input from the clitoris
travels to the brain via the puden dal nerve, information from the vagina and
cervix travels via the pudendal,  pelvic, hypogastric, and vagus nerves. The
vagus nerve is stimulated durin g heterosexual sex as the penis connects
with the cervix. This stimulation appears to be linked to better
cardiovascular and psychological function and increased vagal tone. 36
Research by Beverly Whipple and Barry Komisaruk, authors of The Scienceof Orgasm, demon strates that the vagus nerve plays a role in deep orgasm s
in women. 37 So much so that it is possible for a woman who has a
completely severed spinal cord and no feeling in her lower extremities to
experience orgasms, even in the absence of any connection between the
external clitoris and the brain. 36
More recent research has shown that much of the clitoris is internal,
with four-inch roots reaching into the vagina. 38 This would indicate that
vaginal and G-spot orgasms are, in fact, also clitoral and come from
stimulating the internal parts of the clitoris. It is certainly the case that if the
vaginal walls had as much sensation as the clitoris, childbirt h would be
impossibly painful. Just the tip of the clitoris has over 8,000 nerve endings,
double the number found in the penis. 39 However, it is hardly surprising
that understanding of female orgasm is limited and conflicting, because it
wasn’ t until 2009 that the first sonographic mapping of an erect  clitoris was
carried out. Without this knowle dge, much study of the female anatomy and
female sexual satisfaction has assumed that penile stimulation is necessary
to orgasm—only adding to an unhealthy culture around female sexuality
that may help explain why 1 in 10 women has never had an or gasm. Looking at it from a different direction, the ancient Tantric idea that
restricted breathing creates a type of internal contraction, blocking feeling
and emotions, was confirmed in 2008 by scientists who made a link
between the way a woman walks and her experience of, or potential for,
vaginal orgasm. The researchers speculated that chronic muscle tension
impacts sexual function by impairing feeling and functional movement,
possibly representing mental or emotional blocks. The paper cites a study of
men in which it was found that a method of therapeutic manual tissue
manipulation known as Rolfing  decreased postural problems in the pelvis
and increased cardiac vagal tone, which indicated better parasympathetic
function. Research from 2004 similarly linked physical therapy with better
orgasmic function in women,40 and another review from 2007 indicated that
problems in the muscles of the pelvic floor are closely related to sexual
dysfunction. 41 The 2008 paper concludes,
The discerning observer may infer women’ s experience of vaginal
orgasm from a gait that comprises fluidity, energy, sensuality,freedom, and absence of both flaccid and locked muscles. 36
This raises the question, could the diaphragm—which is central to
breathing, integr al to the core, vital for stability of the spine and pelvis, and
connected to the vagus nerve— also play an important role in the ability to
achieve satisfying or gasms. Significantly, that all-important vagus nerve also innervates the voice
box and throat, and it is direc tly connected to the cervix and uterus. 42
Research into this area is incredibly sparse, but one paper explores the
involuntary vocal noises we typically make during sex, linking the more
powerful sounds with hyperventilation. It is the first study to examine blood
sensitivity to CO 2 during intense sex. It suggests that the metabolic changes
occuring in the brain during hyperventilation may deepen states of sexual
trance. 43 The researchers observe that changes in breathing patterns during
sex are similar in both men and women. However, accelerated breathing is
more accentuated in women. Anecdotal evidence also suggests that women
are more vocal during sexual intercourse. 43
The Multi-Or gasmic Woman  describes the use of the breath to extend
female orgasm by contracting the pubococcygeus muscle and expressing
pleasure with the voice, explaining that, according to Taoist wisdom, the
throat and vagina are connected. 44 As you gain better control of your sexual
energy, “you will be able to extend your orgasm through one long out-
breath, a quick intake of breath, and then another one or two breaths. ” The
book states that if the throat  is open, the genitals will be “open to
pleasure. ”44 In the book The Multi-Or gasmic Man by Mantak Chia and
Douglas Abrams, we learn that the ability for men to control ejaculation and
have more than one orgasm also begins with strengthening and deepening
the breath45. If you are interested in exploring the Taoist techniques for
sexual pleasure more deeply, those books, along with The Multi-Or gasmic
Couple, provide an approachable and informative resource. As we know, hyperventilation alters levels of blood CO2, and CO2
moderates the rate of blood flow in tissues, especially the brain. Hyperventilation also induces changes to the blood’ s acid-base balance,
which increases the affinity of blood hemoglobin for oxygen. This further
decreases the amount of oxygen available for the cells and tissues. Bloodflow to the brain can decrease by as much as 50% during
hyperventilation. 43 At the same time, metaboli c activity in the brain
changes. Functional magnetic resonance imaging (fMRI) studies show that
oxygen consumption is predomi nantly reduced in the neocortex gray matter
and much less in the limbic structures. The limbic systems in the brain are
responsible for our emotional responses, while the gray matter influences
attention, memo ry, thought, and motor control. The study suggests that this
may explain the role of hyperv entilation in intensifying emot ional states
and changing behavioral control during sex. The study also suggests that changes within the nervous system induced
by hyperventila tion could lead to altered states of consciou sness. This
involves a shift in the pattern of activity between different structures within
the brain. The result is someth ing that scientists describe as an “arousal
dissociation,” which may result in a more primitive form of brain function. This brain “state,” which involves activation of pleasure responses, less
self-control, a decrease in abstract thinking, and an increase in emotionally
guided thinking is known to occur during dreams, hypnagogia (the state of
consciousness just before we fall asleep), and in states induced by
hallucinogenic drugs. 43 Hyperventilation may be used instinctively in this
context to intensify experience s of sexual excitation, sexual trance, and
orgasm. 43
Tantra. com founder, Suzie Heumann, speculates that for women,
opening the mouth and chest cavity with slow, deep breathing may connect
with the vagus nerve to greatly enhance orgasmic capacity. 46 Heumann
writes,
When women emit deep, low sounds from their abdomens and with
their mouths wide open this can sometimes lead to longer lasting,
powerful or gasms and even female ejaculation. 46
Since it has been found that people who are more suscep tible to
hypnotic trance have a higher autonomic responsiveness and higher levels
of brain  to body vagal activit y,47 Heuma nn’s suggestion that a highly
activated vagus nerve can produce “out of body pleasure” may not be far
from the truth. WHEN SEX IS DYSFUNCTIONAL
Sexual function is defined in Western medicine as a state of physical,
mental, and social well-being as it pertains to sexuality. It requires a
positive and respectful approach  to sexuality and sexual relation ships, and it
involves the possibility of pleasurable, safe sexual experiences. Sexual
function is about more than just frequency or duration of sex. It includes
sexual desire, arousal, satisfactio n, orgasm, lubrication, and the workings of
the sex hormones22—all of which can ultimately be af fected by breathing. While sexual problems can include lack of desire, pain, inability to
orgasm, erectile dysfunction, aversion, difficulty with vaginal penetration,
premature or delayed ejaculation, lack of arousal, or inappropriate,
unwanted arous al, there is no universally accepted definition of sexual
dysfunction. For women, it encompasses ongoing or recurring decrease in
sexual desire or arousal, the feeling of pain during sex, and an inability to
reach orgasm. For men, it’s generally the inability to “get it up” or early
ejaculation. Few men know (or take advantage of the fact) that orgasm and
ejaculation are two quite distinct functions. 3
Hormonally speaking, there is plenty of evidence to indicate a
relationship between sexual function and testosterone production in men. On the other hand, the relationship with estrogen in women is less clear. What most of us know about female hormones and sex is limited to how it
relates to pregnancy (or trying not to get pregnant) and worries about
vaginal dryness, pain during sex, and changes after menopause. Lack of
knowledge and a paucity of research into female sexual function adds to the
pressure on women to stay “youthful” and the unhealthy prejudice that
postmenopausal women are sexually redundant. On the other side, lack of
understanding about the physiological aspects of sexual function leaves
men feeling emasculated. Neither of these common reactions reflect the
truth. Sexual dysfunction is a problem that can affect anyone, particularly as
we get older and when other health conditions are present. Global
prevalence of sexual dysfunctio n is high. Studies have identified that as
many of 57. 8% of men and 41% of women suffer from lack of desire,
anxiety about sexual performance, and orgasmic dysfunction. A 2003 study
of 1,793 Australians reported sexual dysfunction in 55% of men and 60% ofwomen. Howeve r, while prevalence is high in both sexes, there has been no
breakthrough in the treatment of women equivalent to the PDE5 inhibitor
(Viagra) for men. Although PDE5 inhibitors can increase clitoral blood
flow in postmenopausal women, and some women report heightened
arousal, these drugs have not been found to be consistently ef fective. 25
Overall, male sexual function has been extensively documented and is
well understood. In contrast, in women, the problem has been much
understudied. 25 Ironically, sexual dysfunction  is also considered more
complicated in women due to the combination of anatomical,
psychological, physiological, and social-interpersonal factors that
contribute. 25 Howeve r, it seems likely that this perception is colored by the
lack of research. In middle-aged and older men, factors such as high blood pressure,
diabetes, cardiovascular disease, and obesity (all affected by breathing
issues) clearly contribute to poor sexual performance. Substance use
(including smoking), thyroid conditions, anxiety, and depression can also
play a part. Erectile dysfunction  is normally caused by problems with blood
flow to the penis, hormones, or nerve supply. When the arteries harden due
to cardiovascular disease or hypertension, blood is less able to flow to the
penis, and it becomes dif ficult to achieve or maintain an erection. 48
As with men, female sexual disorders are affected by health  and by
psychosocial factors. Several studies have made the connection with
cardiovascular disease in women, indicating that treatment of sexual
dysfunction purely as a matter of lifestyle may underestimate its importance
as an indicator of health. A 2008 study claimed that 87% of middle-aged
women with heart failure report ed some level of sexual dysfunc tion,49 76%
had problems with dryness, and 63% struggled to or gasm. Cardiovascular and respiratory health are important from a purely
physiological perspective too. One early study, published in 1966, recorded
a peak coital heart rate of betw een 140 and 180 beats per minute and a
mean increase in blood pressure during sex. 50 Even earlier research, from
1956, found a similar outcome. 51 Peak coital heart rates at orgasm
approached 170 beats per minute in both men and women. Respiratory rates and tidal volumes were also recorded in this early
trial. Both measurements increa sed significantly in all subjects, with someparticipants demonstrating a breathing rate of more than 60 breaths per
minute and a peak minute volum e comparable with that during moderately
intense physical exercise. A study of midd le-aged men from 1970 compared the increase  in heart
rate during sex with that seen after climbing two flights of stairs. 52 Body
oxygen consumption was equivalent to 60% of the subject’ s VO 2 max. While the clinical implication is that sex imposes a modest
physiological cost, with maximal heart rates lasting around 15 seconds, this
cost is significant for anyone with heart or lung conditions. Diabetes (see Chapter Fourteen ) can affect the blood vessels and the
nerves that supply the penis. On average, men with diabetes experience
erectile dysfunct ion 15 years earlier and are four times more likely to suffer
from it than men without diabetes. Sexual dysfunction in diabetic women
has been less well studied,25 but recent research shows they are more prone
to sexual dysfunction than healthy women,25,53 suffering with lower sex
drive, vaginal dryness, little or no arousal, difficulty achieving orgasm, and
reduced sexual satisfaction. Obesity is linked to several types of sexual dysfunction in men and
women, both due to health reasons and to the poor body image that often
accompanies excess weight. 23 For people with epilepsy (see Chapter
Fifteen ), hyperventilating during sex can directly cause seizures. The study of female sexual dysfunction is challenging, due to its
multifaceted nature and to preconceptions that labeled women as “frigid” or
“neurotic” until alarmingly recently. It is also more difficult to overtly
define arousal in women, and the understanding of the femal e orgasm is
limited. Even today, the problem  has largely been investigated in terms of
comorbid condi tions such as diabetes and high blood pressure, making it
necessary to interpret results in terms of those disorders. Traditionally,
women with sexual problems were treated with psychological therapy,
whether the underlying cause was mental or physical, and there have been
few medications available. Since  female sexual function was first addressed
in research only 50 or 60 years ago, it’s hardly surprising that treatment
options can, at best, be described  as inadequate,25 which makes the benefits
possible through ef fective breathing all the more important. For both men and women, sex changes as we age. Scientists directly
compared the effects of aging on erectile dysfunction with the impact of
various comorbidities typically associated with aging and found that age
alone increased the risk of sexual dysfunction. Researchers reported that
poor health, diabetes, and urinary incontinence increased the risk of sexual
problems in all age groups. 54 In women, too, aging can, of itself, cause
problems. As we get older, the likelihood of developing decre ased energy
and strength, cardiovascular disease, diabetes, arthritis, cancer, and other
health concerns is greater. Relationships can change if one or both partners
develop chronic medical problems, and the inevitable physica l decline of
the aging body must be accepted  and accommodated if we are to maintain a
satisfying sex life. 55
Aside from the direct impact of poor physical and mental health,
hundreds of common medications also cause sexual dysfunction. These
include depression medications, particularly SSRIs (serotonin reuptake
inhibitors) such as citalopram, fluoxetine, and sertraline, and blood pressure
drugs including beta-blockers. 48 One study found that while SSRIs caused
more incidence of sexual dysfunction in men, the dysfunction experienced
by women using the drugs was more intense. 56
Many hormonal birth control methods can cause side effects, including
decreased sex drive and vaginal dryness. The Multi-Or gasmic W oman  offers
a detaile d overv iew of contraceptive methods and intimate problems such
as urina ry tract and yeast infec tions that may impede sexual function in
women. 44 The book is a valuable resourc e for any woman wanting to gain
better understanding and control of her sexual health. Sexual function can be a useful  measure of how well other systems are
working. Throughout this book, we examine how dysfunctional breathing
impacts general  physical and mental health and longevity, as well as
specific conditions. By making  positive changes to health through better
breathing, your sex life can be improved. BREA THLESS: SEX AND RESPIRA TORY DISEASE
If you have a respiratory disease, the connection between it and sex is much
more obvious. If you suffer from asthma or another chronic respiratorycondition, sex can quite literally leave you breathless. A 2019 study
explored problems of sex and intimacy in patients with severe asthma,
revealing a huge number of constraints facing people with respiratory
symptoms. 57 Some of these had to do with expectations, fear, and
embarrassment, while others directly related to physical exacerbations. This
study, which describes the experiences of nine patients in detail, is the first
to really address a problem that af fects millions of people worldwide. An earlier study had raised the issue of postcoital asthma and rhinitis. 58
The paper descr ibes the case of one male patient whose acute severe asthma
after sex resulted in several emer gency department visits and
hospitalization. Patients with COPD also struggle with breathlessness
during sex, a feeling that may be worsened by hyperventilation. 59 Erectile
dysfunction and low testostero ne levels have been reported in men with
respiratory diseases such as COPD,60 asthma and obstructive sleep apnea
syndrome (OSA). In patients with COPD, breathlessness, coughing, muscle
weakness, and diminished physical activity all contribute to decreased
sexual activity. 61 In these situati ons, anxiety around respiratory symptoms
adds another burden on both the suf ferer and the spouse or lover. A study  of patients with rhinoconjunctivitis —an allergic condition
characterized by nasal congestio n, runny nose, sneezing, postnasal drip, red
eyes (conjunctivitis), and itchin g of the nose or eyes—found a significant
relationship with sexual dysfunction in women and erectile problems in
men. In both genders, sexual function was much better in patients who had
received treatment for nasal and conjunctival symptoms than in those
patients who were untreated. 62
The 2019 asthma study gives the most detailed account of the problems
facing asthmatic s. Each of the nine people interviewed felt that a good
sexual experience required some physical effort,57 yet even moderate
exertion limited their performance due to worsening symptoms. Intimacy
was made difficult by asthma, even to the extent that kissing caused a flare-
up of breathlessness. One partic ipant described having to stop in “full flow”
because of feeling unable to breathe. They described feelings of exhaustion
that came from living with asthma and taking high-dose corticosteroids. Sleep deprivation caused marital strain in one case, as the participant’ s
partner interpreted attempts to get enough sleep as an evasion of intimacy. Patients felt they had to organize equipment or remember to use inhalers or
nebulizers, detracting from any spontaneity. While some could  accept this
as being part of their condition, others found it distressing and a barrier to
intimacy. One commented that her inhaler pump was almost like a third
person in the relationship because it was necessary to maneuv er around it
during sex. There was also a genuine fear that sexual climax might induce severe
bronchospasm requiring emer gency medical intervention. This added level
of anxiety reduced sexual satisfaction. The embarrassment caused by
having to explain the reason for the exacerbation to paramedics and
healthcare professionals was a major consideration. Some devised positive
coping mechanisms, including using pillows as props and finding positions
that didn’ t lead to exacerbations—the “Asthma Sutra. ” Emotional intimacy
has more elements than the purely physical expression of sex, but all of the
participants found that the physical act of sex was restrict ed by their
asthma. Certain positions caused feelings of suffocation, especially for
women, and men perceived their sexual performance to be dampened by the
need for physical exertion. Emotionally, the patients experienced frustration and guilt, and felt
pressure to perform. Often part of the problem was feeling they couldn’ t
broach the subject with their partner. Five of the female participants (83%)
described givin g their partners permission to sleep with other women
because they felt so guilty over being unable to offer sexual satisfaction in
the relationship and feared losing their partner altogether. Many felt that
they should not impose their asthma-related concerns on their partners. Others reported an emotional weight being lifted when they did manage to
explain the situation and receive support. Insights into self-image
uncovered feelings of self-loathing in all participants and problems
balancing the dual role of the partner as a carer and a lover: “One minute
they’re wiping your bum and then the next minute you’re ripping each
other ’s clothes off. It does vary. ” Two of the participants describ ed how this
conflict in roles had caused the breakdown of previous marriages. Weight gain due to long-term corticosteroid use and difficulty
exercising because of symptoms also had a negative impact on body image
and feelings of sexuality. Even things most people take for granted, such as
wearing sensual underwear, were problematic due to feelings of restrictionon the chest wall. All participants voiced some element of struggle on a
daily basis. Despite the significance of these  issues in the day-to-day lives of people
with severe asthma, no healthcare provider had ever initiated discussion of
sexual intimacy during medical appointments with any of the participants. Two even described negative reactions when they tried to raise their
concerns. One commented, “I actually brought it up, and I thought the
counsellor was going to run out of the room screaming. ” Seven of the
participants felt that the topic was too intimate to raise but would welcome
the chance to talk about it with a specialist nurse if the opportunity were
offered. 57
The study confirms that fatigu e has a significant impact on sexual
quality of life for people with severe asthma. The finding that the fear of
exacerbation was so present during sex is new, as is the discovery that
embarrassment about having to call an ambulance was generally worse than
anxiety about the asthma exacerbation itself. Intimacy, from kissing to full
sex, produced breathlessness and feelings of suffocation, and spontaneity
was difficult. All these factors added pressure to the sufferer ’s relationship,
presenting a huge emotional burden on top of the physical limitations. The
study concluded that it is essential for their quality of life that healthcare
professionals openly address sex and intimacy with asthma patients. The breathing exercises in this book have been shown, time and time
again, to reduce asthma symptoms and prevent asthma exacerbations. If
asthma is affecting your quality of life, relationships, and sexual pleasure,
it’s time to take back control. You can read much more about using
breathing exercises to control your asthma in Chapter T en. SLEEPING T OGETHER
Sex and sleep are interesting bedfellows—quite literally both are typically
done in bed—bu t the connection goes far deeper than this. We’ve already
discovered that sexual function  is indicative of health, and we also know
that sleep is fundamental to physical and mental well-being. A healthy sex
life will help decrease stress and improve sleep; conversely, quality sleep is
essential for sexual health. We’ve explored how stress can affect sex drive and sexual function for
physical and psychological reasons. Fatigue, sleep disturbance, and sleep
deprivation, by themselves, can simply make us too tired for sex. The
impact this can have on self-es teem, intimacy, and relationship s is all too
apparent in the study of patients with severe asthma. Accordin g to a 2002
paper, being “too tired” is the primary reason people lose interest in sex. 63
Conversely, 2015 research from scientists at the University of Michigan
Medical School reported that the more sleep people had, the more likely
they were to feel like sex the following day. 64 If all that you and your
partner are doing is actually sleeping together, it’s time to look at the quality
of your sleep. Whenever you can improve the quality and quantity of your sleep, you
are likely to improve the quali ty and quantity of your sex life. We have
already looked in detail (in Chapter Seven ) at sleep-disord ered breathing
and ways we can ensure better sleep and better health through improved
breathing. Howe ver, it is worth examining the statistics here. One research
paper found that about 50% of men aged between 18 and 70 years who
have moderate to severe sleep apnea also suffer from erectile dysfunction. 65
Another study found that 69% of participants with sleep apnea also had
erectile problems. 66 The link may be partly hormonal. Men with sleep
apnea have lower levels of testosterone. 65 Since we already know an
overactive fight -or-flight respo nse inhibits testosterone production, this
makes a lot of sense. For men, it is absolutely norm al for erections to occur durin g sleep. Nighttime erections often go unnoticed, perhaps only becoming obvious
first thing in the morning as “morning wood,” but to use its medical name,
nocturnal penile tumescence (NPT) is actually an important marker of heart
health,67 vascular tone,68 and parasympathetic function. 69 Medical science
frequently uses NPT as an indicator of sexual or hormonal well-being,70
especially when  diagnosing the causes of erectile dysfunction. If a man has
frequent nightly erections but is unable to achieve or maintain  an erection
during sex, it is likely that blood flow and nerve responses in the penis are
healthy. In this instance, erectile dysfunction may have a psychological
basis. If, however, he has no NPT and is unable to function sexually, it ismore likely that the root cause is physical. This differentiation allows
doctors to treat the problem ef fectively. Nocturnal erections usually occur during rapid eye movement (REM)
sleep. 71 The reason that they are most apparent in the morning is that we
tend to wake up at the end of a REM sleep cycle. Equally, testosterone
levels tend to be higher in the morning. It is thought that erect ions of this
type may differ in some way physically from those caused by arousal. Research has reported cases of men who experience pain with NPT but
never with erections related to sexual arousal. 72
It is common for a man to have three to five of these nocturnal
erections, each lasting 30 minut es or longer, during eight hours of sleep. 73
Contrary to what many people believe, these are not the result of sexual
stimulation, thoughts, or dreams. Young men, who have higher testosterone
levels, tend to experience more NPT, and incidence declines in men during
their forties and fifties. This gradual decrease is normal too, but if these
erections stop altogether, this can be a sign of a hormonal imbalance, high
blood pressure, or other potentially serious health problem. We know, for
example, that the production and stability of sex hormones can be strongly
affected by dysfunction in the autonomic nervous system caused by stress. Research found that men with a condition called hypogonadism,74 which
causes diminished function of the gonads and testes (or the ovaries in
women), experienced more NPT after they were given testosterone therapy. Scientists have demonstrated that NPT can be affected by quality of
sleep. 75 Poor or disturb ed sleep prevents us from entering the REM sleep
cycle when nocturnal erectio ns usually occur. We know that sleep-
disordered breathing results in less restful sleep. Men with sleep apnea and
erectile dysfunction experience more nocturnal erections when  they use a
CPAP machine to improve their sleep than those whose OSA is untreated. 76
Mouth breathing  at night is a significant anatomical risk factor for OSA,
increasing the incidence and severity of upper airway collapse77 and
therefore contributing to erectile dysfunction. This underlines how
important it is to ensure nasal breathing during sleep—someth ing that can
be easily achieved by using MyoTape. (You can read more about CPAP
compliance in the chapter on sleep. )One of the hallmarks of sleep apnea is recurrent hypoxia throug hout the
night. In hypoxia, not enough oxygen makes it to the cells and tissues in the
body. This can happen even when blood flow is normal. It is related to
many factors, including heart and respiratory failure, sleep apnea, smoking,
COPD, diabetes, high blood pressure, and clogged arteries. 78 Significantly,
all of these disorders are characterized by erectile dysfunctio n and by a
reduction in sleep-related erections. In one study, scientists used high altitude to reproduce symptoms of
hypoxia in healthy men and assessed the results in terms of penile rigidity. 78
The level of inspired oxygen decreases incrementally as altitude increases. Researchers followed three mountain climbers in their early thirties over a
26-day stay at altitudes ranging from 2,000 to 5,600 meters above sea level. At altitudes over 4,450 meters,  the rigidity of erections decre ased almost
completely, confirming that hypoxia negatively impacts erecti le function. We already know that slow, nasal breathing significantly improves
oxygenation due to the fact that more air reaches the small air sacs of the
lungs. This is yet another reason why nasal breathing during  sleep is so
important. Nitric oxide, which we harness by breathing through the nose, is also
essential both for vascular health and erectile function. In one study,
scientists state that “maximal attention should be placed on measures
known to improve vascular NO production. ”6 This includes the use of
PDE5 inhibitors and exercises to ensure normal functioning of the pelvic
floor muscles. These two approaches are complementary rather than
competing as they work on entirely different aspects of erectile function. 6
As we’ve discussed, normal functioning of the pelvic floor relies on a fully
operational diaphragm, and it is nasal breathing during wakefulness and
sleep that promotes deep breathing from the diaphragm rather than fast,
upper chest breathing. For women, sleep apnea and insomnia have been linked to sexual
dysfunction and decreased sexual satisfaction. This is certainly the case
after menopause, but there are also a few studies of younger women that
examine this connection. A 2017 study of postmenopausal women found
that those with higher insomnia  scores were less satisfied sexually. Also,
women who slept less than seven or eight hours a night were less likely tohave sex with their partners at all. 79 Researchers concluded that shorter
sleep and worse insomnia was associated with decreased sexual function in
these women. Despite the many decades of sexual revolution, studies of younger
women still often focus on fertility80 (or infertility) rather than on sexual
satisfaction in relation to common disorders such as poor sleep. One study
examined femal e sexual function in terms of sexual desire, sexual arousal,
lubrication, orgasm, sexual satisfaction, and intercourse pain in women
aged between 18 and 45 and found significant links with sleep quality. 81
There was a marked inverse relationship between daytime sleepiness,
insomnia, poor sleep quality, and sexual function. Sexual desire was highly
dependent on good sleep, while  poor lubrication, orgasm, and satisfaction
were all associated with sleep  disorders. Pain during intercourse also
increased when  sleep was inadequate. Sexual function decreased
incrementally with each reduction in sleep quality and with each increase in
the time it took to fall asleep. Another study explored factor s in sexual function and infertility in
women with endometriosis82—a common condition where tissue similar to
the lining of the womb starts to grow outside the womb. The authors found
that sleep quality was a primary contributing factor in sexual dysfunction
for these women. As sleep quality, anxiety, depression, and pelvic pain
worsened, sexual function decreased. Again, as we have found in various chronic conditions, quality of sleep
can make a huge difference to how “in control” we feel. When sleep is
restorative, everything is a little bit easier. We feel mentally stronger, more
resilient, and less sensitive to pain. By making the switch to functional
breathing day and night, it is possible to experience significant
improvements in sleep, in quality of life, and in sexual function. LEARNING FROM ANCIENT WISDOM
It may sometimes seem like there is a constant focus on sex. As the old
marketing adag e says, “Sex sells. ” Adverts on the statio n platform,
magazine article s, self-help books, films, talk shows, and gossip columns
are all obsessed with sex and sexuality. Even in a culture where  attitudes tosex and gender are changing, the sexual narrative, an almost competitive,
heteronormative view of sex is ever-present. Ironically, our fast-paced,
thrill-seeking, consumerist world paradoxically creates an environment
where it is difficult to fully enjoy a healthy, truly pleasurable sex life. As
with breathing and sleep, the real power of sex is in the quality, not the
quantity. Phallocentric attitudes have narrowed our view of sex to cente r on the
release of seminal fluid, an end goal which is largely irrelevant and leaves
men and women unsatisfied and disconnected. Sex has become functional. Despite all our advancements as a species, our relationship with sex is far
less healthy than it was thousands of years ago, and our understanding of it
is less assured. For instance, ancient T aoism teaches that men can control ejaculation by
using the breath. This makes no sense if you equate “coming” with orgasm. However, Taoism  also tells us that ejaculation and orgasm are two different
things. If this sounds far-fetched, research from 2015 confirms it to be true. Male orgasm and ejaculation are, in fact, two distinct physiological
processes. 3 Orgasm is “an intense transient peak sensation of intens e
pleasure creating an altered state of consciousness associated with reported
physical changes. ” Ejaculation is “a complex physiological process that is
composed of two phases (emission and expulsion)” and influenced by
complex hormonal and neurological pathways. Although male sexuality is
very well studied, much about this topic is still unknown. However, even
less is known about the “mythical” female or gasm. Taoism and yogic cultures embrace sexual function and orgasm in a
way that many people never experience. They view sex as wholesome and
life-preserving, not a taboo laden with concepts of guilt, sin, voyeurism, and
exploitation. By using the breath to guide and build sexual energy, they
access a health-giving resource. In this mindset, where sex is part of the
human experience and not separate from it, erotic ecstasy is a tool for
spiritual develo pment and physical and mental well-being. Although
research is limited, these conce pts are to some extent being examined and
contextualized in scientific literature. Increasing credence is being given to
the idea that the ancient sages may have been onto something. For exam ple, a 2019 paper in The World Journal of Men’ s Health looks
at yoga for managing prematu re ejaculation. 83 The study describes the
connection between health and sexual function, including the links with
diabetes, heart disease, and chronic illness. It mentions that while
psychological disorders such as anxiety, depression, and stress are often
associated with premature ejaculation, medications used to treat these
conditions can come at a significant cost to sexual function. 83 The
integrated appro ach of yoga therapy has been found to be effective in the
management of many of these diseases. At its core, yoga involves a deep
integration of mind and body, without which it is difficult to enjoy a
fulfilling sex life. This study examines yoga in relation to breath control and
pelvic floor muscle strength, which we know are vital to mental and
physical health and to functional movement, something many other papers
have touched on concerning sexual dysfunction. There are many forms of yoga. Of the better -known types, Tantra yoga
is gener ally perceived to focus on sex, although, in fact, Tantra is more
accurately abou t connection, either with the self, a partner, or the divine. Scientists have supported the potential applications of Tantric practices as a
holistic, accessible way to treat aspects of sexual dysfunction, such as
mental blocks, premature ejaculation, erectile dysfunction, and intimacy
issues. 84 Anothe r branch  of yoga called Kundalini can be used to inten sify
sexual pleasure85 and to produce orgasms without ejaculation in men,
resulting in sex that can last longer and involve multiple orgasms. A
specific concept for conservation of semen, known as Bindu Samrakshana,
was described in a fifteenth-century yogic treatise, Hatha Yoga
Pradeepika. 86
Unfortunately, modern perceptions concerning these practices have
limited their therapeutic use. For instance, you may have heard of Tantric
sex in associatio n with the musician Sting. If you mention his name, the
question of marathon sex is likely to come up. It turns out that claims he
enjoyed seven-hour lovemaking sessions with his wife Trudie Styler were
originally a joke. However, in an interview for Inside the Actor ’s Studio, he
told host James Lipton that the concept of Tantric sex has its roots in a very
serious belief system:The idea of tantric sex is a spiritual act. I don’t know any purer and
better way of expressing a love for another individual than sharing
that wonderful, I call it, “sacram ent. ” I would stand by it. Not seven
hours, but the idea. 87
A 2011 article in the South African information website, Independent
Online  describ ed the prevailing male attitude to yoga as akin to “declaring
yourself a New Age hippy and wearing crystals. ”88 Nevertheless, between
2012 and 2016, the number of men practicing yoga in the United States rose
from 4 million to 10 million. 89 Yoga was long believed to be a traditionally
male-only pract ice, although historians now argue that women played a
central role in its development. 90 Now, in W estern society, yoga for men is a
rapidly growing trend with some classes being marketed as “Broga. ”91
Yoga has many benefits for everyone. Most yoga practices focus on the
breath and have some element of pelvic floor muscle activation. Yoga
improves nervous system functi on and hormonal balance and reduces age-
related decreases in testosterone. It eases stress, suppresses the sympathetic
nervous system,  and promotes parasympathetic activation. Stimulation of
the parasympathetic nervous system through yoga practice is believed to
improve ejacula tory control, providing a nonpharmacological alternative to
treatments such as fluoxetine for premature ejaculation. 92
Yoga builds strength, stamina, flexibility, and muscle tone. It increases
stability in the core muscles, improves control of pelvic and perineal
muscles, and requires a focused interaction of breathing and movement. It is
thought that the deep breathing, better cardiopulmonary efficiency, and
mindfulness that develop through regular yoga practice may also improve
ejaculation control due to better awareness that ejaculation is about to
occur. The 2019 study from The World Journal of Men’ s Health also reports
that focused attention on abdominal breathing is associated with a marked
increase in whole blood serotonin. A heightened level of serotonin is
believed to improve ejaculatory control—SSRI antidepressant s can cause
delayed ejaculation in some men. 93
The researchers suggest that yoga can provide the following benefits for
men who experience premature ejaculation:• Seated postures, in particular, relax the muscles of the pelvic region. Poor control of
the pelvic floor muscles is implicated in premature ejaculation, urinary incontinence,
and erectile dysfunction. • Inverted postures improve the circulation to veins in the pelvis and perineum,
enhancing the flow of blood to the sexual organs. (Recall that one value of nitric
oxide is in increasing blood flow to the erectile tissues. This is the function that is
enhanced by sexual performance drugs like V iagra. ) • Controlled breathing practice ( Pranayama ) is very ef fective in reducing heart rate
and improving cardiovascular health. Specifically, diaphragmatic breathing reduces
sympathetic activation and stimulates the vagus nerve, reducing anxiety. The study
observed that after a five-minute practice of a Pranayama  breathing technique,
involving a respiratory rate of six breaths per minute, systolic and diastolic blood
pressure markedly decreased. • A yogic cleansing practice called a Kriya, which is done by exhaling forcefully and
inhaling passively, both through the nose, may help delay ejaculation. A similar
Tantric breathing technique, involving rapid exhalations through the mouth, can be
practiced as orgasm approaches to trigger changes in blood chemistry that are
believed to delay ejaculation. • Meditation and mindfulness improve sexual well-being by increasing relaxation, body
awareness, and autonomic nervous system balance. Many treatment options are available for men who are confident enough
to approach their doctor about premature ejaculation. Unfortunately, those
treatments can cause side effects and affect sexual satisfaction. However, a
lot of men never seek help at all due to the perceived stigmas around sexual
dysfunction. 83 Yoga, as a nonpharmacological intervention or as a
compliment to standard medical treatments, has been established in
empirical studies as effective, although there is scant research into which
techniques or postures may be most helpful. Even so, it is widely
recognized that alternative methods, such as functional breath training and
yoga, provide low cost, accessi ble alternatives that may benefit men who
are uncomfortable discussing sexual problems with a healthcare
professional. Breathing techniques also help bring focus onto the mind-
body connection—an aspect missing in standard sex therapy—enriching the
sex life. The 2019 study concludes that integration of these techniques into
contemporary sex therapy could have a positive influence on different
facets of human sexuality. 83
REACHING YOUR PEAKOrgasm is characterized by certain physiological features  including
hyperventilation up to 40 breaths a minute, tachycardia (a very fast heart
rate), and high blood pressure. A faster heart rate was found to be indicative
of “real ” (as opposed to fake) orgasm in men during heterosexual
intercourse. 3 Orgasm also produces powerful, highly pleasurable
contractions of the pelvic muscle s. Intense sexual pleasure has been equated
with trance states94 and can even result in synesthesia—a light show akin to
your very own fireworks. 95
It is possible to train the breath to experience powerful orgasm s. While
orgasm is often associated with losing control, ancient practices  like Tantra
emphasize that control is of the utmost importance. If your goal is sexual
ecstasy, you must first learn to master your sexual desire. For men, this
involves a practice of forceful exhalation called Kapalbhati  as orgasm
approaches,96 changing the blood biochemistry, and delaying ejaculation by
reducing blood flow to the genitals. But there’ s more to it than prolonging
sex. These techniques are part of a spiritual practice that may seem at odds
with the Western idea of sex. In discussions of spirituality, some writers
avoid the topic of sex altogether, but across a number of spiritual traditions,
the concept of sexual ener gy is considered fundamental to spiritual growth. In Tantra and Taoism, sexual energy is no less than the manifes tation of
our vital life force. The erotic sculptures in ancient Hindu temples display
rapture rather than lust in the upturned faces of the lovers. 97 Descriptions of
spiritualized sex involve extended intercourse and a sense of timelessness
that makes them very different from everyday sex. Normally, we follow an
automatic series  of behaviors, movements, and fast breath patterns in which
the desire to express love becomes sidelined in the search for physical
pleasure. 97 These ancient practices teach us to take time and to reach new
peaks. In his book Natur e, Man and W oman, Alan Watts describes how sex can
give rise to extraordinary spiritual experiences. 98 He explains that, at its
height, sexual love is one of the most complete experience s of which
humans are capable, but that “prejudice and insensitivity have prevented us
from seeing that in any other circumstances such delight would be called
mystical ecstas y. ” The whole purpose of Tantra is to generate a
transcendental state. In a 1981 edition of Yoga Journal, Dio Urmila Neffconcludes that “Generating spiritual ecstasy may have been. [along with
procreation]. the original purpose for sexual delight. It may indeed be
our most precious grace. ”97
Whether you are interested in exploring the more esoteric concepts at
play here or just want to enjoy a better, healthier sex life, for yourself or as
a couple, these techniques all begin with the breath. Prana  is the ancient
word for breath—or life force. As the ancient yogic text Shiva Samhita,
says,
The wise man does not talk about the capacity of uttering words,
about sight, hearing, or meditation; he speaks only of the different
types of prana that makes all these things possible. Because
everything else is nothing but manifestations of prana. 99,100
WOR TH W AITING FOR
Consciously controlled breathing has considerable benefits. Better
oxygenation gives you more energy, so tiredness doesn’ t curtail your
enjoyment or arousal. Sex that lasts longer before orgasm generally results
in a more intense orgasm and greater satisfaction. Awareness of the breath
can help you to overcome resistance, relax the muscles, and ease difficulty,
for example during anal sex. 101
According to Urmila Neff, the way you breathe during sex has
“everything to do with its duration. ” Both Tantra and Taoism recommend
deep nasal breathing from the diaphragm rather than fast, upper -chest
mouth breathing. In discovering  the functions of the vagus nerve and the
diaphragm, we have learned that there is a direct relationship between the
emotions and the breath, and this is thought to extend to sexual arousal too. While the breath is constant and normally unconscious, we can choose to
change its depth and rhythm. By deliberately directing the breath, it is
possible to modulate the emotions and temper sexual excitement. Another connection lies in the idea that the breath is a rhythmic
extension of the nervous and glandular systems. This idea of rhythm
throughout the systems and its place in the sexual experience has recently
been studied in the context of sexual trance. 94There are various methods that can be used to stop ejaculation, but the
consensus is that fast breathing contributes to orgasm while slow breathing
helps delay (and intensify) it. The first and most basic way in which
breathwork can contribute is that it makes us more aware of the breath and
more attuned to the body. This is significant because unless you have a
certain awareness of your body, you are likely to employ any method of
delaying orgasm too late. Also, until you become accustomed to working
with the breath during rest, you will find it very difficult to adjust your
breathing during sex. For men, tantric breathing for “sexual continence” has two basic
principles: first, rhythmic breathing through the nose to slow the
metabolism and activate the parasympathetic nervous system, and second,
breathing explosively through the mouth, which is import ant for the
expression of feelings. 102 In yoga  and Tantra, slow nasal breathing is used
to contro l sexual energy. The fast breathing generates an explosive external
orgasm—the faster the breath, the more effectively it works. When
breathing is slower, we receive  more vital energy. When it speeds up, we
emit more energy. A daily practice of diaphragm breathing is essential to
controlling ejaculation and increasing erotic sensation in the body. In the book The Multi-Or gasmic Man, authors Mantak Chia and
Douglas Abrams explain that because quick, shallow breathing increases
the heart rate, and a fast heart rate is synonymous with orgasm, deep, slow
breathing to slow the heart will control arousal and delay ejaculation. 45 The
book describes how some men breathe quick, shallow breaths (the yogic
breath of fire) while others find that holding the breath for a few moments
on a deep inhalation lessens the ur ge to ejaculate. In Tantra, once you have reached the goal to no longer ejacul ate, you
need to continue with the breathing exercises to learn how to channel your
sexual energy into conscious mental energy. Diaphragm breathing massages
the prostate and other internal organs, and it relieves the sense of pressure
many men experience when they don’t ejaculate. This tension in the genital
area is common for men who are new to sexual continence practice. It is
caused by a buildup of sexual energy in the pelvis. If this energy is not
diverted, it causes irritability, anxiety, and confusion. At this stage,
diaphragm breathing is used to guide the sexual energy up through thespine. Retaining sperm is not the only aspect to developing the ability to
experience multiple whole-body orgasms: sexual energy must be
transformed, and that is done with the breath. Section summary: 

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Final Answer: The final answer is "THE CURRENT KNOWLEDGE GAP HIGHLIGHTED THE NECESSITY OF INVESTIGATING".
To increase oxygenation and improve overall sexual function.
What is the main goal of functional breathing exercises in the context of sexual arousal?
The primary focus is on traditional masturbation-based techniques, but it is not necessarily effective.
What is the primary focus of traditional sex therapy, and is it effective?
The vagus nerve plays a crucial role in regulating sexual arousal, orgasm, and overall sexual health.
What is the significance of the vagus nerve in the context of sexual function?
Stress can negatively impact sexual function by disrupting the autonomic nervous system, leading to erectile dysfunction, decreased arousal, and orgasmic dysfunction.
What is the relationship between stress and sexual dysfunction in men?
To increase oxygenation, reduce stress, and improve overall sexual function.
What is the primary goal of slow, nasal breathing during sex?