Safe and sustainable sexual wellness
a day ago
By Ronald Allan M. Ponteres, MD, MBAH
Sexual health and lifestyle medicine share a deeper connection than many patients, and even clinicians may expect, according to Dr Maria Rosario Christina Lim, a physician specializing in both fields. She notes that the foundation of effective care in these areas begins with assessing a patient’s readiness for change.
“Sexual health and lifestyle medicine intersect in everyday clinical practices by quite a lot,” Dr. Lim explained. Central to both, she says, is determining whether patients are pursuing change for themselves. At times, she finds it necessary to ask directly, “Is it for them or is it because they want to make someone else happy?”
Dr Lim emphasizes that sustainable progress is most achievable when patients advocate for their own well‑being. Small habit‑building steps become easier, she adds, when motivation is self‑driven. Still, she reminds patients that improvement takes time. “Change in lifestyle and sexual health doesn’t happen overnight.” She encourages them to accept that progress may not always be linear, noting that prioritizing self‑care ultimately leads to better outcomes.
One of the most impactful tools in her clinical approach is motivational interviewing, a technique she believes significantly enhances sexual function. “The lifestyle medicine intervention with the most impact is surprisingly motivational interviewing,” she said. When patients articulate their physical and emotional needs, and integrate them into daily life, she observes notable improvements in sexual wellness.
Dr Lim also highlights that sexual function is shaped not only by physical factors but by past and present experiences. Understanding these connections, she says, helps patients set meaningful goals for improvement.
For general sexual health, her prescription is straightforward: “Listen to your body.” She advocates for quality sleep, hydration, mindful food choices, and regular exercise. And her personal favorite recommendation? Practicing gratitude. “Gratitude brings happiness and contentment,” she shared, benefits that extend to overall satisfaction and sexual wellness alike.
Growing evidence
Peer-reviewed studies have demonstrated that lifestyle medicine pillars are integral to both sexual wellness and infection prevention:
Physical Activity: Sexual function is strongly connected to overall vascular health. Research shows that regular aerobic exercise can significantly improve erectile function scores, even among men with conditions like diabetes, obesity, and heart disease (Gerbild et al., 2018; Silva et al., 2017). On the other hand, long periods of sitting and physical inactivity are linked to poorer cardiometabolic health. Newer genetic and observational studies also suggest that spending extended time in screen‑based sitting may increase the risk of erectile dysfunction (Ajufo et al., 2025; Huangfu et al., 2024). These findings highlight that encouraging physical activity and cutting down on sedentary time are effective first steps in supporting sexual health.
Nutrition: Dietary patterns play a significant role in supporting sexual function and overall reproductive tract health. Evidence from randomized trials and long‑term follow‑up studies shows that following a Mediterranean‑style eating pattern can improve or maintain sexual function in both men and women, especially among individuals with type 2 diabetes or metabolic syndrome (Maiorino et al., 2016; Oteri et al., 2024). This diet’s emphasis on whole foods, healthy fats, and antioxidant‑rich ingredients appears to support vascular and metabolic pathways linked to sexual well‑being. Nutrition also influences venereology by shaping the vaginal microbiome, an essential component of genital and reproductive health. Case–control studies and dietary quality research consistently report that diets high in fruits, vegetables, and whole foods are associated with a lower likelihood of bacterial vaginosis, while highly processed, low‑quality diets increase susceptibility (Noormohammadi et al., 2022; Mehrabani et al., 2025). Together, these findings highlight nutrition as a practical pillar in maintaining sexual and reproductive wellness.
Sleep: Sleep quality is a critical yet often overlooked factor in overall sexual health. A large systematic review and meta‑analysis reports that poor sleep and sleep disorders nearly double the risk of sexual dysfunction in both men and women (Dilixiati et al., 2023). Research further shows that short sleep duration and obstructive sleep apnea are linked to lower libido, impaired arousal, and reduced sexual satisfaction. These associations highlight how sleep disruption affects not only sexual well‑being but also broader cardiometabolic health (Al‑Badri et al., 2022). Taken together, the evidence features sleep optimization as a simple, non‑pharmacologic strategy with wide‑ranging benefits for overall wellness.
Stress and Mental health: Sexual dysfunction and mental health disorders are closely intertwined, with evidence showing how strongly each can influence the other. In their meta‑analysis, Liu et al. (2018) demonstrated a clear bidirectional relationship between depression and erectile dysfunction, finding that individuals with depression have a significantly higher risk of developing erectile dysfunction, and that men with erectile dysfunction are likewise more likely to develop depressive symptoms. Their findings highlight how biological, psychological, and behavioral factors overlap, emphasizing the need for clinicians to screen and address both conditions together rather than in isolation.
Pharmacologic treatments for depression can sometimes worsen sexual side effects, emphasizing the need for a more holistic approach to care. Incorporating lifestyle strategies, such as regular physical activity, stress‑management techniques, and better sleep habits, provides valuable support alongside psychosexual counseling and medical therapy.
Risky Substance Use: Avoiding risky substances plays an important role in supporting sexual health and reducing the likelihood of sexually transmitted infections. Evidence from systematic reviews and longitudinal studies indicates that alcohol and tobacco use are associated with patterns of increased sexual risk‑taking (e.g. having more partners or engaging in condomless sex) which can elevate STI risk in affected populations (Llamosas‑Falcón et al., 2023; Walsh et al., 2017). Research also indicates that when hazardous alcohol use decreases, related sexual risk behaviors tend to decline as well, supporting the inclusion of substance‑use interventions in comprehensive venereology care.
Support-driven encounters
Lifestyle medicine principles closely complement the behavioral approaches commonly used in sexual health settings. The U.S. Preventive Services Task Force recommends behavioral counseling for sexually active adolescents and adults at increased risk, noting moderate evidence that these interventions can reduce STI acquisition (U.S. Preventive Services Task Force, 2020). In the Philippines, local initiatives such as the PrEPPY demonstration project showed that community‑based counseling and support services led to high PrEP acceptability and zero new HIV infections among enrolled participants (FHI 360, 2024). Similarly, the effectiveness of HIV pre‑exposure prophylaxis (PrEP) depends heavily on adherence, and international reviews show that psychosocial support, mental health care, and person‑centered counseling significantly improve PrEP persistence (Haberer et al., 2023; Kamitani et al., 2024). The Connect for Life adherence study conducted in Manila, showing better ART adherence and improvements in quality of life, reinforces the importance of continuous behavioral and psychosocial support in sustaining engagement throughout the HIV prevention and treatment continuum (O’Connor et al., 2024).
Happy ending
In sexual health, the prescription extends beyond the pill bottle. The evidence is clear: how people move, eat, sleep, cope with stress, and make choices around substances and safer sex shapes and sustains sexual performance and protection. Behavioral interventions and person‑centered counseling likewise highlight the value of supporting patients ahead of prescriptions, especially in areas like PrEP adherence and STI prevention. By weaving lifestyle medicine into venereology and sexual health care, clinicians can promote not only longer lives—but better, safer, and more satisfying ones.
References
Ajufo, E., Kany, S., Rämö, J. T., Churchill, T. W., Guseh, J. S., Aragam, K. G., Ellinor, P. T., & Khurshid, S. (2025). Accelerometer-measured sedentary behavior and risk of future cardiovascular disease. Journal of the American College of Cardiology, 85(5), 473–486.
Al-Badri, M., Kapoor, E., Faubion, S. S., & Kling, J. M. (2022). The relationship between sleep and sexual function in women. Current Sexual Health Reports, 14, 231–238.
Dilixiati, D., Kadier, K., Laihaiti, D., Lu, J.-D., Rezhake, R., & Rexiati, M. (2023). The relationship between sleep disorders, sleep quality and duration, and sexual dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 20(6), 766–780.
FHI 360. (2024). When supply meets demand: PrEP scale-up in the Philippines. https://www.fhi360.org/wp-content/uploads/2020/10/resource-epic-philippines-prep-success-story.pdf
Gerbild, H., Larsen, C. M., Graugaard, C., & Areskoug Josefsson, K. (2018). Physical activity to improve erectile function: A systematic review of intervention studies. Sexual Medicine, 6(2), 75–89.
Haberer, J. E., Mujugira, A., & Mayer, K. H. (2023). The future of HIV pre-exposure prophylaxis adherence: Reducing barriers and increasing opportunities. The Lancet HIV, 10(6), e404–e411.
Huangfu, Z., Gan, X., Yang, Y., Pang, Q., Zhu, B., Zhang, X., & Wang, L. (2024). A Mendelian randomization study on causal effects of leisure sedentary behavior on the risk of erectile dysfunction. Andrology, 2024 Nov;12(8):1841-1850.
Kamitani, E., Higa, D. H., Crepaz, N., Wichser, M. M., & Mullins, M. M. (2024). Identifying best practices for increasing HIV pre-exposure prophylaxis use and persistence in the United States: A systematic review. AIDS and Behavior, 28(7), 2340–2349.
Liu, Q., Zhang, Y., Wang, J., Li, S., Cheng, Y., & Zhu, Z. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis. The Journal of Sexual Medicine, 15(8), 1073–1082.
Maiorino, M. I., Bellastella, G., Caputo, M., Castaldo, F., Improta, M. R., Giugliano, D., & Esposito, K. (2016). Effects of Mediterranean diet on sexual function in people with newly diagnosed type 2 diabetes: The MÈDITA trial. Journal of Diabetes and Its Complications, 30(8), 1519–1524.
Mehrabani, S., Hafizi Moori, M., Normohammadi, M., Shoja, M., Eskandarzadeh, S., Kazemi, S. N., Rashidkhani, B., Nouri, M., & Eslamian, G. (2025). Global and prime diet quality scores and risk of bacterial vaginosis. Journal of Health, Population and Nutrition, 44, 58.
Noormohammadi, M., Eslamian, G., Kazemi, S. N., & Rashidkhani, B. (2022). Association between dietary patterns and bacterial vaginosis: A case–control study. Scientific Reports, 12, 13708.
O’Connor, C., Leyritana, K., Doyle, A. M., Lewis, J. J., & Salvaña, E. M. (2024). Changes in adherence and viral load suppression among people with HIV in Manila: Outcomes of the Philippines Connect for Life study. AIDS and Behavior, 28, 837–853.
U.S. Preventive Services Task Force. (2020). Behavioral counseling interventions to prevent sexually transmitted infections: Recommendation statement. JAMA, 324(7), 674–681.
Walsh, J. L., Weinhardt, L. S., Kalichman, S. C., & Carey, M. P. (2017). Changes in alcohol use and sexual risk behavior across STI clinic patients. Annals of Behavioral Medicine, 51(1), 39–56.
Sexual health and lifestyle medicine share a deeper connection than many patients, and even clinicians may expect, according to Dr Maria Rosario Christina Lim, a physician specializing in both fields. She notes that the foundation of effective care in these areas begins with assessing a patient’s readiness for change.
“Sexual health and lifestyle medicine intersect in everyday clinical practices by quite a lot,” Dr. Lim explained. Central to both, she says, is determining whether patients are pursuing change for themselves. At times, she finds it necessary to ask directly, “Is it for them or is it because they want to make someone else happy?”
Dr Lim emphasizes that sustainable progress is most achievable when patients advocate for their own well‑being. Small habit‑building steps become easier, she adds, when motivation is self‑driven. Still, she reminds patients that improvement takes time. “Change in lifestyle and sexual health doesn’t happen overnight.” She encourages them to accept that progress may not always be linear, noting that prioritizing self‑care ultimately leads to better outcomes.
One of the most impactful tools in her clinical approach is motivational interviewing, a technique she believes significantly enhances sexual function. “The lifestyle medicine intervention with the most impact is surprisingly motivational interviewing,” she said. When patients articulate their physical and emotional needs, and integrate them into daily life, she observes notable improvements in sexual wellness.
Dr Lim also highlights that sexual function is shaped not only by physical factors but by past and present experiences. Understanding these connections, she says, helps patients set meaningful goals for improvement.
For general sexual health, her prescription is straightforward: “Listen to your body.” She advocates for quality sleep, hydration, mindful food choices, and regular exercise. And her personal favorite recommendation? Practicing gratitude. “Gratitude brings happiness and contentment,” she shared, benefits that extend to overall satisfaction and sexual wellness alike.
Growing evidence
Peer-reviewed studies have demonstrated that lifestyle medicine pillars are integral to both sexual wellness and infection prevention:
Physical Activity: Sexual function is strongly connected to overall vascular health. Research shows that regular aerobic exercise can significantly improve erectile function scores, even among men with conditions like diabetes, obesity, and heart disease (Gerbild et al., 2018; Silva et al., 2017). On the other hand, long periods of sitting and physical inactivity are linked to poorer cardiometabolic health. Newer genetic and observational studies also suggest that spending extended time in screen‑based sitting may increase the risk of erectile dysfunction (Ajufo et al., 2025; Huangfu et al., 2024). These findings highlight that encouraging physical activity and cutting down on sedentary time are effective first steps in supporting sexual health.
Nutrition: Dietary patterns play a significant role in supporting sexual function and overall reproductive tract health. Evidence from randomized trials and long‑term follow‑up studies shows that following a Mediterranean‑style eating pattern can improve or maintain sexual function in both men and women, especially among individuals with type 2 diabetes or metabolic syndrome (Maiorino et al., 2016; Oteri et al., 2024). This diet’s emphasis on whole foods, healthy fats, and antioxidant‑rich ingredients appears to support vascular and metabolic pathways linked to sexual well‑being. Nutrition also influences venereology by shaping the vaginal microbiome, an essential component of genital and reproductive health. Case–control studies and dietary quality research consistently report that diets high in fruits, vegetables, and whole foods are associated with a lower likelihood of bacterial vaginosis, while highly processed, low‑quality diets increase susceptibility (Noormohammadi et al., 2022; Mehrabani et al., 2025). Together, these findings highlight nutrition as a practical pillar in maintaining sexual and reproductive wellness.
Sleep: Sleep quality is a critical yet often overlooked factor in overall sexual health. A large systematic review and meta‑analysis reports that poor sleep and sleep disorders nearly double the risk of sexual dysfunction in both men and women (Dilixiati et al., 2023). Research further shows that short sleep duration and obstructive sleep apnea are linked to lower libido, impaired arousal, and reduced sexual satisfaction. These associations highlight how sleep disruption affects not only sexual well‑being but also broader cardiometabolic health (Al‑Badri et al., 2022). Taken together, the evidence features sleep optimization as a simple, non‑pharmacologic strategy with wide‑ranging benefits for overall wellness.
Stress and Mental health: Sexual dysfunction and mental health disorders are closely intertwined, with evidence showing how strongly each can influence the other. In their meta‑analysis, Liu et al. (2018) demonstrated a clear bidirectional relationship between depression and erectile dysfunction, finding that individuals with depression have a significantly higher risk of developing erectile dysfunction, and that men with erectile dysfunction are likewise more likely to develop depressive symptoms. Their findings highlight how biological, psychological, and behavioral factors overlap, emphasizing the need for clinicians to screen and address both conditions together rather than in isolation.
Pharmacologic treatments for depression can sometimes worsen sexual side effects, emphasizing the need for a more holistic approach to care. Incorporating lifestyle strategies, such as regular physical activity, stress‑management techniques, and better sleep habits, provides valuable support alongside psychosexual counseling and medical therapy.
Risky Substance Use: Avoiding risky substances plays an important role in supporting sexual health and reducing the likelihood of sexually transmitted infections. Evidence from systematic reviews and longitudinal studies indicates that alcohol and tobacco use are associated with patterns of increased sexual risk‑taking (e.g. having more partners or engaging in condomless sex) which can elevate STI risk in affected populations (Llamosas‑Falcón et al., 2023; Walsh et al., 2017). Research also indicates that when hazardous alcohol use decreases, related sexual risk behaviors tend to decline as well, supporting the inclusion of substance‑use interventions in comprehensive venereology care.
Support-driven encounters
Lifestyle medicine principles closely complement the behavioral approaches commonly used in sexual health settings. The U.S. Preventive Services Task Force recommends behavioral counseling for sexually active adolescents and adults at increased risk, noting moderate evidence that these interventions can reduce STI acquisition (U.S. Preventive Services Task Force, 2020). In the Philippines, local initiatives such as the PrEPPY demonstration project showed that community‑based counseling and support services led to high PrEP acceptability and zero new HIV infections among enrolled participants (FHI 360, 2024). Similarly, the effectiveness of HIV pre‑exposure prophylaxis (PrEP) depends heavily on adherence, and international reviews show that psychosocial support, mental health care, and person‑centered counseling significantly improve PrEP persistence (Haberer et al., 2023; Kamitani et al., 2024). The Connect for Life adherence study conducted in Manila, showing better ART adherence and improvements in quality of life, reinforces the importance of continuous behavioral and psychosocial support in sustaining engagement throughout the HIV prevention and treatment continuum (O’Connor et al., 2024).
Happy ending
In sexual health, the prescription extends beyond the pill bottle. The evidence is clear: how people move, eat, sleep, cope with stress, and make choices around substances and safer sex shapes and sustains sexual performance and protection. Behavioral interventions and person‑centered counseling likewise highlight the value of supporting patients ahead of prescriptions, especially in areas like PrEP adherence and STI prevention. By weaving lifestyle medicine into venereology and sexual health care, clinicians can promote not only longer lives—but better, safer, and more satisfying ones.
References
Ajufo, E., Kany, S., Rämö, J. T., Churchill, T. W., Guseh, J. S., Aragam, K. G., Ellinor, P. T., & Khurshid, S. (2025). Accelerometer-measured sedentary behavior and risk of future cardiovascular disease. Journal of the American College of Cardiology, 85(5), 473–486.
Al-Badri, M., Kapoor, E., Faubion, S. S., & Kling, J. M. (2022). The relationship between sleep and sexual function in women. Current Sexual Health Reports, 14, 231–238.
Dilixiati, D., Kadier, K., Laihaiti, D., Lu, J.-D., Rezhake, R., & Rexiati, M. (2023). The relationship between sleep disorders, sleep quality and duration, and sexual dysfunction: A systematic review and meta-analysis. The Journal of Sexual Medicine, 20(6), 766–780.
FHI 360. (2024). When supply meets demand: PrEP scale-up in the Philippines. https://www.fhi360.org/wp-content/uploads/2020/10/resource-epic-philippines-prep-success-story.pdf
Gerbild, H., Larsen, C. M., Graugaard, C., & Areskoug Josefsson, K. (2018). Physical activity to improve erectile function: A systematic review of intervention studies. Sexual Medicine, 6(2), 75–89.
Haberer, J. E., Mujugira, A., & Mayer, K. H. (2023). The future of HIV pre-exposure prophylaxis adherence: Reducing barriers and increasing opportunities. The Lancet HIV, 10(6), e404–e411.
Huangfu, Z., Gan, X., Yang, Y., Pang, Q., Zhu, B., Zhang, X., & Wang, L. (2024). A Mendelian randomization study on causal effects of leisure sedentary behavior on the risk of erectile dysfunction. Andrology, 2024 Nov;12(8):1841-1850.
Kamitani, E., Higa, D. H., Crepaz, N., Wichser, M. M., & Mullins, M. M. (2024). Identifying best practices for increasing HIV pre-exposure prophylaxis use and persistence in the United States: A systematic review. AIDS and Behavior, 28(7), 2340–2349.
Liu, Q., Zhang, Y., Wang, J., Li, S., Cheng, Y., & Zhu, Z. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis. The Journal of Sexual Medicine, 15(8), 1073–1082.
Maiorino, M. I., Bellastella, G., Caputo, M., Castaldo, F., Improta, M. R., Giugliano, D., & Esposito, K. (2016). Effects of Mediterranean diet on sexual function in people with newly diagnosed type 2 diabetes: The MÈDITA trial. Journal of Diabetes and Its Complications, 30(8), 1519–1524.
Mehrabani, S., Hafizi Moori, M., Normohammadi, M., Shoja, M., Eskandarzadeh, S., Kazemi, S. N., Rashidkhani, B., Nouri, M., & Eslamian, G. (2025). Global and prime diet quality scores and risk of bacterial vaginosis. Journal of Health, Population and Nutrition, 44, 58.
Noormohammadi, M., Eslamian, G., Kazemi, S. N., & Rashidkhani, B. (2022). Association between dietary patterns and bacterial vaginosis: A case–control study. Scientific Reports, 12, 13708.
O’Connor, C., Leyritana, K., Doyle, A. M., Lewis, J. J., & Salvaña, E. M. (2024). Changes in adherence and viral load suppression among people with HIV in Manila: Outcomes of the Philippines Connect for Life study. AIDS and Behavior, 28, 837–853.
U.S. Preventive Services Task Force. (2020). Behavioral counseling interventions to prevent sexually transmitted infections: Recommendation statement. JAMA, 324(7), 674–681.
Walsh, J. L., Weinhardt, L. S., Kalichman, S. C., & Carey, M. P. (2017). Changes in alcohol use and sexual risk behavior across STI clinic patients. Annals of Behavioral Medicine, 51(1), 39–56.