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Dhikav, V., Karmarkar, G., Anand, K. (2011): Yoga and Sexuality: a Novel Way to Improve Sexual Functioning.
In: P.Nikic, ed. Proceedings “Yoga – the Light of Microuniverse” of the International Interdisciplinary Scientific
Conference “Yoga in Science – Future and Perspectives”, September 23-24, 2010, Belgrade, Serbia. Belgrade:
Yoga Federation of Serbia, p. 119-124
Vikas Dhikav, MD, Girish Karmarkar, Kuljeet Anand
Department of Neurology, Dr. Ram Manohar Lohia Hospital, GGS-IP University
New Delhi, India
YOGA AND SEXUALITY:
A NOVEL WAY TO IMPROVE SEXUAL FUNCTIONING
Summary: Yoga is an ancient practice and has the objective and perceived ability to calm down mind
and body. Medical studies about effects of yoga practicing had been conducted worldwide. Many results
of the conducted researches show that practicing yoga have value in a plethora of mind and body
conditions. In this paper, we have shown its beneficial utility in sexual function. Our first study published
in the year 2007 showed that it is useful in treating premature ejaculation (PE). We had compared yoga
with fluoxetine, a well known treatment option for PE. We have demonstrated in our subsequent studies
(Published in 2010) that yoga is not only effective in PE but also improves all major parameters of males
and female sexual functions. Our ongoing studies will test ability of yoga in erectile dysfunction and
sexual satisfaction.
Key words: yoga, sexuality, sexual functioning
Introduction
Yoga is a popular form of complementary and alternative therapy. It is practiced both in
developing and developed countries alike. In India, the ancient literature indicates that it has been
practiced for centuries. Yoga means ‘to unite’. It is a Sanskrit word, possibly designed to show integration
of mind and body. Contemporary literature related to yoga didn’t contain lot of scientific description.
However, this is not to disparage the value of conducted, insufficiently known empirical researches.
Indeed in recent years, efforts have been directed to produce scientific literature related to yoga. Western
medicine refers yoga as a ‘mind body’ method. Several of the yoga protagonists and patients claim that it
is effective in improving sexual functions and treating sexual disorders. Since, yoga and its putative
benefits have long remained mystified; we have conducted 3 studies at different time intervals to verify
this claim.
Study one (yoga in premature ejaculation)
In our first study1, a total of 68 patients (38 yoga group; 30 fluoxetine group) attending the
Outpatient Department of Psychiatry of a tertiary care hospital were enrolled. It was a comparative trial,
wherein fluoxetine, a commonly used selective serotonin reuptake inhibitor was used as a control. Both
subjective and objective assessment tools were administered to evaluate the efficacy of the yoga and
fluoxetine in premature ejaculation. Table-1 & Figure-1 depicts the yoga protocol adopted in this study.
Similar protocols were designed for rest of the two studies described below2-3 (please see individual
references for detailed protocols). Three patients dropped out of the study citing their inability to cope up
with the yoga schedule as the reason. Intravaginal ejaculatory latencies in yoga group and fluoxetine
control groups were noted. We found that all 38 patients (25–65.7% = good, 13–34.2% = fair) belonging
to yoga and 25 out of 30 of the fluoxetine group (82.3%) had statistically significant improvement in PE.
www.yoga-science.rs
www.yogasavezsrbije.com
Dhikav, V., Karmarkar, G., Anand, K. (2011): Yoga and Sexuality: a Novel Way to Improve Sexual Functioning.
In: P.Nikic, ed. Proceedings “Yoga – the Light of Microuniverse” of the International Interdisciplinary Scientific
Conference “Yoga in Science – Future and Perspectives”, September 23-24, 2010, Belgrade, Serbia. Belgrade:
Yoga Federation of Serbia, p. 119-124
Figure 1: Various yogic postures adopted by participants of first study1.
Table 1: Brief description of yogasanas used in the present study1
1. Kapalbhati (Figure-A, kapal = skull, bhati = bright; “forehead brightener”) - Sit straight in squatting
posture with eyes closed. Put hands on the knees. Fix the chest and consciously contract abdominal
muscles.
2. Vajarasana (Figure-B, vajra = diamond) - Fold legs at knee joints and sit on the legs, and touch the
knee caps as shown.
3. Yog mudra (Figure-C, Yog = after yogis, mudra = posture; “symbol of yoga”) -Take hands to the lower
back. Catch the right wrist with the left palm and bend forward.
4. Marjarasan (Figure-D, Cat’s posture) - Sit in vajarasana and after that be in the cat’s posture and move
the spine and neck.
5. Pavanmukatasan (Figure-E, hanging in air) - Lie down on your back, bend the legs, bring them inside;
clasp them with hands. Now, bring the head up to touch the knee as shown.
6. Viparita karani mudra (Figure-F, viparit = opposite, mudra = posture) - “legs-up-the-wall pose”
7. Matsyasana (Figure-G, Fish’s posture) - Lie down flat on the back and bend the neck backwards.
8. Halasan (Figure-H, Hala=plough) - Lie down flat; then, turn legs overhead while maintaining hands on
the ground firmly.
9. Ardhmatsyendra mudra (Figure-I, Half-spinal twist) - Sit straight, bend right knee, and put it below
buttocks. Now cross the left leg and bring it in front of the right knee.
10. Paschimottoasana (Figure-J, Back stretching pose) - Sit with legs straight, touch toes, and try to bend
the head forward and kiss the toes.
www.yoga-science.rs
www.yogasavezsrbije.com
Dhikav, V., Karmarkar, G., Anand, K. (2011): Yoga and Sexuality: a Novel Way to Improve Sexual Functioning.
In: P.Nikic, ed. Proceedings “Yoga – the Light of Microuniverse” of the International Interdisciplinary Scientific
Conference “Yoga in Science – Future and Perspectives”, September 23-24, 2010, Belgrade, Serbia. Belgrade:
Yoga Federation of Serbia, p. 119-124
11. Paravatasan ( Figure-K, Parvata=mountain; mountain pose) - Sitting with head and spine intact with
hands stretched overhead like a mountain.
12. Bhujangasan (Figure-L, Bhujang=Snake) - Lie down in prone position and transfer weight on palms.
Attempt should be made to stretch the back muscles.
13. Shalabhasan ( Figure-M, Locust pose) - Lie down on your chest and rest the head on ground. Lift the
legs to the extent that the entire body rest on the chest and abdomen. Keep hands firm on ground.
14. Naukasana (Figure-N, Nauka=boat; Boat posture) - Lying prone and lifting hands and legs in air.
15. Dhanurasan (Figure-O, Dhanu=Bow) - Body gets a “bow-like shape.”
16. Bhushirasana (Figure-P, Prelimnary posture of Shirshashan)- Sit in Vajarasan and touch head on floor
with the help of wall.
17. Hansasana ( Figure-Q, swan pose; prelimnary posture of Mayurasan) - Sit in Vajarasan and transfer
your weight on both palms. Body will hang in air but feet are supported by ground. It gives all the
benefits of Mayurasan without difficulty. Particularly suited for overweight or old people.
18. Chakarasan (Figure-R, wheal pose) -This asana is so named because the body takes the shape of a
circle or a semi-circle.
19. Trikonasana (Figure-S,Triangle pose) - Stand up, open the legs, and touch the right leg with right
hand and move the left arm in air. Look towards fingertips of left hand.
20. Uddiyana bandha/agnisara (Figure-T, Rapid abdominal lifts) - Exhale out all air and then draw
abdominal muscles under rib cage.
21. Pranayama (Figure-U, Breath control) - Sit comfortably with eyes closed in squatting posture. Deep
breathing should be done via alternating nostrils as shown.
22. Shava asana (Figure-V, Dead posture) - It involves lying relaxed, eyes closed with arms placed on
both sides of the body1.
Study two (yoga in male sexual functions)
In our second study2, we studied 65 males (Age range=24-60 years, average age=40±8.26 years)
who were enrolled in a yoga camp and administered a known questionnaire i.e. Male Sexual Quotient
(MSQ) before and after 12 weeks sessions of yoga. MSQ scores before and after yoga sessions were used
as assessment tools. It was found that after the completion of yoga sessions; the sexual functions scores
were significantly improved (p<0.0001). The improvement occurred in scores of all the domains of sexual
functions as studied by MSQ (desire, intercourse satisfaction, performance, confidence, partner
synchronization, erection, ejaculatory control, orgasm).
Study three (yoga in female sexual functions)
In our third3, we recruited 40 females (age range 22–55 years, average age 34.7±8.49 years) who
were enrolled in a yoga camp and were given a Standardized Questionnaire named Female Sexual
Function Index (FSFI) before and after the 12 weeks session of yoga. It was found that after the
completion of yoga sessions; the sexual functions scores were significantly improved (P < 0.0001). The
improvement occurred in all six domains of FSFI (i.e., desire, arousal, lubrication, orgasm, satisfaction,
and pain). The improvement was more in older women (age > 45 years) compared with younger women
(age < 45 years).
1 Publisher’s note: Description of asanas is not complete and therefore it is not recommended to practice them based on this
description, but only with assistance and guidance of the certified yoga instructors.
www.yoga-science.rs
www.yogasavezsrbije.com
Dhikav, V., Karmarkar, G., Anand, K. (2011): Yoga and Sexuality: a Novel Way to Improve Sexual Functioning.
In: P.Nikic, ed. Proceedings “Yoga – the Light of Microuniverse” of the International Interdisciplinary Scientific
Conference “Yoga in Science – Future and Perspectives”, September 23-24, 2010, Belgrade, Serbia. Belgrade:
Yoga Federation of Serbia, p. 119-124
Scope of researches
Based upon, our studies three involving yoga and sexuality, we feel that yoga is an effective
method of improving all domains of sexual functions and perhaps preventing or treating sexual
dysfunctions.
We are presently in the process of evaluating yoga in a large number of subjects (both men and women)
to know more about the therapeutic potential of yoga. So far, few of the limitations of our studies have
been:
1. Small sample size
2. Lack of a control group in two of our recent studies
3. Lack of psychometrical analysis
In first of the ongoing study; we are comparing tadalafil, an important drug for erectile
dysfunction and yoga in treatment of erectile dysfunction. In rest of the two, we plan to compare in both
men and women the effect of yoga in sexual satisfaction. We have taken people who are walking
everyday for one hour as control group. In all of the 3 studies that we are presently undertaking we have
taken controls and also doing psychometrical analysis (Hamilton Depression Rating & Hamilton Anxiety
Rating Scales). Thus we are removing the drawbacks in ongoing studies to answer questions related to
yoga efficacy in a more comprehensive way.
Discussion
Though life style practices like yoga are very old yet psycho-medical approach to sexual
problems is not a very old practice4. Around 2 decades back, behavioral approaches to treatment of sexual
problems started falling out of favour and mainstream medicine started taking charge of these patients.
This was probably because biological basis of sexual disorders started coming out and this led urologists
and sexologists to try out medical treatment rather than purely psychologically or behaviorally based
options. Yoga is an ancient practice that involves both physical postures (asanas), breathing techniques
(pranayamas) and meditation, which aids in achieving the goal of union between the “self and the
spiritual”. From an objective angle, it becomes difficult to understand how such a seemingly
philosophical practice could become useful in treating sexual disorders. But there has been long standing
beliefs that yoga does improve sexual functioning. We have explored the scientific value of this empirical
belief and we found that yoga tones up abdomino-pelvic muscles6, improves endocrinal functioning,
stabilizes and calms down both body and mind and also has some potential spiritual healing ability. On a
local level, pelvic-perineal muscles are strengthened by specific yoga postures. Yoga practice improve
blood flow to genitals, reduce menstrual problems and improves both male and female sexual problems5.
Pelvic exercises, for long, have been shown to be beneficial in improving sexual functioning5. Yoga could
also be improving pelvic muscle strength, in addition to many more things stated above. So, a
combination of factors could have been responsible for brining about improvements in men's sexual
performance.
Popularity and acceptability of yoga
Yoga is popular maybe exactely because of its natural non-pharmacological approach. It is used
as a supporting method in a plethora of bodily and psychological conditions. This paper should also
contribute to the acceptance of yoga as an option of supporting method in healing without medicaments.
www.yoga-science.rs
www.yogasavezsrbije.com
Dhikav, V., Karmarkar, G., Anand, K. (2011): Yoga and Sexuality: a Novel Way to Improve Sexual Functioning.
In: P.Nikic, ed. Proceedings “Yoga – the Light of Microuniverse” of the International Interdisciplinary Scientific
Conference “Yoga in Science – Future and Perspectives”, September 23-24, 2010, Belgrade, Serbia. Belgrade:
Yoga Federation of Serbia, p. 119-124
www.yoga-science.rs
www.yogasavezsrbije.com
Conclusions
Yoga has been practiced by people of India and world at large for long time now. It is accepted
widely, cheap, effective and is free from serious side effects. Considering lot of rumors that it has lot of
abilities, specially the alleged ability to boost sexual function, we thought it worthwhile to explore the
effect and test it scientifically. We have been so far able to bring to surface ability of yoga to positively
affect sexual functions. Our studies indicate that yoga is a cheap non pharmacological measure to improve
sexuality or has potential to treat sexual dysfunction. After visiting doctor, patients can practice yoga
according to the doctor’s advices. And people who wish to “boost” their normal sexuality; yoga could be
a cheap and an effective way.
References:
1. Dhikav V, Karmarkar G, Gupta M, Anand KS. Yoga in premature ejaculation: a comparative trial with fluoxetine. J
Sex Med. 2007 Nov;4(6):1726-32. Epub 2007 Sep 21.
2. Dhikav V, Karmarkar G, Verma M, Gupta R, Gupta S, Mittal D, Anand K. Yoga in male sexual functioning: a
noncompararive pilot study. J Sex Med. 2010 Oct;7(10):3460-6. doi: 10.1111/j.1743-6109.2010.01930.x.
3. Dhikav V, Karmarkar G, Gupta R, Verma M, Gupta R, Gupta S, Anand KS. Yoga in female sexual functions. J Sex
Med. 2010 Feb;7(2 Pt 2):964-70. Epub 2009 Nov 12.
4. Brotto LA, Mehak L, Kit C. Yoga and sexual functioning: a review. J Sex Marital Ther. 2009 Oct;35(5):378-90.
5. Kegel exercise. http://en.wikipedia.org/wiki/Kegel_exercise (accessed on July 30, 2010).
6. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement
Med. 2010 Jan;16(1):3-12.
7. Sex-asnas to women’ rescue: http://www.fox41.com/story/12005520/sexercises-workouts-to-work-you-
up?clienttype=printable&redirected=true (accessed on July 30, 2010).
8. Complementary and alternative medicine in men’s health: http://www.mdconsult.com/das/article/body/228651238-
2/jorg=journal&source=&sp=21537383&sid=0/N/672845/1.html?issn=1875-6867 (accessed on July 30, 2010).
9. Sexercises: workouts to work you up: http://www.wbay.com/Global/story.asp?S=12005520 (accessed on July 30,
2010).
10. Premature ejaculation: test and diagnosis: http://www.mayoclinic.com/health/premature-
ejaculation/DS00578/DSECTION=tests-and-diagnosis (accessed on July 30, 2010).
11. Yoga and female sexual functions:
http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2010/April/yoga-and-female-sexual-
function (accessed on July 30, 2010).
12. Yoga improves premature ejaculation: http://www.nature.com/nrurol/journal/v5/n2/full/ncpuro1007.html (accessed on
July 30, 2010).
