Run Well

by Juliet McGrattan

  The male reproductive system includes the penis, the contents of the scrotum, the prostate and seminal vesicles (the glands that make the fluid for semen). We’ve already covered the prostate (see here) so here we’ll just be dealing with the crown jewels. Inside the scrotum you’ll find two testicles, each with an epididymis and a vas deferens. Sperm is made in the testicle and stored in the epididymis until ejaculation, when it travels along the vas deferens, mixes with fluid from the prostate and seminal vesicles, and leaves as semen via the urethra in the penis. The testicles also make hormones, including testosterone, the main male hormone. Testosterone has many roles in the body other than sperm production, including regulating sex drive, controlling muscle, bone and fat metabolism, and prompting red blood cell production. Testosterone can also influence mood and behaviour.

  The female reproductive system includes the uterus, ovaries, fallopian tubes, cervix, vagina and vulva. The ovaries make the main female hormones, progesterone and oestrogen. They also make small amounts of testosterone. The two ovaries take it in turns to release an egg each month. This is called ovulation. The egg travels along the fallopian tube and, if it meets a sperm, it can become fertilised, nestle into the wall of the uterus and result in a pregnancy. If it’s not fertilised by a sperm then the lining of the uterus, which has been bulked up for possible pregnancy, is shed in a monthly bleed. The menstrual blood passes through the cervix (neck of the womb) and into the vagina. The vagina opens to the outside in the vulva. Many people (men and women) get the terminology wrong. The vulva is not the vagina. The vulva is the whole area inside the lips, also called the labia majora, and includes the inner lips (labia minora), the clitoris, the urethral (water works) opening and the vaginal opening. More information on all aspects of the female reproductive system, including menstruation, periods, pregnancy and menopause, is covered in my previous book, Sorted: The Active Woman’s Guide to Health.

  Problems and questions related to these systems crop up all the time, so let’s dive in and consider them. We’ll start with sex and move onto fertility, periods, pregnancy and beyond.

  Q Will sex the night before a race help my ­performance or am I better to abstain?

  A In the past there has been a view that having sex before a sporting fixture could decrease performance, and that a degree of sexual frustration would lead to a more aggressive, competitive and successful performance. As a result, many individuals have been advised or even prevented from having sex before important fixtures. Research in this area is generally of low quality and mostly involves male participants. There seems to be little evidence to support the theory that sex negatively impacts performance. One study showed that there is no negative effect if the sex occurs at least ten hours before the exercise test, but there is a negative effect if it’s less than two hours. It seems reasonable to presume that a late night with hours of sex might not put you in the best physical shape for an endurance event the following morning, due to expended energy and little sleep. However, a 2017 survey of over 4000 Brits by online adult toy business Lovehoney revealed that the average time for sex in the UK is 19 minutes (ten minutes of foreplay and nine minutes of intercourse), which would burn around 70 calories and not put too much of a dent in your energy or sleep.

  If pre-race anxiety levels are high, sex can be relaxing and aid sleep, so potentially this could improve performance. There’s some evidence that the female orgasm lowers pain thresholds, which if that effect lasted long enough (and we don’t know if it does), could be handy when you’re hurting in the toughest parts of a race the next day. They say never try anything new on race day and you could add the night before race day too. It’s not the best time for new sex positions if you want to avoid a muscular injury. All in all, it’s an individual thing – do what works for you and have fun with the trial and error testing!

  Q Can running increase your sex drive?

  A There are many causes of a low sex drive or libido. While running can’t help reduce some of them, such as pain on intercourse, neurological diseases and side-effects of medications, it can help counteract many others. A low libido is often linked to mental health problems, such as anxiety and depression, and we know that regular exercise can help alleviate and treat these (see here). Running is a useful tool for managing daily life stress and fatigue, both of which can have a significant effect on how keen you are to have sex. Low self-esteem and poor body image can lower libido, and running has an amazing ability to help people build confidence through goal setting and improving their relationships with their bodies. Regular running is a healthy lifestyle choice and reduces the risk of developing medical conditions that can affect libido, including high blood pressure, obesity and type 2 diabetes.

  Did you know?

  Erectile dysfunction – problems getting and maintaining erections – affects 40 per cent of men aged 40. By age 70, the figure rises to 70 per cent. If it’s happening to you, visit your GP or a sexual health clinic to check for underlying causes.

  Q Will running improve sexual performance?

  A Studies on this subject rely on surveys and self-reporting so there is always the risk that people don’t give accurate answers to questions about their sex lives and exercise habits. One of the larger, more recent studies carried out by the University of California in 2019 surveyed around 3900 men and 2200 women, with an average age of over 40, to determine whether more cardiovascular activity (running, cycling and swimming) each week reduced the likelihood of sexual problems. They found that men doing more cardio exercise each week reported less erectile dysfunction and women exercising more vigorously suffered less sexual dysfunction too, with easier arousal and better orgasm satisfaction. In summary, the more exercise, the greater the sexual performance and satisfaction. The reasons for this are unclear and many factors, both psychological and physical, will have a role, but improved circulation may play a part. Erections rely on an increased blood flow to the penis and women’s genitals become engorged with blood during arousal. Remember too that conditions such as high blood pressure, obesity and type 2 diabetes are all causes of erectile dysfunction, which regular running can help to counteract. So, for a great sex life, you are well justified in spending plenty of time in your trainers!

  Did you know?

  People experience exercise-induced orgasms. Whilst there is little medical evidence to support the claims and poor understanding of why they happen, they seem to be more common in women and more likely during workouts that involve the deep abdominal and pelvic muscles, hence the descriptive term ‘coregasm’.

  Q Will running affect my fertility and sperm count?

  A Sperm-related problems are the most common cause of infertility in men. The sperm may be low in number, abnormal in shape or unable to swim effectively to reach the egg. In the majority of cases the reason for this is unexplained. Lifestyle can affect sperm quality and quantity. Excessive alcohol intake can reduce sperm quality. In overweight or obese people, losing weight can improve sperm counts. We know too that stress and poor sleep can affect sperm production, so using running to maintain good mental health could lead to an improvement. There’s strong evidence that smoking reduces sperm counts, so if running helps you to stop smoking then it’s having an indirect but significant effect on your fertility. Underlying medical causes for sperm abnormalities include testicular problems such as injury, infection and undescended testicles. Reduced sperm production can result from low testosterone levels due to testicular or pituitary gland tumours. Taking illegal drugs can also affect sperm quality.

  What about the direct effect of running on sperm production and quality? A 2017 study from Iran, widely shared in the media, concluded that exercising three times per week can improve sperm quality and number, and that moderate intensity exercise showed the most benefit. There were no changes in sperm in the control group that didn’t exercise. This sounds encouraging, but it’s wise to consider the limitations of this study. People in all the exercise groups lost weight, so we
don’t know whether the sperm improvements were due to weight loss or exercise. It’s also worth noting that the people in the study didn’t exercise prior to taking part, so we can’t automatically assume that current runners could improve their sperm counts by running more.

  There have been studies showing that excessive exercise can reduce sperm counts. This is particularly frequent in long distance cycling, possibly due to reduced blood flow from saddle pressure and over-heating of the scrotum which may be relevant to endurance runners too. The jury is still very much out on how much of what type of exercise will have the most benefit on sperm production or whether this will actually lead to successful pregnancies. For now, it seems reasonable to say that including moderate amounts of regular running as part of a healthy lifestyle may improve – and won’t decrease – your fertility.

  Did you know?

  According to World Health Organisation guidelines, a normal semen sample will be at least 1.5 millilitres and contain at least 15 million sperm per millilitre with a total of 39 million per ejaculate.

  Q My balls ache when I run. Why? And is it harmful?

  A There are several reasons why you might get pain in your testicles when you run. The most common is that they simply object to being bounced around. If you’re wearing loose fitting boxers or sports shorts, then simply switching to something more supportive could be the answer. You could try tighter underpants or Lycra shorts (on their own or under looser ones, depending on your preference). Compression wear (super-tight clothing that aims to increase blood flow) might be the answer, but if you get any pain or numbness then it means it’s too tight. If support doesn’t solve the problem or you get pain at other times too, then make an appointment to see your GP to rule out any underlying problem such as inflammation or infection.

  Have you heard of a varicocele? There’s a little network of veins next to the testicle and if blood flow backs up in these, similar to a varicose vein, then you can develop a squishy swelling called a varicocele, usually on the left testicle due to a slightly increased blood volume compared to the right testicle. They’re generally harmless, but because of the increased blood flow during running and the effects of gravity, they can ache and throb during exercise. Supportive underwear can help, but don’t self-diagnose. Any lumps or bumps in the scrotum should be checked by a doctor.

  Finally, it’s possible the pain might be coming from elsewhere and is radiating to your testicles. Pain from the lower back, hernias, urinary tract or thighs can all be felt in the testicles. If in doubt, get checked out and remember that sudden and severe one-sided testicular pain could be torsion, where the testicle has twisted and blood flow is blocked. This is an emergency requiring urgent assessment.

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  How to check your balls

  Examining your testicles once a month will help you to get familiar with how they feel and ensure that you pick up any potentially harmful changes early. Remember that most lumps won’t be cancer and if testicular cancer is found early it is nearly always treatable.

  Checking yourself is simple. Here’s how to do it:

  1 Have a warm bath or shower so your scrotal skin is relaxed – checking while you’re in the shower is a good idea.

  2 Remember, it’s normal for one testicle to be larger or hang lower than the other.

  3 Standing up, cup your balls in one hand. You can use the other hand to press your penis and the top of your scrotum against your body to keep everything still.

  4 Check one testicle at a time and roll the testicle between your thumb and index and middle fingers.

  5 The surface should be smooth and uniform. Check for lumps or bumps of any size on the surface of the testicle.

  6 At the top and back of each testicle, you will feel a soft, stringy, lumpy area called the epididymis and a firmer, longer, thinner spermatic cord. These are a normal part of the anatomy.

  7 If you notice any lumps, changes in size or consistency of the testicle, or any painful areas, then see your doctor.

  Q My menstrual cycle really seems to affect my ­running performance. Is this possible?

  A There is an under-representation of women when it comes to sports medicine research so questions like this are difficult to answer. A review in the British Journal of Sports Medicine in 2017 found that over 6 million people were included in exercise research studies between 2011 and 2013 and women made up only 39 per cent of that total. Most studies looking at the effect of the menstrual cycle on performance have been carried out with elite athletes as the participants. Measurements such as their oxygen consumption, heart rate and lactic acid production have been monitored, and there’s little convincing evidence that performance alters at different times of the cycle. However, if we look at different measures, such as energy levels and motivation, you’ll be hard pushed to find a menstruating woman who doesn’t report that at certain times of the month running is harder than at others. A study of over 1000 women running the London Marathon in 2015 found that nearly one third of them felt that their menstrual cycle affected their performance and training. With the increasing number of women running and the topic of periods thankfully becoming less taboo, there’s more research going on in this area and in non-elite athletes too. Hopefully we’ll soon have a much clearer picture of the possible effects and how to counteract them.

  Generally, most women report they can run well from the second or third day of their period through until mid-cycle. This seems to be a good time to do high intensity interval and sprint work. Around mid-cycle there is an increased risk of injury, particularly the cruciate ligaments in the knee, probably due to hormonal softening of ligaments. The second half of the cycle seems to be better for endurance runs, but towards the end of this, when pre-menstrual symptoms kick in, motivation and speed take a downturn and body temperature rises. This is a good time for easier runs and cross training. It is a very individual thing and finding what works for you takes time.

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  Tracking your menstrual cycle

  If you’re interested in seeing how your menstrual cycle affects your running and training, then start keeping a record of your activity. You can use a simple written diary of your runs. Note down how you felt and any problems you encountered. You could also rate your energy levels, average heart rate and pace. Tally this with your periods and see if there is any pattern throughout the month. There are several menstrual cycle tracking apps available which offer advice on what changes you can make to work with your cycle.

  Q My period is due on marathon day! Is there a way I can stop it coming?

  A How frustrating! It is possible to delay menstruation using hormonal medications. If you already use the combined oral contraceptive pill and the marathon is falling during your usual pill-free break, then it’s easy. Miss the break and carry straight onto the next packet. Be aware that if you use a pill which has seven inactive pills instead of a pill-free break, then you will need to miss out the dummy pills and go straight onto the active pills in a new packet. If you take a pill that has different hormone content on different days (known as a phasic pill) then you should get advice from your practice nurse or a family planning clinic to make sure your contraceptive cover is maintained.

  If you aren’t on the pill and simply want to delay this period as a one-off, then there is only one drug licensed for this purpose in the UK. It’s a progesterone called norethisterone. This is available from your GP and some pharmacies offer it too. You will be asked questions to check it is suitable for you and the possible risks of deep vein thrombosis should be assessed and discussed. Norethisterone needs to be started three days before you expect your period to begin and taken three times a day until after your marathon. You can expect a bleed within three days of stopping it. However, it might not help you perform at your best as it can cause bloating, sluggishness and tender breasts in some women. You could look at using the combined oral contraceptive to control and delay this peri
od, but ideally you would need to start it at least a month or two before the marathon, because irregular bleeding is common in the first few months.

  Remember that no method is guaranteed to stop your period and there’s no evidence that athletic performance is affected during menstruation, so unless your bleeding is heavy and unmanageable then you may prefer to pad up and run. If heavy periods are frequently affecting your running and racing plans, and you aren’t planning to get pregnant, then have a chat with your practice nurse about contraceptive options that might reduce or eliminate your heavy periods.

  Q My periods are really heavy, but I don’t want to take hormonal contraception. What can I do to stop them affecting my running?

  A Many runners have heavy periods. A survey of over 1000 women at the London Marathon in 2015 found that 35.5 per cent of them met the criteria for heavy menstrual bleeding (HMB) and less than half of them had sought medical help for the issue. Interestingly, elite marathon runners were included in this study and 36.7 per cent of them had HMB and just over half said their cycle has an impact on their training and performance. While this doesn’t mean you shouldn’t run during a period, HMB can make women fear blood leaking onto their clothes and it could potentially cause light-headedness and a lack of energy. It can be associated with cramping pain too. There’s also an increased risk of an iron deficiency anaemia with HMB. This may be transient or longer lasting, but can certainly reduce performance (see here).