Background: A sexually active lifestyle is generally associated with positive effects on physical condition and health. However, engaging in sexual activity prior to a sports competition could affect athletic performance. This systematic review examines the current literature on the impact of pre-exercise sexual activity on sports performance, with particular attention paid to its effects on physiological, hormonal, cognitive, and perceptual markers. Method: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed original studies published within the last 25 years. Eligible studies were randomized or non-randomized controlled design and indexed on PubMed, Scopus, Dialnet, and Cochrane. Additional sources were consulted including a network diagram with Connected Papers®. Two methodological quality scales, McMaster University Occupational Therapy Evidence-Based Practice Research Group and Physiotherapy Evidence Database (PEDro), were used. The study was registered in PROSPERO (#CRD42023426555). Results: A total of 244 records were identified through the search process, of which 7 studies met the inclusion criteria. The studies involved 117 (115 men) physically and sexually active subjects including 29 elite top athletes. When comparing the sexual activity condition/group (SexG) to abstinence (AbsG), significant (p < 0.05) decreases were observed in average speed and maximum strength. In contrast, non-significant trends towards improvement (p > 0.05) were observed in exercise capacity, reaction time, and muscular endurance. No significant changes (p > 0.05) were found in physiological and hormonal biomarkers and fatigue perception. However, perceived exertion was significantly higher (p < 0.05) in SexG compared to AbsG. Conclusions: Current evidence does not conclusively support the influence of pre-exercise sexual activity on sports performance, or physiological and hormonal biomarkers. However, it could contribute to increased perception of exercise intensity.
