Objectives Investigate sexual function of elite athletes and characterise homogeneous groups with risk factors.

Study design Observational cohort study, concerning French elite athletes, of over 18 years, training in the National Institute of Sport, Expertise and Performance, who consented to complete an anonymous survey about their sexuality during their regulatory check-up.

The questionnaire included general data: age, hours of weekly training, use of alcohol, tobacco, cannabis, and dietary supplements, ongoing treatments, medical pathologies such as overtraining, depressive syndrome, and eating disorders, the sport categories according to the classification of Mitchell, data concerning the sexual function and different categories of sexual dysfunctions.

Results 341 athletes filled out the survey. One athlete did not complete the change over competition periods and the sexual disorders sections.

The ratio of males to females is 0.92. 135 out of them were in a relationship, 23 have at least one child. Over half were students. Four age classes were defined. The most numerous was the athlete aged 20-25 years (n = 178), then those aged under 20 (n = 79), those aged 26–30 (n = 46) and lastly over 30 (n = 38).

Surveyed athletes occasionally used alcohol (41%), dietary supplements (17%). The drugs used were mainly non-steroidal anti-inflammatory (15%), anti- histamine (4%) and sleeping medications (3%), the majority did not take any medication (78%). Under 10% of athletes reported pathologies, in order of frequency, anxiety, overtraining, urinary pathologies and depressive syndrome.

25 women and 10 men were not sexually active over the past 6 months.

The intercourse frequency of “once to twice per week “was reported respectively by 26% (n = 46) of women and 34% (n = 56) of men, the 2^nd most common response “once to twice per month” respectively by 23% (n = 42) of women and 21% (n = 34) of men.

54% of the athletes reported sexual satisfaction “very satisfied to moderately satisfied”.

53% did not alter their sexual behaviour before, during and after the competitions; when athletes change, the frequency is decreased before and during the competition, and increased after. Athletes consider their sexuality has no impact on their sport results.

More than half didn’t present any sexual disorders, 40% one or more. Among those who reported dysfunction, it was at a rare frequency for 67% of them. In males, the main disorders related to sexual desire and erection problems; in women, loss of desire, pain during intercourse and lubrication difficulties. 88% of athletes have never discussed their symptoms and received no care.

The characterisation of groups highlights a single cluster with 3 times greater risk of sexual disorders; it combined the following factors :an average training of 20 hours per week, a high rate of overtraining, consumption of dietary supplements, anxiety and depressive syndrome, absence of stable relationship. Overtraining multiplies the risk by 4.6 (OR = 4.68; CI: 95% 1.6–12.9).

Conclusion this study evaluating the impact of high level training on sexuality highlights the good sexual health of elite athletes, the lack of care in case of dysfunction, and a risk factor, overtraining.