The controversies of sex and health benefits – should we believe everything we read?
Sex is an enjoyable experience for most people and our sexuality can be a big part of who we are. Popular press promotes sex as a health-improving activity and there are countless articles appearing not only on health-related websites but also on media outlets like Forbes, CNN, and even Time magazine (1–3). It has been estimated that the market for sexual wellness will reach $37 billion by 2023(4). Googling “benefits of sex” and thousands of hits come up where sex and health are put in one sentence in the title. Reading these articles, one may get the feeling that having sex is as important as having nutritious food, enough sleep, and exercise. But if that was the case, why is sex not regularly discussed with your doctor; why do public campaigns around the subject only involve how to prevent pregnancies or bring awareness to sexually transmitted diseases, instead of promoting sex the same way as vaccination? Is it because of stigmatization and taboos, or perhaps because of a lack of concrete evidence? Is that going to change as health care is moving towards value-based medicine and preventative care becomes more and more important?
In this article we will first mention some of the most often cited health benefits of sex found in the popular press, then we will investigate the link between sex and longevity, and finally we will bring up some controversies we found around the published literature.
Are there health benefits of sex?
The short answer is yes!
But more research is needed to conclude that with high confidence. There is an abundance of information readily available on the web about the health benefits of sex. Some of the benefits, as reported by Time magazine, are that sex burns calories, helps with your sleep, lowers blood pressure and stress levels, strengthens your heart, and may even protect against cancer (3)! The results from these studies, however, seem to be a bit exaggerated. Could it be because sex sells? We decided to put three of the most cited studies through a critical view. These particular studies are often used by the popular press when claiming the benefits of sex: better cardiovascular health, improved immunity, and a prolonged life.
Does sex improve cardiovascular health?
One commonly cited benefit of sex is that it improves cardiovascular health (5). The study in question supports this idea but only for women (6). It was concluded that too much sex may actually increase the risk of cardiovascular disease in older men.
The study investigated whether partner in older men (1046 subjects) and women (1158 subjects) (ages 57-85) is associated with cardiovascular risk (6). The researchers proposed that partnered sexuality should be associated with cardiovascular health for several reasons. First, partner sexuality is seen as a form of exercise that can promote cardiovascular health. Second, the intimacy embedded in sexual relationships is a source of emotional and social support promoting stress recovery, thereby reducing the risk of cardiovascular disease. The researchers also suggest that the benefits of partnered sexuality, especially in older adults, come not only in the physical act of sex itself, but also come from the closeness, benefits of physical touch, and social and emotional connection. In addition, it is noted that partnered sexuality may provide stress relief due to the release of oxytocin – the “love hormone”, which promotes bonding, lowers stress, and thus promotes cardiovascular health.
The study also found that a fairly large proportion of older adults were sexually active (6). Older men were more likely to report being sexually active than older women. The study also found that for women, partnered sex of good quality seems to promote cardiovascular health, specifically reducing the risks of hypertension. Good quality of sex is the responder’s opinion if the sex brought them physical pleasure and emotional satisfaction. The study also found that good sexual quality does not protect men against cardiovascular risk. Although moderate frequency of sex may bring some health benefits for older men, too frequent sex might be a risk factor for experiencing cardiovascular disease events over time. These findings challenge the assumption that sex brings uniform health benefits to everyone, and that the more sex one has, the better.
The authors acknowledge the limitations of the study, such as the age of the participants, lack of cholesterol measurements as well as other markers of cardiovascular disease, and sexual quality as only one dimension of quality in a relationship. However, these limitations are often omitted when the study is discussed in popular press.
To summarize, the findings aren’t as straightforward as popular literature might suggest. There might be benefits to cardiovascular health, but more studies are needed to figure out the optimal “dosage”.
Sex boosts the immune system – but not too much sex.
Another frequently cited benefit of sex is that it boosts the immune system (5). This claim is largely based on a study that concluded that people who have frequent sex (once or twice a week) have higher levels of salivary Immunoglobulin A (IgA) (7). IgA is the most abundant antibody, and it helps our immune system to fight disease and prevent illness. The participants, 112 college students aged 16-23, were separated into 4 groups depending on the frequency they had sex: none, infrequent (less than 1 occurrence per week), frequent (1-2 times per week), very frequent (3 or more occurrences per week). The participants in the frequent group showed significantly higher levels of IgA than in the other 3 groups.
The researchers themselves note that the data is preliminary and needs to be replicated to draw conclusions. One would expect that the more sex you have the higher levels of IgA you would have. However, it is still unclear why the group who had sex very frequently (3 or more times per week) had the lowest level of IgA. This crucial detail is frequently omitted when the study is presented in popular press.
Further, the study had very few participants (112), in the ages 16-23 years old, with self-reported sex frequency. One might question how robust these findings are, and how applicable they are for the rest of society. More studies are for sure needed!
Does sex prolong life?
The third benefit of sex relates to women and is usually presented in the popular press as “weekly sex can prolong life” (8).
The study examined the relationship between sexual intimacy in couples and telomere length in women (9). Telomeres are the protective caps on the end of human chromosomes, and they shorten as we age. Telomere length has emerged as a powerful marker of age-related diseases (10) (More about the Hallmarks of aging can be read here). The study involved 129 mothers in committed relationships with available data on telomere length. The participants were asked to keep diaries about their overall relationship satisfaction, stress, and intimacy during the study period. Telomere length was measured after 1 week. Women who reported having sex more than once a week had longer telomeres. The researchers suggested that perhaps sexual intimacy may dampen the effects of stress response and up-regulate the immune response.
The authors noted that some of the limitations of this study were its small size. Research should also be expanded to include males. This study was also observational – what if the healthiest women were the most sexually active and not vice versa?
Is there a relationship between sex and longevity?
Our sexuality is an important aspect of our lives. Human sexuality has been linked to health benefits and longevity, as partnership and sexual activity have been positively associated with health in middle age and later in life (11).
So, does it mean that being sexually active will result in longer life?
Optimal sex frequency may lead to longer life – but general health advice is even better
One study suggests that being a sexually active male may result in longer life (12). A Welsh cohort study investigated the connection between sex and death in men (12). The researchers wanted to investigate the relation between the frequency of orgasm and mortality. They looked at 918 reasonably healthy males from a Welsh community who were 45 to 59, when the study began (1979-83) and a decade later, they checked back with the men. The researchers then correlated the men’s sexual frequency, as reported in the original survey with their death or survival 10 years later. Compared with men who had sex just once a month, those who reported having it twice a week had only half the death rate. It was concluded by the authors that sexual activity seems to have a protective effect on men’s health. Similarly to the study above on cardiovascular disease risk, having the right frequency of sex may be the key to better health (6).
Another study also supports the idea that being sexually active and enjoying good quality of sexual life brings better health (11). The study examined the relationship between health and several dimensions of sexuality in middle aged and older adults. Overall, men were more likely than women to be sexually active, report good quality sex life and be interested in sex. Among sexually active men good health was associated with frequent sex (once or more weekly). In both genders good health was associated with good quality sex life and interest in sex. Therefore, the study concluded that sexual activity, good quality of sexual life, and interest in sex were positively associated with better health in middle age and later life.
Finally, others have also tried to answer the question of whether sexual health can contribute to longevity but landed on a different conclusion than the two studies above (13). The researchers noted that men, on average, report more sex in their lifetime compared to women. Women in general, however, live 5-8 years longer than men in most countries in the world. So, if men have more sex during their lifetime, and sex can “do wonders” and lead to better health, why are men then dying before women? The conclusion of the research, based on the existing literature evidence, was that it is difficult to determine if sexual health contributes to longevity in the same way as general health and the availability of a better healthcare system.
Is it just that healthier people have more sex?
Over the last years number of studies in Western countries promoted sex as a health improving activity. In some ways this “sex for health” debate fits the overall promotion of holistic health communication (14). Health promotion and healthy living require the individual to take responsibility to remain healthy. But we wondered, is it sex that promotes health, or is it being healthy that promotes sexual behaviour?
To answer this question, we need to look at the way the studies are designed. As most studies in the field are observational in nature, there is always the risk that the association is correlated but not causal. This means that being sexually active may be correlated with better health but that does not necessary mean that being sexually active causes better health (12). Most studies do not account for several factors in the baseline that may influence the outcome such as general health status, BMI, presence of heart disease, occupation, overall stress levels, smoking and other lifestyle habits etc. Indeed, it has been noted that “Sexual health is strictly related with general health in both genders” (15). Moreover, with poorly defined definitions of sex amongst the different research articles, is it the act of sex or the emotional bonding, or both, that brings health benefits?
Omitted information and misleading health advice
We also noted that there was a difference on the way the scientific articles were represented in the popular press. This is perhaps due to the different purposes and audiences, and it is understandable and appropriate depending on the target audience. However, by omitting some of the information, such as a study sample or age of participants, the readers may be misled to believe that the statement is very general and broad. For example, many of the popular press articles referenced the study above on the relation of sex frequency and immunity (IgA) (7). A lot of the reports, however, did not include that the sample was from 112 college students and that the group who had sex very frequently had the lowest amount of IgA. By omitting that information the readers may be led to believe that the findings are universally acceptable – and the data is more robust than is suggested by the scientific literature itself (14).
Lack of inclusiveness – does it only apply to heterosexuals?
There is evidence that sex is healthy, but science and popular press, seem to send mixed messages on what type of sex and with whom. Most of the research describes normative sexual behaviour in a monogamous relationship including penis-vagina interaction, and there is anxiety around “risky sex”, and “promiscuity”. Most of the photos accompanying the popular press show young, happy, heterosexual, white couples on white background setting, suggesting monogamous relationship and cleanliness. This may increase the pressure on “individuals to confirm to normative expectations and contribute to the further marginalization of those individuals who cannot or will not live up to these norms” (14). Additionally, due to the “mounting evidence” available on the web that sex is healthy, some people may feel pressured to engage in sex more frequently and that may lead to the suffering of individuals who abstain from sex or engage in sexual activity infrequently. One may argue that different forms of sexual activities can be healthy for different people, and the “not one fits all” approach.
Is it as simple as – sex sells?
In conclusion, we found that there are benefits of sex, but these benefits are exaggerated in popular press. The scientific studies have their limitations, as acknowledged by the researchers themselves but very often omitted by popular press. More robust studies, and studies outside the normative sexual behaviour (penis-vagina), are needed to show the clear benefits of sex, and for your physician to start “prescribing” sex as a mean to improve your health status. How have these few findings developed into such hot topics and multiple popular articles? Perhaps it is as simple as “sex sells”?
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