If you didn’t know that sex is good for your health, you haven’t been paying attention. Depending on which headline you believe, sex has six or eight or 10 or 16 or 17 different health benefits. According to the scientific research touted in stories like these, sex can burn calories, cut stress, ease depression, relieve pain, reduce the risk of cancer and heart attacks, lessen your risk of dying, and even reduce the frequency of hot flashes in menopausal women.
Assuming that these studies are correct (more on that in a minute), and that sex is good for your health, then the obvious next question would be, how should you arrange your sex life so as to maximize the health benefits? Is a series of one-night stands as salubrious as a long-term coupling? Could a few bouts of masturbation be as nourishing and wholesome as a single night of conventional intercourse? Stuart Brody, a psychologist at the University of the West of Scotland, has made a career of studying such matters, and his 2010 review paper, "The Relative Health Benefits of Different Sexual Activities," concluded that penile-vaginal intercourse (PVI) gives the greatest physiological boost. He backs up this assertion with data from a 2009 survey of nearly 3,000 Swedes, in which people who reported the highest frequencies of PVI also reported high levels of sexual satisfaction, health, and well-being.
Not that masturbation is so bad. A 1988 study found that genital self-stimulation increases pain thresholds and produces an analgesic effect in women, and a 2003 study linked masturbation to a reduction in prostate-cancer risk, which the researchers attributed to ejaculation frequency. But a subsequent study failed to confirm the relationship and, no doubt to the chagrin of many men, concluded that prostate cancer risk was unrelated to a man’s ejaculation count. (Some studies suggest a link between sex and breast cancer, too: One found a reduced risk of breast cancer among women who’d had multiple sexual partners, though another found that women who’d had children fathered by different partners did not have a lessened risk of the disease.)
If you’re tempted to go it alone, know this. Masturbating might get you off, but it probably won’t help you out of a funk. Brody’s Swedish study found that people who reported frequent masturbation scored lower on measures of health and well-being than those who engaged in frequent PVI. A 2004 study of middle-aged women found that those who suffered from depression masturbated more and reported less satisfaction in their partnered sexual experiences than women without depression.
The sexual cure for depression, apparently, involves semen. A survey of just under 300 female college students in Albany, N.Y. found that depression (as measured on a depression scale) increased the longer it had been since a woman had experienced PVI. The happiest women in the study were those who had the most PVI, but this antidepressant effect evaporated if they’d used condoms. Students who hadn’t engaged in PVI, or said they used condoms, reported more suicide attempts than those who said they never used condoms during sex. While the study isn’t rigorous enough to provide any solid conclusions, it’s theoretically possible that semen really does have antidepressant properties, since it’s loaded with hormones, neurotransmitters and other chemicals, including testosterone, prostaglandins, and hormones that stimulate ovulation.
OK, so let's say you have a partner. What's the best—and by best I mean healthiest, of course—sexual position? Research shows that if you’re getting busy to burn calories, the missionary position would be your best bet. But don’t skip your workout just yet: A 2008 study found that the physical demands of sexual activity are both moderate and short-lived.
Sex with a spouse may be healthier for men than sex with an illicit lover, especially if they’re doing the latter in a secret place. A paper published in September found that the majority of penile fractures seen in one Maryland hospital happened during extramarital sex in “out-of-the-ordinary” locations like cars, elevators, and public restrooms.
Here's the summary so far: If you want to maximize your sexual health, or your sexually-induced health, then engage in as much penile-vaginal intercourse as possible, using the missionary position in your bedroom at home without a condom. There's only one problem, though. None of the studies described above would qualify as top-shelf medical research. Even Irwin Goldstein, editor-in-chief of the Journal of Sexual Medicine, admits the evidence is flimsy: “This is sort of, you find what you want to find. The papers are controversial. It’s a lot of anecdotal work.”
Some have criticized Stuart Brody’s work in particular as showing a bias toward specific heterosexual acts. (“He’s obsessed with PVI,” one expert told me.) But almost all the studies in this area suffer from a suspect methodology. First, they tend to rely on self-reported figures for sex and orgasm frequency. If you want to believe the results, you'll also have to believe that the people surveyed gave completely honest information about their sex lives to total strangers. For the studies examining links between prostate cancer and ejaculation frequency, you must also trust the participants to tabulate and report their average numbers of ejaculations per month over a span of several decades.
Even if the self-reported numbers were accurate, most of these studies would still be too small to produce anything more than suggestive correlations. Vascular disease is a common cause of impotence. Does sex make men’s hearts healthier, or do healthy hearts and blood vessels simply enable men to have more sex? Standard sex-and-health research can’t answer basic questions like this.
For more solid answers to questions of sex and health, researchers would need to randomly assign people to engage in various sex acts, then see how their health fares. Such studies might compare PVI to oral sex, masturbation, or stimulation with a vibrator to find out once and for all if standard heterosexual intercourse is really as superior as Brody asserts. Randomized trials, especially ones that included gay men, could help clarify semen’s potential as an antidepressant, but such trials might be difficult. How would you ensure that participants are complying with your instructions? What if a couple breaks up before the study is over? Could a participant who’s getting sex on the side skew the results?
Existing work involves people who’ve chosen to have sex on their own accord, and (for the most part) at a frequency of their choosing. It’s not clear that participants would get the same benefits if they were having sex because it was prescribed to them by a doctor. It’s hard to imagine that having sex you don’t desire (or with a less-than-eager partner) would enhance your health—or your relationship.
But I have a bigger complaint about these studies. I normally find sex an alluring topic, but a few pages into Brody’s 26-page tome, I found myself losing interest—not just in his tedious explanations or his obsessive devotion to PVI, but in whatever health benefits sex might really offer.
Turning sex into medicine takes all the fun out of it. I don’t have sex because it’s good for me. I have sex because it’s awesome. My husband and I have sex as frequently as we do because we’re attracted to one another and crave the intimacy and intense pleasure that comes from rubbing our naked bodies together, not because we’re on some healthy sex prescription plan. It’s the desire itself and the pleasure of giving in to it that make sex wonderful. I don't doubt that frisky urges are a sign of good health (unless you've been bitten by a rabid animal), but those of us who want to get laid shouldn't need a doctor's permission to do so.