Sex and Wellbeing

Part 1: Health Dividends from an Active Sex Life

Sex is natural. Sex is good. Not everybody does it, but everybody should. George Michael, 1987 pop hit

This song caused a great deal of controversy when it was originally released in the midst of the AIDS epidemic. Many U.S. radio stations refused to play it. Later, however, it was understood that the message was not about promiscuity but about the celebration of what is a normal, healthy human activity and the song later became widely accepted.

The Link Between Intimacy and Heart Health

Intimacy is so tightly linked with heart health—and vice versa—that we represent Valentine’s Day and romantic love with images of the human heart. It should not come as a surprise therefore that sexuality and heart health are closely linked. It is time to provide a discourse on the health benefits of intercourse... and more.

The Purpose of This Series

In this first of a two-part series, we will share data on the connection between sexual activity and health. In the second part—to be released in a future issue—we will discuss some of the more common sexual difficulties and strategies to manage them so that we all may, regardless of the challenges, enjoy the health benefits of sex.

The internet is awash in misinformation about this hot topic; we will provide scientifically valid info that was obtained from reliable and academic sources.

The Essential Question

Without sex, none of us would have been blessed by the miracle of being alive. Almost none of us will exit this life without at least some participation in this fascinating but confusing, alluring but frightening, and controversial but exhilarating activity.

The question is, how does sexual activity affect overall health?

Health Benefits of Regular Sexual Activity

A lifestyle that includes regular sexual activity bestows a host of scientifically-documented benefits to well-being and longevity.

Here are just some of the perks:

• Sexual activity is associated with better life expectancy. Several longitudinal studies of varying duration have demonstrated an inverse relationship between sexual activity and mortality risk in the general population across multiple different countries and racial groups.

  
  

  • A study from the British Medical Journal, “Sex and death: are they related?,” followed 918 men aged 45 to 59 for 10 years. During the study, those who had highest frequency of orgasm had half the all-cause mortality compared to men with the lowest frequency of orgasm. For every 100 orgasms per year there was a 36% reduction in death from any cause during the next decade.

  • In a 2017 Australian study, sexual activity was assessed repeatedly over seven years among 1,705 men aged 70 and older. It was observed that men who did not have sexual activity had a twofold increase in mortality compared with sexually active men.

  • Participants in the Duke First Longitudinal Study of Aging included 252 men and women aged 60 to 94. It was a relatively small study but had long follow-up. Over 25 years, sexual activity was a significant predictor of longevity in men, but not in women.

  • Wait. What about women? They seem to benefit too when enough subjects are included in the analysis. A 14-year study involving 2,453 Taiwanese men and women aged ≥65 also suggested an inverse relationship between sexual activity and mortality risk. Participants showed a 33% reduction in mortality for sexually active men and a 16% reduction in mortality in sexually active women compared to sexually inactive people. They showed a dose-response association too. Those who had sex once a week or more had the lowest mortality; those who had sex between once a week and once a month had the next lowest mortality. The highest mortality was in those who had sex less frequently than once a month or not at all.

Is it that only healthy people have more sex, or is it that sex makes people healthier? More study is needed to determine cause and effect. But some of the following benefits may give us a clue that sexual activity itself is conferring vigor and longevity.

• Sexual activity improves resting Heart Rate Variability (HRV).Why is resting HRV important? Resting HRV reflects heart rate fluctuations in response to life’s demands. Higher resting HRV is predictive of lower mortality rates among both normal people and those with a history of heart disease. Resting HRV is driven largely by the parasympathetic nervous system, which also plays a key role in sexual arousal. This vagal branch of the autonomic nervous system, also known as the “feed and breed” response, balances the “fight or flight” response in a yin-yang relationship.

  
  

A study of healthy German women and men found that higher sexual intercourse frequency was associated with greater HRV.

• Sexual activity after a heart attack is associated with improved survival. According to a 2020 study published in The American Journal of Medicine, there was an inverse association with sexual activity and mortality after a heart attack. People who had sex more than once a week had the lowest mortality, followed by those who had sex once a week or less, compared to those who had no sex at all. The reduction in risk of death for the most sexually active was about 30%.

  
  

If you have just had a heart attack, please don’t jump in the sack without first checking with your doctor to make sure your heart is ready for that kind of activity.

• Sexual activity improves blood pressure. Multiple studies from Germany found that greater frequency of sexual intercourse was associated with lower resting blood pressure.

In an Italian study of married men, those with newly diagnosed high blood pressure had a frequency of sexual intercourse 25% lower than a control group of married men who had normal blood pressure.

How does getting frisky lower blood pressure? Sexual activity appears to blunt stress. In a study of healthy adults, blood pressure was recorded at baseline, and then after giving a speech to an unsupportive audience for five minutes (plus five minutes of time-pressured verbal arithmetic). Persons who engaged in sexual intercourse during the two-week period prior to the stressful episode had a markedly diminished blood pressure increase during and after the anxiety-provoking speech than did persons engaging in no sexual activities beforehand. They also had faster recovery from the stressor.

Looks like having a romp in the sack within two weeks of a big event might be a good element to add to your prep before an important presentation!

• Sexual activity bolsters the immune system. Immunoglobulin A (IgA) levels help fend off respiratory infections like influenza or COVID.

In one study, 112 college students were divided into four categories of sexual activity, from none to very frequent—three or more times per week (yes, these were college students!). Then saliva samples were tested for the valuable immunity-boosting IgA.

Individuals in the frequent-sex group showed significantly higher levels of IgA than the other three groups, which were comparable in other aspects.

• Sexual activity improves female pelvic health. Women who orgasm during menstruation have a lower risk of developing endometriosis and have more regular periods. Sexual activity is also good for bladder control because when you have sex, your pelvic floor muscles get exercise. Vaginal intercourse helps to maintain vaginal and pelvic function.

It appears that chemicals in semen such as prostaglandin PGE1 may help maintain vaginal oxygenation and blood flow. Improving blood flow could be expected to support sexual response and vaginal health (and perhaps general health).

Interestingly, using condoms appears to deprive sexually active women of many benefits, including those blood flow and oxygenation advantages. Of course, condoms can also confer important benefits to women, including avoidance of sexually-transmitted diseases and costs of child rearing and college!

• Sexual activity may reduce prostate cancer risk. Increased frequency of male ejaculation has been shown to reduce the future risk of prostate cancer.

A 2016 study of more than 31,000 men with over 18 years of follow-up showed that men who ejaculated more than 21 times per month had 20% less prostate cancer than men who ejaculated only four to seven times per month.

• Sexual intercourse reduces depression. A study of young women in the United States found depression worsens with increasing time since last sexual intercourse. Interestingly it also showed that the use of condoms obliterated the apparent antidepressant effects of sexual intercourse. The authors proposed that there may be components of semen that improve mood in the recipients.

  
  

• Having a happier spouse leads to a longer life for YOU. It has been long known that married people live longer than single people, though some have joked, “You don’t really live longer; it just seems longer.”

A recent study of 4,374 couples followed for up to eight years showed that having a happy spouse was associated with a 13% lower mortality risk. The effect was independent of socioeconomic status and baseline health.

What does this have to do with sex? We throw this one in because most couples subconsciously know what would make their spouse happy. If you’re looking for a longer, healthier life for you and your partner, focus on making your spouse happy, including bringing more love and joy to her or him in the bedroom.

• Sexual activity, when aided by erectile medications, may lead to a reduction in major adverse cardiac events. A 2023 study in the Journal of Sexual Medicine comprising 23,816 men with erectile dysfunction (ED) reported that heart attack, stroke, and cardiac death were lower by 13% in men who used ED drugs like sildenafil or tadalafil.

The men who used Viagra-like drugs had lower rates of bypass surgery, stents, heart failure, chest pain, and cardiac death than the men with ED who didn’t use ED drugs.

There was a 25% reduction in overall mortality and it was dose dependent—the greatest reduction in risk of death during follow-up was noted in men who used the Viagra-like drugs the most, with a 50% mortality reduction compared to those who used these drugs the least.

Although the authors postulated the drugs provided direct health benefits, it seems more likely that it was the increased sexual activity made possible by the ED drugs that was the real longevity secret.

• Orgasm improves sleep. Getting enough good sleep makes it easier for us have better sex, and, at the same time, an active sex life will improve the quality of our sleep.

A survey of 778 adults found that about two-thirds of women and men reported that they fell asleep faster and experienced deeper sleep following sex.

Dr. Justin, a physician with expertise in sexual function, writes:

“If you’re having trouble falling asleep, consider taking matters into your own hands, so to speak. For most people, self-pleasure to the point of orgasm is a handy way of getting to sleep—and staying asleep all night long. And make your partner’s sleep a priority, too. Research finds that, for women in relationships, getting one extra hour of sleep on a given night translates to a 14% increase in the likelihood of having sex with their partner the next day.”