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Benefits of sexual activity for women

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Benefits of sexual activity for women

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Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters

Research questions:

  • What are the general health benefits of partnered sexual activity with a paid sex worker for a single woman in their 30s, compared to benefits from partnered sexual activity within a relationship?
  • What are the risks and harms for women who use the services of a sex worker?
  • What general health benefits are associated with sexual activity?
  • What is the frequency of sexual activity required to gain beneficial health outcomes?

Date: 20/05/2024 Requestor: Paula (redacted) Endorsed by: Jane (redacted) Researcher: Aaron (redacted) Cleared by: Stephanie (redacted)

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Contents

Benefits of sexual activity for women …………………………………………………………………………….. 1 * Contents ………………………………………………………………………………………………………….. 2 * Summary …………………………………………………………………………………………………………. 2 * Women who engage sex workers ……………………………………………………………………….. 3 * Risks ………………………………………………………………………………………………………… 4 * Health benefits of sexual activity …………………………………………………………………………. 4 * Quality of life ……………………………………………………………………………………………… 5 * Cardiovascular health …………………………………………………………………………………. 5 * Immune system ………………………………………………………………………………………….. 6 * Pain ………………………………………………………………………………………………………….. 7 * Sleep ………………………………………………………………………………………………………… 7 * Stress and mood ………………………………………………………………………………………… 8 * Memory and cognition …………………………………………………………………………………. 8 * References ………………………………………………………………………………………………………. 9

Summary

There is consistent evidence that sexual activity is correlated with positive health outcomes for women. However, the current evidence cannot establish causal direction. One recent review summarises the available evidence “it cannot yet be proved that ‘good sex promotes good health’ since good health also favors good sex” (Gianotten et al; 2021, p.478).

There is inconsistent evidence regarding frequency of sexual activity correlated with positive health outcomes. Some studies indicate sexual activity at least once per week is associated with more beneficial outcomes. However, this varies with outcome, relationship type, type of sexual activity and other contextual factors.

Some studies speculate that positive outcomes related to sleep, stress, mood, and quality of life that are correlated with sexual activity may be mediated through stable and committed relationships. However, as evidence is not clear on direction of causation, it is difficult to determine the most important factors contributing to positive outcomes.

To establish a causal role for sexual activity and to understand required frequency of sexual activity for achieving positive outcomes would require further high-quality studies with appropriately experimental and controlled study designs.

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Minimal research was found detailing the experiences of women who engage sex workers. Qualitative studies note several self-reported benefits including pleasure, confidence, self- efficacy, and convenience. Some women also report that engaging sex workers assists them to heal and recover from physical or psychological injury or illness. No experimental studies were found to establish positive or negative outcomes for women who engage sex workers.

Women who engage sex workers

Most health and social science research relating to sex work focusses on interactions between female sex workers and male clients (Kingston et al, 2022; Kingston et al, 2020; Berg et al, 2020; Caldwell, 2018; Wotton, 2016). In their review, Berg et al (2020) found 25 articles that focus on women as buyers of sex from men. Of these, 19 focussed on romance tourism, or the practice of women engaging sex workers while travelling in other countries. There is a growing research effort underway to understand the motivations and practices of women who engage sex workers, though this research is still minimal (Kingston et al, 2022; Kingston et al, 2020; Berg et al, 2020; Caldwell, 2018; Wotton, 2016). No experimental studies were found to establish positive or negative outcomes for the women who engage sex workers.

Qualitative studies that discuss the motivations of women who engage sex workers note several self-reported benefits. Study participants who prefer commercial sexual interactions suggest they are more pleasurable, more satisfying, more therapeutic, more convenient, and safer than non-commercial sexual interactions.

One primary reason for engaging sex workers is the desire for sexual and emotional satisfaction, including feelings of intimacy and self-confidence (Kingston et al, 2022; Berg et al, 2020; Kingston et al, 2020; Caldwell, 2018; Wotton, 2016). Some women say they engage sex workers because the worker is more responsive to their preferences and needs than non- commercial sex partners. In addition, women can schedule the interactions to suit other demands in their life. Study participants say this can be more convenient than sex within a relationship or that it is a convenient means to access sexual pleasure when not in a relationship. Study participants also note that this contributes to a sense of self-efficacy and allows them to achieve a control over the situation that is not possible in non-commercial interactions (Kingston et al, 2022; Berg et al, 2020; Kingston et al, 2020; Caldwell, 2018; Wotton, 2016).

Some studies suggest women with disability may engage sex workers to overcome past traumatic sexual experiences and to satisfy sexual needs in a way that is inaccessible in non- commercial relationships (Kingston et al, 2022; Wotton, 2016). In her doctoral thesis, Caldwell (2018) found the most common reason given for engaging a sex worker was to address physical or mental health conditions (10 of 21 study participants). Several participants conceptualised the practice as therapy. The author notes:

conditions indicating a need for therapy were, vaginismus (3), healing from intimate partner violence (3), healing from childhood sexual abuse (2), “trans issues” (1), and

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The combined goals of therapy were, to achieve physical penetration, to learn about bodies and sexuality, and to practise good sexual communication around boundaries and consent (Caldwell, 2018, p.148).

Risks

No experimental studies were found that describe positive or negative outcomes for women who engage sex workers. Qualitative studies mainly focus on motivating factors and reasons to pursue commercial sexual interactions rather than risks, harms or reasons to avoid commercial sexual interactions.

Lancaster University in the UK has released a health and safety guide containing advice for woman who choose to engage a sex worker (Kingston et al, 2022). The authors note:

As with any sexual encounter, commercial or not, there are sexual safety strategies that can employed to stay safe. While our study documented largely positive experiences of purchasing commercial sex by women clients, this may not be the experience of all women clients (Kingston et al, 2022, p.4).

Precautions and positive strategies used to maintain health and safety in commercial sexual interactions are listed in detail in Women Who Buy Sex – Health and Safety Guide.

Health benefits of sexual activity

It is widely acknowledged that sexual activity is part of a healthy lifestyle. This is supported by established correlations between more frequent sexual activity and positive outcomes such as quality of life, longevity, strong relationships and better physical and mental health (Bagherinia et al, 2024; Gianotten et al, 2021; Ueda et al, 2020). Online sources claiming a variety of possible benefits of sexual activity for women including improvements to:

  • quality of life
  • fitness and muscle strength
  • blood pressure and cardiovascular health
  • immune system
  • bladder control
  • pain
  • sleep
  • self-esteem, mood and emotional regulation
  • stress levels
  • memory and cognition
  • relationships (Wilson & Rogers, 2023; Centre for Women’s Health, n.d.).

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While some studies support correlations of positive outcomes with frequency of sexual activity, there is less clear evidence regarding the connections between types of sexual activity, frequency of sexual activity, specific positive outcomes, and variables which might mediate the connection between sexual activity and outcomes (Gianotten et al, 2023; Gianotten et al, 2021). For example, most studies have been unable to establish a causal role for sexual activity. It may be that more frequent sexual activity promotes better health outcomes, or that healthy people with strong relationships have the desire and opportunity for more frequent and positive sexual experiences. It is also possible that sexual activity and positive health outcomes are mutually reinforcing.

In their 2021 review, Gianotten et al summarise the available evidence, “For the time being, it cannot yet be proved that ‘good sex promotes good health’ since good health also favors good sex” (p.478). To establish a causal role for sexual activity in achieving positive outcomes would require further high-quality studies with an appropriately experimental and controlled study design (Bagherinia et al, 2024; Gianotten et al, 2021).

Quality of life

There is evidence of positive correlations between sexual activity and quality of life (Boyacıoğlu et al, 2023; Gianotten et al, 2021; Smith et al, 2019; Flynn & Gow, 2015). Boyacıoğlu et al (2023) found that more frequent sexual activity was associated with better quality of life but not with psychological well-being in adults over 60 years old. This relationship held for both men and women. A study of 558 menopausal women found quality of life was significantly correlated with sexual activity and sexual self-efficacy (Jalali et al, 2021). Other large sample observational studies have found more frequent sexual activity is correlated with better quality of life in middle aged and older adults (Gianotten et al, 2021).

The functional and health domains including in the definition of quality of life can be a complicating factor in assessing the relationship between sexual activity and quality of life. Sexual expression is often included as a component of quality of life via the idea of sexual quality of life (Bagherinia et al, 2024; McHugh et al, 2022):

Sexual quality of life is the person’s assessment of positive and negative aspects of their sexual life and their response to this assessment. Sexual quality of life is tightly interwoven with the extent of satisfaction with life and general level of quality of life. Low Sexual quality of life can refect the health status and general quality of life (Bagherinia et al, 2024, p.2).

Cardiovascular health

Sources report a correlation between frequency of sexual activity, lower blood pressure and better cardiovascular health (Wilson & Rogers, 2023; Gianotten et al, 2023; Gianotten et al, 2021; Ueda et al, 2020; Centre for Women’s Health, n.d). A large study of 15,269 adults with a mean age of 40 years showed lower risk of death due to cardiovascular disease in people

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reporting sexual activity at least 52 times per year (Cao et al, 2020). In a large-scale longitudinal study of older adults, Liu et al (2016) found

  • high frequency of sex is positively related to later risk of cardiovascular events for men but not women, whereas good sexual quality seems to protect women but not men from cardiovascular risk in later life. We find no evidence that poor cardiovascular health interferes with later sexuality for either gender (Liu et al, 2016, p.276).

Several mediating factors may explain the associations between sexual activity and cardiovascular health, e.g., quality of life, stress, relationship strength or other lifestyle factors. One possible explanation for this correlation is that sexual activity can be good cardiovascular exercise. A 2022 systematic review found evidence that partnered sexual activity can be considered a moderate intensity exercise. Physical exertion and energy expenditure is generally higher in men than in women, though this depends on several contextual factors including duration, position, and health status (Oliva-Lozano et al, 2022).

Immune system

Online sources which note the possible beneficial effect of sexual activity on the immune system usually cite a single 2004 study (Wilson & Rogers, 2023; Gianotten et al, 2021; Charnetski & Brennan, 2004; Centre for Women’s Health, n.d.). This study showed university students who have sex 1 – 2 times per week have higher levels of salivary immunoglobulin A, an antibody which is taken to indicate overall immune system health. This was not observed in students who reported sexual activity 3 – 4 times per week. One explanation for this effect hypothesises stress as a mediator, since there is evidence that lower stress levels are correlated with high levels of immunoglobulin A (Gianotten et al, 2021; Charnetski & Brennan, 2004).

Lorenz et al (2018) suggest that it is likely that sexual activity does have some association with immune response, though the relationship between sexual activity and immune response may be more complex:

  • Several recent studies have suggested that sexual activity may moderate immune responses in healthy individuals. These effects appear to be particularly relevant in women’s immune responses, as there are trade-offs between immunity and reproduction: Although the female immune system must defend against pathogens, it cannot risk accidentally attacking or rejecting sperm or conceptus. Sexual activity may thus serve as a trigger to modulate immune response, promoting defense during nonfertile times but allowing a more permissive environment around ovulation, during maximal fertility. Although beneficial for conception, this “window of opportunity” may increase infection risk. Indeed, several studies have suggested that healthy sexually active women show significant cycle-related variation in immune responses while sexually abstinent women do not (Lorenz et al, 2018, p.2).

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Pain

Some women report sex, masturbation and orgasm as pain relief strategies (Wehrli et al, 2024; Wilson & Rogers, 2023; Gianotten et al, 2023; Gianotten et al, 2021; Centre for Women’s Health, n.d). Several mechanisms might account for analgesic effect of sexual activity:

Sexuality might alleviate pain by providing a source of distraction, but there might be additional pathways. One study found that pressure stimulation of the anterior vaginal wall and self-stimulation of the clitoris had an analgesic effect, reaching maximum effect with orgasm. Endorphins might also explain the pain-reducing effect of sexual activity, along with oxytocin. Women with higher oxytocin levels have a higher pain threshold. Muscle relaxation might contribute to the pain-reducing effects of sexual activity: Clinical practice in patients with multiple sclerosis and research in patients with spinal cord injury show that sexual vibration and orgasm can produce reductions in spasm and muscle relaxation that last for several hours (Gianotten et al, 2021, p.481).

Observational studies show mixed results. In a survey study of 370 women, 7 women reported using masturbation for pain relief (Wehrli et al, 2024). Pain relief during or after sexual activity was reported in a small proportion of migraine and cluster headache patients (Wilson & Rogers, 2023; Hambach et al, 2013). Men were twice as likely to experience pain relief compared to women and a larger proportion of patients reported that sexual activity worsens pain symptoms (Hambach et al, 2013). Studies have found no significant association between frequency of sexual activity and pain for menopausal women (Waetjen et al, 2022) and women with fibromyalgia (Karpuz et al, 2024). Further research is required to determine the extent of analgesic effect, types of pain, types of sexual activity and circumstances associated with an analgesic effect (Wehrli et al, 2024).

Sleep

Frequency and quality of sexual activity are correlated with better sleep outcomes, though the causal direction is unclear (Gianotten et al, 2021). Sracjer et al (2023) conducted a survey of almost 800 people with a mean age of 34.5 years. They found more frequent orgasm, stable relationships and emotional satisfaction with sex are all associated with falling asleep faster for both men and women. A survey study of 224 people with a mean age of 22 years supports the association of partnered sex with better sleep quality and reduced time to fall asleep (Oesterling et al, 2022).

Several studies show women report using masturbation as a strategy to help fall asleep (Wehrli et al, 2024). However, the same study complicates results related to orgasm and masturbation:

both men and women perceive partnered sex and masturbation with orgasm to improve sleep latency and sleep quality, while sexual activity without orgasm is perceived to exert negative effects on these sleep parameters, most strongly by men… [However,]

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analyses revealed that only partnered sex with orgasm was associated with a significantly reduced sleep latency and increased sleep quality. Sexual activity without orgasm and masturbation with and without orgasm were not associated with changes in sleep (Oesterling et al, 2022, p.1).

There are also good physiological reasons to suppose that sexual activity assists people to fall asleep faster. The biochemical processes associated with sex and orgasm (increased oxytocin, lower cortisol, endorphins etc.) have a calming and sedative effect (Wilson & Rogers, 2023; McHugh et al, 2022; Gianotten et al, 2021).

Stress and mood

Studies consistently show that sexual activity is correlated with lower stress levels and increased mood:

  • Chronic stress has a significant negative impact on female sexual health. Chronic stress is associated with decreased sexual thoughts, desire, and physiologic genital arousal.
  • Stress-related distraction from sexual stimuli, low mood, and anxiety all play a role.
  • Conversely, orgasm is found to coincide with the release of prolactin, which may reduce stress (McHugh et al, 2022, p.582).

Results from mixed-effects models suggest that being sexually active, having sex more frequently, feeling okay with sexual frequency, and reporting better sexual quality were all related to better mental health outcomes. Relationship quality partially explained the effects of sex on mental health (Zhang & Liu, 2020, p.1772).

Women report using masturbation as a coping strategy to manage stress and distress (Wehrli et al, 2024) and there is consistent evidence that depression scores are correlated with sexual activity. People who are depressed have less partnered sex, and this is true of both women and men (Karpuz et al, 2024; Yavuzkir et al, 2024; Wilson & Rogers, 2023; Gianotten et al, 2023; Li et al, 2022; Gianotten, 2021; Mollaioli et al, 2021; Centre for Women’s Health, n.d.).

The direction of causation between sexual activity and stress or mood is still unknown:

  • The physical act of sex may alleviate stress directly in the same way as does any exercise. Sex may also work indirectly through the increased access to coping resources such as emotional support from a sexual relationship, which may alleviate the negative effect of stress. The efficacy of sexual activity for relieving stress may depend on the quality of the experience, with only satisfying sex reducing stress, in much the same way as only marriages of high quality improve physical health (Liu et al, 2016, p.5).

Memory and cognition

There is minimal evidence indicating sexual activity is associated with better cognitive function in later life, though the evidence is not straight forward. A large longitudinal study of older adults found better quality sexual activity was associated with better cognitive functioning in

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people aged 62-74 but not in those aged 75 – 90. The authors also found more frequent sexual activity was associated with better cognitive functioning in the 75 – 90 age group, but not the 65 – 74 age group (Shen et al, 2023).

There is less evidence regarding cognitive function in younger people. Following on from animal studies, a 2017 study investigated the relationship between frequency of sexual activity and memory performance in of 80 women aged 18 – 29 (Maunder et al, 2017). The authors found that frequency of male-female partnered sexual activity was associated with higher scores on abstract word memory tests. The authors found no correlation with memory of faces.

References

  • Bagherinia, M., Dolatian, M., Mahmoodi, Z., Ozgoli, G., & Alavi Majd, H. (2024). Predictors of social intermediate factors associated with sexual quality of life of women: systematic review and meta-analysis. BMC women’s health, 24(1), 64.
  • Berg, R. C., Molin, S. B., & Nanavati, J. (2020). Women Who Trade Sexual Services from Men: A Systematic Mapping Review. Journal of sex research, 57(1), 104–118.
  • Boyacıoğlu, N. E., Oflaz, F., Karaahmet, A. Y., Hodaeı, B. K., Afşin, Y., & Taşabat, S. E. (2023). Sexuality, quality of life and psychological well-being in older adults: A correlational study. European journal of obstetrics & gynecology and reproductive biology X, 17, 100177.
  • Caldwell, H. J. (2018). Women who buy sex in Australia: From social representations to lived experiences [Thesis]. University of New South Wales.
  • Cao, C., Yang, L., Xu, T., Cavazos-Rehg, P. A., Liu, Q., McDermott, D., Veronese, N., Waldhoer, T., Ilie, P. C., Shariat, S. F., & Smith, L. (2020). Trends in Sexual Activity and Associations With All-Cause and Cause-Specific Mortality Among US Adults. The journal of sexual medicine, 17(10), 1903–1913.
  • Centre for Women’s Health. (n.d.). The benefits of a healthy sex life. Oregon Health and Science University.
  • Charnetski, C. J., & Brennan, F. X. (2004). Sexual frequency and salivary immunoglobulin A (IgA). Psychological reports, 94(3 Pt 1), 839–844.
  • Flynn, T-J. & Gow, A. J. (2015). Examining associations between sexual behaviours and quality of life in older adults. Age and Ageing, 44(5). 823–828.

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  • Gianotten, W. L., Alley, J. C., & Diamond, L. M. (2021). The Health Benefits of Sexual Expression. International journal of sexual health, 33(4), 478–493. https://doi.org/10.1080/19317611.2021.1966564
  • Gianotten, W. L. (2023). The Health Benefits of Sexual Expression. In Geuens, S., Polona Mivšek, A., & Gianotten, W. [Eds]Midwifery and Sexuality (p. 368). Springer Nature. https://doi.org/10.1007/978-3-031-18432-1
  • Hambach, A., Evers, S., Summ, O., Husstedt, I. W., & Frese, A. (2013). The impact of sexual activity on idiopathic headaches: an observational study. Cephalalgia: an international journal of headache, 33(6), 384–389. https://doi.org/10.1177/0333102413476374
  • Jalali, T., Bostani Khalesi, Z., & Jafarzadeh-Kenarsari, F. (2021). The Association between Sexual Self-Efficacy and the Quality of Life among Menopausal Women. Journal of menopausal medicine, 27(2), 87–93. https://doi.org/10.6118/jmm.21006
  • Karpuz, S., Yilmaz, R., Akdere, E., Aksanyar, B., Tuncez, I. H., & Yilmaz, H. (2024). The Effect of Frequency of Sexual Intercourse on Symptoms in Women with Fibromyalgia. Medical Bulletin of Sisli Etfal Hospital, 58(1). https://doi.org/10.14744/SEMB.2023.97254
  • Kingston, S., Hammond, N., & Redman, S. (2020). Women who buy sex: Converging sexualities? Routledge.
  • Kingston, S., Hammond, N., Redman, S., Stoops, S., Langley, S. (2022). Women who buy sex: Health and Safety Guide. The University of Central Lancashire. https://clok.uclan.ac.uk/44330/
  • Lorenz, T. K., Heiman, J. R., & Demas, G. E. (2018). Interactions Among Sexual Activity, Menstrual Cycle Phase, and Immune Function in Healthy Women. Journal of sex research, 55(9), 1087–1095. https://doi.org/10.1080/00224499.2017.1394961
  • McHugh, J., Alexander, M., Kudesia, R., Krant, J., Comander, A., Tollefson, M., & Geyer, C. (2022). Living Your Best Life: Lifestyle Medicine for All Women. American journal of lifestyle medicine, 16(5), 577–588. https://doi.org/10.1177/15598276221087677
  • Mollaioli, D., Sansone, A., Ciocca, G., Limoncin, E., Colonnello, E., Di Lorenzo, G., & Jannini, E. A. (2021). Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. The journal of sexual medicine, 18(1), 35–49. https://doi.org/10.1016/j.jsxm.2020.10.008
  • Oesterling, C. F., Borg, C., Juhola, E., & Lancel, M. (2023). The influence of sexual activity on sleep: A diary study. Journal of sleep research, 32(4), e13814. https://doi.org/10.1111/jsr.13814
  • Shen, S., & Liu, H. (2023). Is Sex Good for Your Brain? A National Longitudinal Study on Sexuality and Cognitive Function among Older Adults in the United States. Journal of sex research, 60(9), 1345–1355. https://doi.org/10.1080/00224499.2023.2238257

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  • Smith, L., Yang, L., Veronese, N., Soysal, P., Stubbs, B., & Jackson, S. E. (2019). Sexual Activity is Associated with Greater Enjoyment of Life in Older Adults. Sexual medicine, 7(1), 11–18. https://doi.org/10.1016/j.esxm.2018.11.001

  • Sprajcer, M., O’Mullan, C., Reynolds, A., Paterson, J. L., Bachmann, A., & Lastella, M. (2022). Sleeping together: understanding the association between relationship type, sexual activity, and sleep. Sleep Science, 15(S 01), 80-88. https://doi.org/10.5935/1984-0063.20220005

  • Ueda, P., Mercer, C. H., Ghaznavi, C., & Herbenick, D. (2020). Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000-2018. JAMA network open, 3(6), e203833. https://doi.org/10.1001/jamanetworkopen.2020.3833

  • Waetjen, L. E., Johnson, W. O., Xing, G., Hess, R., Avis, N. E., Reed, B. D., Dugan, S. A., Neal-Perry, G., Gold, E. B., & Study of Women’s Health Across the Nation (SWAN) (2022). Patterns of Sexual Activity and the Development of Sexual Pain Across the Menopausal Transition. Obstetrics and gynecology, 139(6), 1130–1140. https://doi.org/10.1097/AOG.0000000000004810

  • Wehrli, F. S. V., Bodenmann, G. J., Clemen, J., & Weitkamp, K. (2024). Exploring the Role of Masturbation as a Coping Strategy in Women. International Journal of Sexual Health, 1–20. https://doi.org/10.1080/19317611.2024.2344812

  • Wilson, D. R., & Rogers, P. (2023). The Health Benefits of Sex. Healthline. https://www.healthline.com/health/healthy-sex-health-benefits

  • Wotton, R. A. (2016). Sex workers who provide services to clients with disability in New South Wales, Australia [Thesis]. University of Sydney. http://hdl.handle.net/2123/16875

  • Yavuzkir, Ş., Aslan, M., Yurt, N., & Baykara, S. (2024). Association between non-penetrative sexual activities and depression in women with vaginismus: a cross-sectional study. The Journal of international medical research, 52(4), 3000605241244762. https://doi.org/10.1177/03000605241244762

  • Zhang, Y., & Liu, H. (2020). A National Longitudinal Study of Partnered Sex, Relationship Quality, and Mental Health Among Older Adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 75(8), 1772–1782. https://doi.org/10.1093/geronb/gbz074

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