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“Is Sex Just Fun? Sexual Activity and Health”
By Michael Goodman, M.D.

"Sex is the most fun you can have without laughing" --Woody Allen, in the movie "Manhattan."

" Sex is good, but not as good as fresh sweet corn" --Garrison Keillor

Sexual and general health are entwined in both men and women. It is well known in the medical literature that sexual activity can affect testosterone ("T") levels in both men and women. Also known is the fact that lowered T levels reduce sexuality. For this reason, it can be hypothesized that sexual activity is able to biffed itself through activation of the feedback loop that exists between the pituitary gland in the brain, and T-sensitive receptors which regulate sexual activity, energy production and mood, among others. More sex means more physiologically produced T, and more T correlates with both psychological and general health. Ample evidence exists in medical literature to suggest that full, satisfactory sexual intercourse is not only associated with better hormonal function, but with improvement of corresponding physical and psychological parameters.

Sexual health correlates so much with general health that general health may be considered as a surrogate marker for sexual health. A famous study published in 1997 in the British Medical Journal found that men who had fewer orgasms were twice as likely to die of any cause than those having 2 or more orgasms a week. In a "chicken and egg" scenario, arterial vascular disease (the kind that leads to heart attacks, stroke, and peripheral vascular disease) first effects small arterial vessels, such as the penile artery, responsible for bringing the penis the blood necessary for erection. Poor arteries = poor erections. Poor erections, poor T; poor T, poor erections. 'Round it goes..

What about sexual activity and depression? Well respected investigators in the field of sexual health have reported effects as diverse as an increased pain threshold in women undergoing vaginal stimulation. Deposition of sperm into the female genital track may have mood-enhancing and anti-depressant effects. Sexual auto activity (self-pleasuring) has been shown to represent a reliable primary reinforcer for depressed women in a situation where other pleasures such as food may have lost their reinforcing value, and that masturbation may represent a self-administered mood enhancer. Reduced sexual interest is one of the signs of depression in both men and women; conversely, clinically depressed individuals have less interest in sex. Another vicious cycle. Paradoxically, the same medications that may lift the cloud of depression rain on the parade by diminishing sexual desire and frequently blunting arousal and orgasmic response.

A recent study in the journal Climacteric, a journal devoted to aging ("Testosterone Treatment of Hypoactive Sexual Desire Disorder in Naturally Menopausal Women: The ADORE study) proved again, as have other studies, that transdermal testosterone, in this case administered via a skin patch, significantly improved sexual desire in women whose low desire was problematic. Another study in the Journal of Women's Health ("Sexual Desire During the Menopausal Transition: Observations from the Seattle Midlife Omens Health Study") supported a vulnerability to reduced sexual desire with aging. Lower estrogen and testosterone levels were correlated with poorer perceived health, elevated sense of stress, and menopausal symptoms of depressed mood, fatigue, and sleep disturbance.

The same dietary factors that improve overall health, such as a "Mediterranean diet" actually also improve sexual health. Fit individuals have greater sexual desire and experience more sexual activity than the unfit and/or obese. Conversely, roadrunners,I individuals with very little body fat, especially those who train excessively, have significantly lower testosterone levels and diminished desire (and lower bone density), secondary to increases in endorphins and serotonin, which bind testosterone and render it less active.

Moderate alcohol intake is associated in many studies with greater sexual activity and improved sexual health (another "chicken EMI egg??") Another recent study in the Journal of Sexual Medicine ("Regular Moderate Intake of Red Wine is Linked to Better Omens Sexual Health") out of Italy (where else?!) finds that regular moderate intake of red wine is associated with higher scores on tests for sexual desire, lubrication, and overall sexual function, pointing to a potential relationship between red wine consumption and better sexuality.

On the more smarmy side of the issue are what I call the "Snake Oil salesmen" who lead a multi-billion dollar a year "sexual hope" industry promising everything from better erections to long-lasting desire and improved orgasms, misusing the legitimate terms alternatives or complementary or integrative therapy for their own gain, capitalizing on the natural healing powers of the body and a strong placebo effect produced by satisfying sexual encounters (again,"chicken and egg") by taking credit for improvement, and if the treatment doesn't work, shift the blame to damage caused by prior conventional medical treatment. People will pay lots out of pocket for poorly tested and frequently worthless products, cleverly marketed, yet balk at paying a $50 co-pay for a tested and verified product if it is second on their insurance!

The brain mediates sexuality like no other organ, responding positively to stimulation from oxytocin (a product that I have compounded and utilized with success) which improves trust and communication, and dopamine, a key player in the brains pleasure center. The largest sexual organ we have is between our ears. Health, trust and intimacy, acting on a brain bathed in appropriate hormonal levels lead to enhanced sexual health.



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