An associate professor of obstetrics and gynecology at the University of Chicago, poses a question to her medical students: Would they rather give up their non-dominant arm or sex for the rest of their lives?
The room usually falls silent, and then erupts in laughter. But at some point, in private, each student silently answers that question for him or herself – and Lindau suspects that the answers would be about half and half between those who would keep their arm, and those who would preserve their sex lives.
Sex, Lindau adds, “Is not like icing on the cake – most people wouldn’t willingly give it up.” Sex arguably makes life better, more enjoyable and healthier for lots of familiar reasons.
But is not having it – for whatever reason – necessarily unhealthy?
Not really, experts say, at least not physiologically. And the good news is you’re not going to die from abstinence – nor will it likely lead directly to conditions such as cancer and heart disease, from which you may die. Abstinence, unlike not eating, doesn’t physically damage you, at least not directly.
“It’s not a health crisis if you don’t,” Debra Herbenick, a research scientist and professor at Indiana University Bloomington School of Public Health, says. “No one is going to say that abstinence for six months is going to hurt you.”
At the same time, whether or not abstinence is healthy depends on the circumstances surrounding it. There are times that – for the same reasons your junior high health teacher probably told you – abstinence is healthy and protective: when you don’t want to risk sexually transmitted infections or pregnancy. Or you’re in a bad relationship.
Herbenick tells her students that they shouldn’t rely on the fact that sex makes you more relaxed or helps you fall asleep because, depending on the circumstances, it may ultimately increase your overall stress level by posing other risks.
Abstinence, however, can become unhealthy – psychologically – when you want to have sex but aren’t. “People will say, ‘I want to but I’m shy,’ or ‘I don’t know how to approach people.’ That’s really hard for people and can make them feel awful about themselves.”
And the anxiety of unfulfilled desire, coupled with the pressure to have sex – whether it’s societal or self-inflicted – can become a vicious cycle, Herbenick adds. Those types of behavioral trends can start early. Studies looking at when people began having sex found that those who started late – mid-20s to early 30s – were more likely to suffer from anxiety that may prevent them from having sex. “If you’re so anxious you can’t try online dating,” it is not abstinence that will pose a health issue, but the anxiety or depression it causes.
“If a person strongly desires but is unable to because they are unwell physically, or can’t find a partner, that is distressing,” Lindau says, adding that doctors aren’t usually the ear for that type of malaise. “Normally they take that to a friend or a psychologist.”
Still, Herbenick adds, “I don’t think anyone should be worrying if they’re not having sex.” There are other ways to improve your health: eating well, exercising. “It’s an even playing field,” in terms of healthy activities – sex included – that make for a healthy lifestyle.
And the best predictor of sexual well-being is overall well-being, Emily Nagoski, a sex educator at Smith College, says. Three things in particular influence a healthy sex life, she adds: your stress level (your libido tends to decrease when you are anxious, depressed or sleep-deprived). Having a good relationship with your body leads to good sex, Nagoski says. “If you love every living cell inside your body, for your partner to touch you feels really good.” And, a good quality relationship goes far in the bedroom. “Trust is crucial for pretty much everybody,” Nagoski adds.
So what are the health benefits of sex, besides relieving stress and helping you fall asleep? Studies have shown that regular sex has a protective effect on the heart, lowering the risk of heart attack in men. For both men and women, “It increases blood flow to the genitals and probably helps the immune system,” Herbenick says. “All things being equal, it’s also fun when things are going well [in your relationship.]”
So abstaining – especially long-term – can carry some physical consequences. In women, it can cause the atrophying of underused vaginal or hip muscles, Lindau says. Vaginismus is a common condition characterized by hypersensitivity of the muscles around the opening of the vagina, she adds. Those muscles – along with the pelvic floor muscles – are important for controlling penetration, and they need to be in a relaxed state during sexual intercourse. If they are hyper-contracted – not necessarily from abstinence itself, but accumulated fear or anticipation of the first sexual experience – sex can be very painful. “They say it feels like he’s hit a wall,” Lindausays, adding that vaginismus can be treated.
Frustration over abstinence can also be overcome, Nagoski says, by shifting your focus from having sex to creating connections with people. “If your priority is connecting with the person in front of you, that’s the way to keep it most open to sex happening,” she adds. “Sex is a destination,” but meanwhile enjoy the journey, Nagoski continues. “Just go where the flow takes you.”
And in the meantime, stop thinking about it – which is, for most people, easier said than done.
“If I tell you not to think about a bear, all you’ll think about is a bear,” Nagoski says. What she calls the “ironic process effect” also creates a context in abstinence teaching in which all you think about is sex.
“Notice when you’re stuck in that loop and shift your attention,” she says, adding that while extracting yourself entirely from the loop may be difficult, awareness of being stuck in the loop at least helps you create some distance from it.