Why Sex Is Good for You 10 Benefits of a Healthy Sex Life

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Why Sex Is Good for You
10 Benefits of a Healthy Sex Life
By Daniel Gwartney, MD

You must have your own personal list of the 10 benefits of sex – after all, humans have survived because they are wired to enjoy and benefit from sex. It turns out the collective efforts of health care professionals and researchers have come up with their own list that is more scientific and beneficial to one’s health. This list demonstrates some of the benefits of a healthy sex life and supports a desired action and may influence one’s partner if placed prominently on the nightstand.1 It is important to note that this list assumes the sex is occurring between consenting adults, preferably in an emotionally invested relationship. So, here are some healthy reasons to rekindle the romance and turn up the flames of passion.



Perhaps it is a primitive pressure ingrained in our genes, as our species has climbed up the food chain, struggling for eons to evade faster and fiercer carnivores. For Homo sapiens to survive, it was necessary to breed early and often. Typically, the fittest members of a tribe or clan claimed mating rights. Later, as civilizations emerged, individuals facing mortality could find solace in knowing that their bloodline continued through offspring. It is easy to intuit how frequent and satisfying sex might signal to the primitive brain that not only will mankind survive, but one is a mighty hunter whose legacy will be carried out by his many scions as the bards sing his praise. Well, maybe that is stretching it a bit, but in the moment, it seems that glorious.

Of course, modern man worries more about what’s for dinner than becoming dinner. Nonetheless, the signs of stress are the same, including high blood pressure. Research from Scotland published in the journal Biological Psychology reported on the relationship between blood pressure response to stress (e.g., speaking in public, answering verbal math questions).2 No shock to the intimately initiated, the subjects who enjoyed intercourse, as opposed to abstinence or “other sexual behaviors” kept their cool better, with lower blood pressure during periods of calm. This study confirmed earlier research that showed that people who lived with his/her sex partner had lower diastolic blood pressure and a more dominant parasympathetic tone, suggesting a calmer physiology.3

2. Sex Improves One’s Immune System

In Pennsylvania, researchers measured the salivary IgA (an antibody found in one’s saliva and other secretions) in college students and compared the levels to reported sexual frequency.4 They discovered that subjects having frequent sex (once to twice a week) had higher levels of IgA than those with less vigorous sex lives. Surprisingly, having sex more frequently resulted in lower IgA levels. IgA protects against colds, flus, etc. However, before getting too excited (no pun intended) about this romantic alternative to Kleenex (another unintended pun), realize that the increase in IgA, which occurs in other secretions as well, isn’t designed for improving health; it is actually protecting against certain things that are passed between intimate partners. IgA levels in the cervical mucus (the cervix is the opening to the uterus in women) increase to peak levels just prior to ovulation as estrogen levels rise.5 In lower species, this is the period when a female is most receptive sexually and therefore most likely to be exposed to sexually transmissible diseases. While higher IgA may be a healthy benefit, it is likely your body fighting off the invasion of your partner’s foreign germs and secretions.

3. Sex Burns Calories

While sex on a treadmill may burn even more calories, the average person can burn 85 calories during a 30-minute lovemaking session. Given the “untraditional” designations given for certain forms of sexual activity, it is difficult to assign much validity to the figures. This figure is likely generous, as more recognized sources suggest sex is the metabolic equivalent to walking briskly for 10 minutes, then climbing two flights of stairs.6,7 Further, the average duration for sexual activity is roughly half the 30-minute period used in our estimate.8

4. Sex Is Good for the Heart

No, not in a Valentine’s Day way, though emotions may play a role in the effect. As people age, concerns about heart attacks and strokes during sex become more prevalent. Considering the elevation in blood pressure and heart rate that occur during intercourse, this is a reasonable concern.6,7 However, in a report published in the Journal of Epidemiology and Community Health, researchers in the United Kingdom learned after following a large group of men for 20 years that frequency of intercourse was not associated with stroke incidence.9 Further, those having sex at least twice a week had half the risk of suffering a fatal heart attack as those who “coupled” less than once per month.

5. Sex Allows One to Feel Better About Himself

Maybe … this is an area that is just entirely too complicated to say that a hop in the sack will cure low self-esteem, the blues, depression, etc. Antidepressant prescriptions sit near the top of all drug classes dispensed from pharmacies. Certainly, many people get an ego boost after satisfying one’s self and partner, but low self-esteem can also deter from sexual interest, confidence and performance, turning what should be an emotionally enriching experience into another and more personal failure.10,11 Interestingly, many people point to a survey performed at the University of Texas and pick out one or another reason for having sex.12 However, the range of answers (237 different reasons) really prevents one from reaching any conclusion than it is a very individual experience. Not to dampen anyone’s enthusiasm about or for sex, but regardless of whether it be casual conquest or intimate intercourse, the effect of sex on a person’s psyche goes deeper than the physical achievement, reflecting one’s emotional, psychological and environmental state at the time.13,14

6. A Happy Sex Life Supports a Healthy Relationship

As inferred above, self-esteem and relationships are very complex issues. Yet, the prototypical relationship in the human experience – that of a mother and child – includes hormonal responses that strengthen the emotional bonding of an experience. The natural birth of a baby is associated with a number of hormonal bursts that prime the uterus to contract and dull the pain response. Among these is the secretion of a hormone from the pituitary (a gland in the brain) and placenta of a rarely mentioned hormone called oxytocin. Oxytocin affects most tissues in the body, but its relevant role in relationships and intercourse is its ability to initiate, promote and enhance emotional bonding.15 Oxytocin is released in high concentration at the time of childbirth and during nursing, priming the emotional bond between a mother and her newborn. It is also released during orgasm and if supported by physical and social cues, may enhance the emotional bond between sex partners.15,16 Of course, if the immediate post-coital action is pulling one’s pants on while rushing out the door, the bonding is less intense than if the couple continues sharing intimate conversation and contact.

7. Sex Can Provide (Brief) Pain Relief

As mentioned earlier, during childbirth, the mother’s system is flooded with a cocktail of hormones and neurotransmitters. Oxytocin and prolactin both surge during childbirth and while breast-feeding. The effects of these and other hormones goes beyond giving birth and feeding an infant, and obviously have other functions in men. Oxytocin and prolactin levels are elevated during and following orgasm, presumably serving to support the emotional bonding of lovers.17-19 However, as many have noted anecdotally, sex seemingly reduces pain, whether it be a headache or an injury.20,21 This effect is usually written off as being all in one’s head (meaning mind) due to the sex act(s) distracting one from pain rather than providing pain relief. However, it has been shown from animal studies to pregnant women to healthy volunteers that an oxytocin surge (inhaled, due to childbirth or orgasm) makes one more tolerant of pain. Something to keep in mind for the next time a partner says, “I have a headache.”20

8. Healthy Sex, Healthier Prostate

The relationship between orgasm frequency and prostate health has been debated for centuries. Texts written about Eastern religions, such as Buddhism, assert that semen represents one’s vitality or life fluid. The goal in some sects is to transcend the desire for ejaculation, preserving the life fluid and reducing suffering.22 However, other ideologies believe that suppression of sexual desire increases one’s stress, harms the psyche and promotes violence.23 Personal beliefs aside, research suggests that frequent ejaculation (five or more times per week) during the peak childbearing years (20 to 30 years old) protects against the later development of prostate cancer; later sexual activity had no association with prostate cancer.24 A study published in the Journal of the American MedicalAssociation confirmed the protective effect of ejaculation against prostate cancer, extending the benefits through midlife (40-49 years old).25 Though the mechanism is not explained, it appears to be similar to the protective effect provided by breast-feeding against certain forms of breast cancer in women.26

9. Sex Exercises the Pelvic Floor Muscles

Exercising pelvic floor muscles may sound like something done during the lambada (a Brazilian dance). However, the pelvic organs are supported by a mesh of muscles that play a much greater role in women. During Lamaze classes, women are instructed to perform exercises called Kegels to strengthen these muscles; this prevents later prolapse (the bulging of female sex organs through the pelvic floor). Even minor prolapse can lead to urinary incontinence (leaking, dribbling) and sexual dysfunction. For men, Kegels are suggested to combat urinary incontinence, improve erections and control over orgasms.27 Instructions for performing Kegels can be found online.

10. A Great Night of Sex Can Lead to a Great Night’s Sleep

The importance of sleep for optimal health is greatly underestimated. Poor sleep can lead to obesity, pre-diabetes, type 2 diabetes, hypertension, metabolic syndrome, and a variety of other disorders that negatively affect health and may lead to a premature death.28-30 Fortunately, as many disgruntled spouses attest to each other in coffee shops or via group texts, the release of sex can put a person to sleep quickly and deeply. The hormonal flush of an orgasm, combined with the psychological benefits of consensual passion, induces a state of relaxation. Much of the credit has been assigned to oxytocin (once again).31 However, the state of sexual arousal induces elevations in excitatory neurotransmitters. Following orgasm, these “excitors” plummet, leaving the individual in a relative state of stupor. It is a physiologic analogy to being at the Super Bowl one weekend, jumping amongst a cheering crowd, compared to standing in an empty stadium the next day. The physical letdown makes a person want to curl up and go to sleep.

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References:

1. Doheny K. 10 surprising health benefits of sex. WebMD. Available at http://www.webmd.com/sex-relationships/features/10-surprising-health-benefits-of-sex, accessed June 18, 2008.

2. Brody S. Blood pressure reactivity to stress is better for people who recently had penile-vaginal intercourse than for people who had other or no sexual activity. Biol Psychol, 2006 Feb;71(2):214-22.

3. Brody S, Veit R, et al. A preliminary report relating frequency of vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure and cohabitation status. Biol Psychol, 2000 Apr;52(3):251-7.

4. Charnetski CJ, Brennan FX. Sexual frequency and salivary immunoglobulin A (IgA). Psychol Rep, 2004 Jun;94(3 Pt 1):839-44.

5. Franklin RD, Kutteh WH. Characterization of immunoglobulins and cytokines in human cervical mucus: influence of exogenous and endogenous hormones. J Reprod Immunol, 1999 Mar;42(2):93-106.

6. Rerkpattanapipat P, Stanek MS, et al. Sex and the heart: what is the role of the cardiologist? Eur Heart Journal, 2001;22:201-8.

7. Larson JL, McNaughton MW, Kennedy JW, Mansfield LW. Heart rate and blood pressure responses to sexual activity and a stair-climbing test. Heart Lung, 1980;9:1025-30.

8. Miller SA, Byers ES. Actual and desired duration of foreplay and intercourse: discordance and misperceptions within heterosexual couples. J Sex Res, 2004 Aug;41(3):301-9.

9. Ebrahim S, May M, et al. Sexual intercourse and risk of ischaemic stroke and coronary heart disease: the Caerphilly study. J Epidemiol Community Health, 2002 Feb;56(2):99-102.

10. Althof SE, O’Leary MP, et al. Self-esteem, confidence, and relationships in men treated with sildenafil citrate for erectile dysfunction: results of two double-blind, placebo-controlled trials. J Gen Intern Med, 2006 Oct;21(10):1069-74.

11. Montorsi F, Padma-Nathan H, et al. Erectile function and assessments of erection hardness correlate positively with measures of emotional well-being, sexual satisfaction, and treatment satisfaction in men with erectile dysfunction treated with sildenafil citrate (Viagra). Urology, 2006 Sep;68(3 Suppl):26-37.

12. Meston CM, Buss DM. Why humans have sex. Arch Sex Behav, 2007 Aug;36(4):477-507.

13. Brody S, Costa RM. Vaginal orgasm is associated with less use of immature psychological defense mechanisms. J Sex Med, 2008 May;5(5):1167-76.

14. Haning RV, O’Keefe SL, et al. Intimacy, orgasm likelihood, and conflict predict sexual satisfaction in heterosexual male and female respondents. J Sex Marital Ther, 2007 Mar-Apr;33(2):93-113.

15. Gimpl G, Fahrenholz F. The oxytocin receptor system: structure, function, and regulation. Physiol Rev, 2001 Apr;81(2):629-83.

16. Donatucci CF. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med, 2006 Sep;3 Suppl 4:303-8.

17. Kruger TH, Haake P, et al. Specificity of the neuroendocrine response to orgasm during sexual arousal in men. J Endocrinol, 2003 Apr;177(1):57-64.

18. de Wied D, Diamant M, et al. Central nervous system effects of the neurohypophyseal hormones and related peptides. Front Neuroendocrinol, 1993 Oct;14(4):251-302.

19. Carter CS, Altemus M. Integrative functions of lactational hormones in social behavior and stress management. Ann N Y Acad Sci, 1997 Jan 15;807:164-74.

20. Phillips WJ, Ostrovsky O, et al. Relief of acute migraine headache with intravenous oxytocin: report of two cases. J Pain Palliat Care Pharmacother, 2006;20(3):25-8.

21. Uryvaev YV, Petrov GA. Extremely low doses of oxytocin reduce pain sensitivity in men. Bulletin Exp Biol Med, 1996;122(5):1071-3.

22. Faure B. (1998) The Red Thread: Buddhist Approaches to Sexuality. Princeton, NJ: Princeton University Press, ISBN-13: 978-0691059976.

23. Prescott JW. Body pleasure and the origins of violence. The Bulletin of the Atomic Scientists 1975 Nov;10-20. Available at http://www.eurowrc.org/01.eurowrc/04.eurowrc_en/20.en_ewrc.htm, accessed June 18, 2008.

24. Giles GG, Severi G, et al. Sexual factors and prostate cancer. BJU Int, 2003;92:211-216.

25. Leitzmann MF, Platz EA, et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA, 2004;291:1578-1586.

26. Hietala M, Olsson H, et al. Prolactin levels, breast-feeding and milk production in a cohort of young healthy women from high-risk breast cancer families: implications for breast cancer risk. Fam Cancer, 2007 Dec 15. [Epub ahead of print].

27. Moul JW. Pelvic muscle rehabilitation in males following prostatectomy. Urol Nurs, 1998 Dec;18(4):296-301.

28. Gottlieb DJ, Redline S, et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep, 2006 Aug 1;29(8):1009-14.

29. Hall MH, Muldoon MF, et al. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep, 2008 May 1;31(5):635-43.

30. Chaput JP, Despres JP, et al. The association between sleep duration and weight gain in adults: a 6-year prospective study from the Quebec Family Study. Sleep, 2008 Apr 1;31(4):517-23.

31. Ellison, Carol Rinkleib. (2000) Women’s Sexualities. Oakland, CA: New Harbinger Publications, Inc.



Why-Sex-Is-Good-for-You.jpg.pagespeed.ce_.xibTOaHoq0.jpg






Why Sex Is Good for You


10 Benefits of a Healthy Sex Life


By Daniel Gwartney, MD



You must have your own personal list of the 10 benefits of sex – after all, humans have survived because they are wired to enjoy and benefit from sex. It turns out the collective efforts of health care professionals and researchers have come up with their own list that is more scientific and beneficial to one’s health. This list demonstrates some of the benefits of a healthy sex life and supports a desired action and may influence one’s partner if placed prominently on the nightstand.1 It is important to note that this list assumes the sex is occurring between consenting adults, preferably in an emotionally invested relationship. So, here are some healthy reasons to rekindle the romance and turn up the flames of passion.







Perhaps it is a primitive pressure ingrained in our genes, as our species has climbed up the food chain, struggling for eons to evade faster and fiercer carnivores. For Homo sapiens to survive, it was necessary to breed early and often. Typically, the fittest members of a tribe or clan claimed mating rights. Later, as civilizations emerged, individuals facing mortality could find solace in knowing that their bloodline continued through offspring. It is easy to intuit how frequent and satisfying sex might signal to the primitive brain that not only will mankind survive, but one is a mighty hunter whose legacy will be carried out by his many scions as the bards sing his praise. Well, maybe that is stretching it a bit, but in the moment, it seems that glorious.





Of course, modern man worries more about what’s for dinner than becoming dinner. Nonetheless, the signs of stress are the same, including high blood pressure. Research from Scotland published in the journal Biological Psychology reported on the relationship between blood pressure response to stress (e.g., speaking in public, answering verbal math questions).2 No shock to the intimately initiated, the subjects who enjoyed intercourse, as opposed to abstinence or “other sexual behaviors” kept their cool better, with lower blood pressure during periods of calm. This study confirmed earlier research that showed that people who lived with his/her sex partner had lower diastolic blood pressure and a more dominant parasympathetic tone, suggesting a calmer physiology.3





2. Sex Improves One’s Immune System





In Pennsylvania, researchers measured the salivary IgA (an antibody found in one’s saliva and other secretions) in college students and compared the levels to reported sexual frequency.4 They discovered that subjects having frequent sex (once to twice a week) had higher levels of IgA than those with less vigorous sex lives. Surprisingly, having sex more frequently resulted in lower IgA levels. IgA protects against colds, flus, etc. However, before getting too excited (no pun intended) about this romantic alternative to Kleenex (another unintended pun), realize that the increase in IgA, which occurs in other secretions as well, isn’t designed for improving health; it is actually protecting against certain things that are passed between intimate partners. IgA levels in the cervical mucus (the cervix is the opening to the uterus in women) increase to peak levels just prior to ovulation as estrogen levels rise.5 In lower species, this is the period when a female is most receptive sexually and therefore most likely to be exposed to sexually transmissible diseases. While higher IgA may be a healthy benefit, it is likely your body fighting off the invasion of your partner’s foreign germs and secretions.





3. Sex Burns Calories





While sex on a treadmill may burn even more calories, the average person can burn 85 calories during a 30-minute lovemaking session. Given the “untraditional” designations given for certain forms of sexual activity, it is difficult to assign much validity to the figures. This figure is likely generous, as more recognized sources suggest sex is the metabolic equivalent to walking briskly for 10 minutes, then climbing two flights of stairs.6,7 Further, the average duration for sexual activity is roughly half the 30-minute period used in our estimate.8





4. Sex Is Good for the Heart





No, not in a Valentine’s Day way, though emotions may play a role in the effect. As people age, concerns about heart attacks and strokes during sex become more prevalent. Considering the elevation in blood pressure and heart rate that occur during intercourse, this is a reasonable concern.6,7 However, in a report published in the Journal of Epidemiology and Community Health, researchers in the United Kingdom learned after following a large group of men for 20 years that frequency of intercourse was not associated with stroke incidence.9 Further, those having sex at least twice a week had half the risk of suffering a fatal heart attack as those who “coupled” less than once per month.





5. Sex Allows One to Feel Better About Himself





Maybe … this is an area that is just entirely too complicated to say that a hop in the sack will cure low self-esteem, the blues, depression, etc. Antidepressant prescriptions sit near the top of all drug classes dispensed from pharmacies. Certainly, many people get an ego boost after satisfying one’s self and partner, but low self-esteem can also deter from sexual interest, confidence and performance, turning what should be an emotionally enriching experience into another and more personal failure.10,11 Interestingly, many people point to a survey performed at the University of Texas and pick out one or another reason for having sex.12 However, the range of answers (237 different reasons) really prevents one from reaching any conclusion than it is a very individual experience. Not to dampen anyone’s enthusiasm about or for sex, but regardless of whether it be casual conquest or intimate intercourse, the effect of sex on a person’s psyche goes deeper than the physical achievement, reflecting one’s emotional, psychological and environmental state at the time.13,14





6. A Happy Sex Life Supports a Healthy Relationship





As inferred above, self-esteem and relationships are very complex issues. Yet, the prototypical relationship in the human experience – that of a mother and child – includes hormonal responses that strengthen the emotional bonding of an experience. The natural birth of a baby is associated with a number of hormonal bursts that prime the uterus to contract and dull the pain response. Among these is the secretion of a hormone from the pituitary (a gland in the brain) and placenta of a rarely mentioned hormone called oxytocin. Oxytocin affects most tissues in the body, but its relevant role in relationships and intercourse is its ability to initiate, promote and enhance emotional bonding.15 Oxytocin is released in high concentration at the time of childbirth and during nursing, priming the emotional bond between a mother and her newborn. It is also released during orgasm and if supported by physical and social cues, may enhance the emotional bond between sex partners.15,16 Of course, if the immediate post-coital action is pulling one’s pants on while rushing out the door, the bonding is less intense than if the couple continues sharing intimate conversation and contact.





7. Sex Can Provide (Brief) Pain Relief





As mentioned earlier, during childbirth, the mother’s system is flooded with a cocktail of hormones and neurotransmitters. Oxytocin and prolactin both surge during childbirth and while breast-feeding. The effects of these and other hormones goes beyond giving birth and feeding an infant, and obviously have other functions in men. Oxytocin and prolactin levels are elevated during and following orgasm, presumably serving to support the emotional bonding of lovers.17-19 However, as many have noted anecdotally, sex seemingly reduces pain, whether it be a headache or an injury.20,21 This effect is usually written off as being all in one’s head (meaning mind) due to the sex act(s) distracting one from pain rather than providing pain relief. However, it has been shown from animal studies to pregnant women to healthy volunteers that an oxytocin surge (inhaled, due to childbirth or orgasm) makes one more tolerant of pain. Something to keep in mind for the next time a partner says, “I have a headache.”20





8. Healthy Sex, Healthier Prostate





The relationship between orgasm frequency and prostate health has been debated for centuries. Texts written about Eastern religions, such as Buddhism, assert that semen represents one’s vitality or life fluid. The goal in some sects is to transcend the desire for ejaculation, preserving the life fluid and reducing suffering.22 However, other ideologies believe that suppression of sexual desire increases one’s stress, harms the psyche and promotes violence.23 Personal beliefs aside, research suggests that frequent ejaculation (five or more times per week) during the peak childbearing years (20 to 30 years old) protects against the later development of prostate cancer; later sexual activity had no association with prostate cancer.24 A study published in the Journal of the American MedicalAssociation confirmed the protective effect of ejaculation against prostate cancer, extending the benefits through midlife (40-49 years old).25 Though the mechanism is not explained, it appears to be similar to the protective effect provided by breast-feeding against certain forms of breast cancer in women.26





9. Sex Exercises the Pelvic Floor Muscles





Exercising pelvic floor muscles may sound like something done during the lambada (a Brazilian dance). However, the pelvic organs are supported by a mesh of muscles that play a much greater role in women. During Lamaze classes, women are instructed to perform exercises called Kegels to strengthen these muscles; this prevents later prolapse (the bulging of female sex organs through the pelvic floor). Even minor prolapse can lead to urinary incontinence (leaking, dribbling) and sexual dysfunction. For men, Kegels are suggested to combat urinary incontinence, improve erections and control over orgasms.27 Instructions for performing Kegels can be found online.





10. A Great Night of Sex Can Lead to a Great Night’s Sleep





The importance of sleep for optimal health is greatly underestimated. Poor sleep can lead to obesity, pre-diabetes, type 2 diabetes, hypertension, metabolic syndrome, and a variety of other disorders that negatively affect health and may lead to a premature death.28-30 Fortunately, as many disgruntled spouses attest to each other in coffee shops or via group texts, the release of sex can put a person to sleep quickly and deeply. The hormonal flush of an orgasm, combined with the psychological benefits of consensual passion, induces a state of relaxation. Much of the credit has been assigned to oxytocin (once again).31 However, the state of sexual arousal induces elevations in excitatory neurotransmitters. Following orgasm, these “excitors” plummet, leaving the individual in a relative state of stupor. It is a physiologic analogy to being at the Super Bowl one weekend, jumping amongst a cheering crowd, compared to standing in an empty stadium the next day. The physical letdown makes a person want to curl up and go to sleep.





DISCUSS ON OUR FORUMS

SUBSCRIBE TO MD TODAY


GET OFFICIAL MD STUFF

VISIT OUR STORE


SUBSCRIBE TO OUR NEWSLETTER





ALSO, MAKE SURE TO FOLLOW US ON:



FACEBOOK

TWITTER

INSTAGRAM

YOUTUBE



References:





1. Doheny K. 10 surprising health benefits of sex. WebMD. Available at http://www.webmd.com/sex-relationships/features/10-surprising-health-benefits-of-sex, accessed June 18, 2008.





2. Brody S. Blood pressure reactivity to stress is better for people who recently had penile-vaginal intercourse than for people who had other or no sexual activity. Biol Psychol, 2006 Feb;71(2):214-22.





3. Brody S, Veit R, et al. A preliminary report relating frequency of vaginal intercourse to heart rate variability, Valsalva ratio, blood pressure and cohabitation status. Biol Psychol, 2000 Apr;52(3):251-7.





4. Charnetski CJ, Brennan FX. Sexual frequency and salivary immunoglobulin A (IgA). Psychol Rep, 2004 Jun;94(3 Pt 1):839-44.





5. Franklin RD, Kutteh WH. Characterization of immunoglobulins and cytokines in human cervical mucus: influence of exogenous and endogenous hormones. J Reprod Immunol, 1999 Mar;42(2):93-106.





6. Rerkpattanapipat P, Stanek MS, et al. Sex and the heart: what is the role of the cardiologist? Eur Heart Journal, 2001;22:201-8.





7. Larson JL, McNaughton MW, Kennedy JW, Mansfield LW. Heart rate and blood pressure responses to sexual activity and a stair-climbing test. Heart Lung, 1980;9:1025-30.





8. Miller SA, Byers ES. Actual and desired duration of foreplay and intercourse: discordance and misperceptions within heterosexual couples. J Sex Res, 2004 Aug;41(3):301-9.





9. Ebrahim S, May M, et al. Sexual intercourse and risk of ischaemic stroke and coronary heart disease: the Caerphilly study. J Epidemiol Community Health, 2002 Feb;56(2):99-102.





10. Althof SE, O’Leary MP, et al. Self-esteem, confidence, and relationships in men treated with sildenafil citrate for erectile dysfunction: results of two double-blind, placebo-controlled trials. J Gen Intern Med, 2006 Oct;21(10):1069-74.





11. Montorsi F, Padma-Nathan H, et al. Erectile function and assessments of erection hardness correlate positively with measures of emotional well-being, sexual satisfaction, and treatment satisfaction in men with erectile dysfunction treated with sildenafil citrate (Viagra). Urology, 2006 Sep;68(3 Suppl):26-37.





12. Meston CM, Buss DM. Why humans have sex. Arch Sex Behav, 2007 Aug;36(4):477-507.





13. Brody S, Costa RM. Vaginal orgasm is associated with less use of immature psychological defense mechanisms. J Sex Med, 2008 May;5(5):1167-76.





14. Haning RV, O’Keefe SL, et al. Intimacy, orgasm likelihood, and conflict predict sexual satisfaction in heterosexual male and female respondents. J Sex Marital Ther, 2007 Mar-Apr;33(2):93-113.





15. Gimpl G, Fahrenholz F. The oxytocin receptor system: structure, function, and regulation. Physiol Rev, 2001 Apr;81(2):629-83.





16. Donatucci CF. Etiology of ejaculation and pathophysiology of premature ejaculation. J Sex Med, 2006 Sep;3 Suppl 4:303-8.





17. Kruger TH, Haake P, et al. Specificity of the neuroendocrine response to orgasm during sexual arousal in men. J Endocrinol, 2003 Apr;177(1):57-64.





18. de Wied D, Diamant M, et al. Central nervous system effects of the neurohypophyseal hormones and related peptides. Front Neuroendocrinol, 1993 Oct;14(4):251-302.





19. Carter CS, Altemus M. Integrative functions of lactational hormones in social behavior and stress management. Ann N Y Acad Sci, 1997 Jan 15;807:164-74.





20. Phillips WJ, Ostrovsky O, et al. Relief of acute migraine headache with intravenous oxytocin: report of two cases. J Pain Palliat Care Pharmacother, 2006;20(3):25-8.





21. Uryvaev YV, Petrov GA. Extremely low doses of oxytocin reduce pain sensitivity in men. Bulletin Exp Biol Med, 1996;122(5):1071-3.





22. Faure B. (1998) The Red Thread: Buddhist Approaches to Sexuality. Princeton, NJ: Princeton University Press, ISBN-13: 978-0691059976.





23. Prescott JW. Body pleasure and the origins of violence. The Bulletin of the Atomic Scientists 1975 Nov;10-20. Available at http://www.eurowrc.org/01.eurowrc/04.eurowrc_en/20.en_ewrc.htm, accessed June 18, 2008.





24. Giles GG, Severi G, et al. Sexual factors and prostate cancer. BJU Int, 2003;92:211-216.





25. Leitzmann MF, Platz EA, et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA, 2004;291:1578-1586.





26. Hietala M, Olsson H, et al. Prolactin levels, breast-feeding and milk production in a cohort of young healthy women from high-risk breast cancer families: implications for breast cancer risk. Fam Cancer, 2007 Dec 15. [Epub ahead of print].





27. Moul JW. Pelvic muscle rehabilitation in males following prostatectomy. Urol Nurs, 1998 Dec;18(4):296-301.





28. Gottlieb DJ, Redline S, et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep, 2006 Aug 1;29(8):1009-14.





29. Hall MH, Muldoon MF, et al. Self-reported sleep duration is associated with the metabolic syndrome in midlife adults. Sleep, 2008 May 1;31(5):635-43.





30. Chaput JP, Despres JP, et al. The association between sleep duration and weight gain in adults: a 6-year prospective study from the Quebec Family Study. Sleep, 2008 Apr 1;31(4):517-23.





31. Ellison, Carol Rinkleib. (2000) Women’s Sexualities. Oakland, CA: New Harbinger Publications, Inc.










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