An artist and a child collaborate during a community paint day that brought residents out of their homes and into the street to participate in the rejuvenation of the neighborhood. Photograph by Steve Weinik. Printed with permission.
We congratulate Higgins et al. on their study of American university students,1 in which they found that frequency of vaginal intercourse—and for women, frequent orgasm therefrom—was associated with greater physiological and psychological satisfaction. However, it is unfortunate that the authors claim “virtually no public health research has examined sexual well-being outcomes, including sexual satisfaction,”1(p1643) and that they extrapolate their observed favorable correlates of vaginal intercourse to other sexual activities. The most extensive review of the physiological and psychological health benefits associated with various sexual activities found that across a wide range of health measures (e.g., neurohormonal and other biochemical indices, immune function, mood, and relationship and psychological function), it is consistently and nearly exclusively penile-vaginal intercourse (PVI)—and the orgasm that comes directly from it—that is associated with better health.2 Other sexual activities are variously uncorrelated or associated with poorer health outcomes.
As for satisfaction measures, an age-adjusted multivariate analysis of a large, nationally representative sample of Swedes found that for both men and women, only PVI frequency was positively associated with greater sexual, intimate relationship, mental health, and life satisfaction.3 Other sexual activities (e.g., masturbation, oral sex, and anal sex) were negatively associated or uncorrelated with satisfaction measures in the multivariate model that controlled for PVI frequency. Similar results were obtained in studies of German women4 and Chinese industrial workers of both sexes,5 the latter benefitting from examining the effects of social desirability response bias.
The finding of Higgins et al. that women's frequent orgasm from vaginal intercourse is strongly associated with greater physiological and psychological satisfaction is consistent with findings that women's orgasm elicited by PVI (without additional clitoral masturbation for the orgasm) is associated with better relationship quality,6 capacity for healthy relationships and better psychological function,7 and less risk of eventual sexual dysfunction,8 but other orgasm triggers (e.g., masturbation and vibrator) are associated with poorer function. These results are consistent with experimental research demonstrating different neurohormonal responses to different orgasm triggers9 and even different brain region activation triggered by stimulation of different genital regions.10
As already recommended,2 it is imperative that researchers and educators differentiate between different sexual behaviors (and orgasm sources), lest results be muddled, inferences be misleading, and health recommendations be counterproductive.
References
- 1.Higgins JA, Mullinax M, Trussell J, Davidson JK, Sr, Moore NB. Sexual satisfaction and sexual health among university students in the United States. Am J Public Health. 2011;101(9):1643–1654 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Brody S. The relative health benefits of different sexual activities. J Sex Med. 2010;7:1336–1361 [DOI] [PubMed] [Google Scholar]
- 3.Brody S, Costa RM. Satisfaction (sexual, life, relationship, and mental health) is associated directly with penile-vaginal intercourse but inversely with other sexual behavior frequencies. J Sex Med. 2009;6:1947–1954 [DOI] [PubMed] [Google Scholar]
- 4.Philippsohn S, Hartmann U. Determinants of sexual satisfaction in a sample of German women. J Sex Med. 2009;6(4):1001–1010 [DOI] [PubMed] [Google Scholar]
- 5.Tao P, Brody S. Sexual behavior predictors of satisfaction in a Chinese sample. J Sex Med. 2011;8:455–460 [DOI] [PubMed] [Google Scholar]
- 6.Costa RM, Brody S. Women's relationship quality is associated with specifically penile-vaginal intercourse orgasm and frequency. J Sex Marital Ther. 2007;33(4):319–327 [DOI] [PubMed] [Google Scholar]
- 7.Costa RM, Brody S. Anxious and avoidant attachment, vibrator use, anal sex, and impaired vaginal orgasm. J Sex Med. 2011;8(9):2493–2500 [DOI] [PubMed] [Google Scholar]
- 8.Weiss P, Brody S. Female sexual arousal disorder with and without a distress criterion: prevalence and correlates in a representative Czech sample. J Sex Med. 2009;6:3385–3389 [DOI] [PubMed] [Google Scholar]
- 9.Brody S, Kruger THC. The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety. Biol Psychol. 2006;71:312–315 [DOI] [PubMed] [Google Scholar]
- 10.Komisaruk BR, Wise N, Frangos E, Liu W-C, Allen K, Brody S. Women's clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. J Sex Med. 2011;8(10):2822–2830 [DOI] [PMC free article] [PubMed] [Google Scholar]