More sex = a longer life? Really???

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The local South African magazine Health Intelligence Edition 12 proclaims on its cover: "Passion promotes health – sex for a longer life".

 

(Note: The highlighting box has been added.) On page 20 the article has the title: "Sex, so necessary for positive health: sex is a buzzword that defies trendsetting and social mores, staying top of mind and tip of tongue" and is written by Kirsten Alexander.  It is seemingly supported by 12 "scientific references" .

The Solal Technologies website Health Intelligence includes the following "product information": "Health Intelligence goes further and deeper [than other health magazines], because our focus falls squarely on the facts. Health Intelligence offers breakthrough science, enabling you to better protect your health. Thoroughly researched and using only the latest, peer-reviewed studies by leading international and local experts, Health Intelligence articles are not only credible, they are revolutionary, all the while offering life-enhancing advice in a readable and intelligent way." (emphases added) 

We have previously shown that this is not true.

Look a little closer at the 12 references for the article about sex, health and a longer life, and this is what you'll find: 

1. Not applicable in humans, misinterpreted (mouse study)

2. Incomplete, possible misattribution

3. Inaccurate non-factual interpretation of study results

4. Misinterpreted, misquoted

5. Probably misquoted, out of date, inaccurate

6. Wrong reference

7. Wrongly attributed, not applicable animal study

8. Mainly misinterpreted, partially correct, not applicable

9. Mainly misinterpreted, partially correct, out of date

10. Inappropriate, misinterpreted and incorrectly extrapolated

11. Incorrectly extrapolated; misquoted, inaccurate and misleading

12. Inaccurate, misleading, misquoted, not proven in humans (laboratory test tube study)

 You can link to the original article as it appeared in the magazine here: it is made available as "fair use" and in the interests of the public good.

A deconstruction of the article and its references follows below:

"Sex, so necessary for positive health: Sex is a buzzword that defies trendsetting and social mores, staying top of mind and tip of tongue

by Kirsten Alexander

What is it about sex that gets us all aflutter with flaming cheeks and snide giggles? Has it something to do with our innate fear of rejection? Or perhaps the ingrained social idealism that sex should be kept under wraps at all costs, despite the fact that everybody experiences its sensuous pull?

Physicians, philosophers and psychologists insist our bodies know what's good for us. They're adamant that if we just listen carefully to our physiology, we'll be able to fully tune in to wellness. So, let's cut to the bone on this one and acknowledge that we desire sex because our body knows what's good for it. Let's face it, if procreation were the only reason for having sex, we wouldn't be dealing with world over-population issues.

Whole Mind

The benefits of a good romp are overwhelming, from helping with hay fever to cancer prevention."[1] 

Reference 1: The reference is to an article by Fagarasan and Honjo which appeared in Nature Reviews: Immunology in 2003. However the reference is about mice and Immunoglobulin A secreted in their intestines. I could find no mention of hay fever, cancer, sex, mating or even copulation in this article. I do not know how one would diagnose hay fever in mice. It is completely misleading, irresponsible and unethical to use this article to support the statement that sex is beneficial in helping with hay fever or for cancer prevention. One wonders how the editor in chief, the editorial director , the executive editor or the publishing editor* could have allowed this complete mismatch of statement and reference. It seems as if none of the editorial team even proofread the article!

* Jacqueline Moskovitz, Brent Murphy, Melani Botes, Colin Levin respectively

"But let's first explore what occurs in the brain. In a study outlined in his book, The Science of Orgasm, Prof Barry Komisaruk scrutinises women under an MRI scanner to explore what happens in the brain during an orgasm.[2] The entire brain lights up like a firework display, indicating that an orgasm is a whole brain experience."

This reference fails to include the third author of the book. I was unfortunately unable to gain access to a copy of the book. The article is written so that the sentence about the "firework display" seems to have come from the book, but this description appears more likely to have come from a newspaper report in the UK's Daily Mail rather than the book itself. If the newspaper report is the source of the phrase, it is not referenced and could even be considered to have been plagiarised.

"It's become common knowledge that sex is a stress beater; conversely, stress can be a sex defeater and if you're finding it difficult to step up in the bedroom, try a little relaxation. The loving touch of your partner in the form of a massage, a foot tickle, or just some good old-fashioned nurturing with your favourite tune softly playing in the background is a great start to overcoming stress-induced bed fright.

A general feeling of well-being goes a long way to reducing stress levels, increasing endorphins and health. The ability to cope with daily stressors is much increased in people who regularly engage in sexual intimacy or at least live with someone else, compared with those who are physically isolated."[3]

The reference is given in the references list is incomplete. The phrase "or at least live with someone else" is not reflected in the cited article, nor does the study refer to "physically isolated people" but includes people who are not in a romantic relationship. What the study does say is: 

"Some caution is, however, warranted in the interpretation of these results, given the controversies which exist regarding the reliability of plasma oxytocin levels as a peripheral mirror of central concentrations" [in other words oxytocin in the blood is not necessarily a reflection of oxytocin in the brain]; and "our findings may constitute undoubtedly the first report of a link between oxytocin and that state of anxiety which is associated with romantic attachment in our species";

and

"we would suggest tentatively that . . . oxytocin might serve to help to counteract anxiety – or, at least, that form of anxious stress associated with romantic attachment and deep concern over its continuance";

and

"oxytocin might thus be considered an essential element in securing the rewarding effects of a romantic relationship, as a result of its increasing a prospective sexual partner's willingness to accept the risk deriving from social contacts, through the modulation of anxiety mechanisms". (emphases added)

It must be noted that the study did not measure oxytocin related to sexual activity but was based on a questionnaire about relationships. No control group was involved although it is stated that the distribution of attachment styles was the same as expected in "healthy subjects". The article makes no mention of endorphins. This hardly meets Health Intelligence's claim of thoroughly researched or breakthrough science.

"The up-and-down effect of sexual intimacy is found again in self-esteem. People with high self-esteem are more open to sexual encounters, and people who have regular sex find their self-esteem rising. If your partner's desire wanes, it may just be that a little bit of ego boosting is required to coax them back under the covers. After sexual activity, men and women's oxytocin levels are in harmony, inducing the desire for a good cuddle. Of course, this evokes all sorts of warm and fuzzy feelings, enhancing self-esteem, comfort and security."

This is an unreferenced statement without any scientific foundation. Although oxytocin is commonly referred to as the "cuddle hormone", its "levels" cannot be "in harmony" between separate individuals. It seems that the effects of oxytocin are varied in individuals and cannot be generalised as has been done here. For some people a different response may occur and there is no "of course" about the feelings induced.

"SEXUAL HEALING

Top-selling 1960s Motown crooner Marvin Gaye sings about "sexual healing", but his lyrics just highlight the desire aspect, as opposed to the very real health benefits. Contrary to many jokes on the subject, a headache doesn't constitute a good enough, "not tonight dear" excuse. In fact, a sore head is a great reason to have sex because increased levels of oxytocin release endorphins, turning on pain-relieving mechanisms – not just for headaches, but cramps and overall body pains, too. In a study published in Experimental Biology and Medicine, volunteers who inhaled oxytocin vapour and then had their fingers pricked, felt less than half the pain than before inhalation."[4]

The claim that increased levels of oxytocin from having sex in turn release endorphins which help with pain such as headaches is supposedly supported by a 1996 study. This is certainly not the "latest" research. The study involved male volunteers who inhaled oxytocin vapour and then had their fingers pricked. What the study showed was that there was a difference in pain thresholds depending on whether the oxytocin vapour could or could not be detected through the sense of smell. There was also a difference in the response of the men to oxytocin depending on their underlying autonomic nervous system activity. The study makes no mention of endorphins. Health Intelligence's interpretation of this reference is not factual.

 "As for hay fever, well, the hormone prolactin (a peptide hormone primarily associated with lactation wherein oxytocin production is stimulated by infant suckling) surges in the afterglow [of sex], and this fires new neurons into the brain's olfactory bulb (the part of the brain that controls smell), giving you a heightened sense of smell, opening up airwaves (sic) and even activating tastebuds."[5]

 The reference is a 2007 textbook of anatomy and physiology, which I was unable to obtain. Apart from an updated 2010 edition being available, it is highly unlikely that the textbook made this or a similar statement. The idea that a hormone can "fire new neurons into the brain's olfactory bulb" is extraordinarily misleading. Neurons cannot be "fired" into another structure and this has nothing to do with hay fever. Hay fever has a very different pathophysiology. Furthermore "opening up the airwaves" usually refers to socio-economic-political decisions related to broadcasting frequencies. Clearly the intended word was "airways" – but this would still be inaccurate as even "opening up the airways" does not help hay fever.

"Flu and the common cold are also kept at bay – a study at Wilkes University Pennsylvania showed higher levels of the antibody immunoglobulin A (IgA) in groups who reported having frequent (once or twice weekly) sexual intercourse."[6]     

Reference 6 is about prostate cancer and makes no mention of immunoglobulins, flu or colds! The first author actually comes from the Cancer Epidemiology Centre in Australia and not Wilkes University.  What the Wilkes University research shows is that people having "very frequent" sex (three or more times a week) have lower IgA saliva levels than those having "frequent" sex (one or two times per week). So the author of the article has selected one aspect of the study out of context. The correct reference is: Charnetski CJ, Brennan FX. Sexual Frequency and Salivary Immunoglobulin A (IgA). Psychological Reports 2004;94(3):839-844. (Unfortunately I am only able to access the abstract for this article.) Such a blatant error in referencing would be unacceptable even in an undergraduate student. This must be one of the most glaring errors I have yet come across in Health Intelligence – which reflects extremely poorly on its credibility – especially in light of the claims the magazine makes that it "pushes the boundaries in health reporting" and is "[f]illed with cutting edge content, giving you the true (sic) story about everything . . ."  (http://www.himag.co.za/)

"A good cardio workout is almost always recommended to enhance health. People expend different amounts of energy during sex, and although levels of movement are individualised, the heart-pumping, spine tingling arousal stage certainly has cardio benefits, increasing bloodflow and providing a healthy dose of oxygen to the brain and bloodstream, stimulating detoxification.

In men, studies have shown that ejaculating more than five times a week can reduce their risk of prostate cancer by as much as a third."[7]

Clearly this reference comes from the Australian study about prostate cancer – reference 6. However once again, incomplete information is provided – there's an age frame given. The finding is that "men in their twenties" (and not all men) who ejaculate more than five times a week may have a reduction in their risk of developing prostate cancer later in life. The  limitations described by the authors in their study were not taken into account by the writer of the Health Intelligence article. In the references list, reference 7 states: "See reference 1". As pointed out above, reference 1 is about mice and cannot be applied to humans. The question arises as to whether it's better to ejaculate five times a week to reduce the risk of prostate cancer or once or twice a week to prevent flu and the common cold. But since both references have been used incorrectly, one cannot say anything about the frequency of sex and the risk of prostate cancer or reducing flu and colds. Health Intelligence is wrong again. 

 "A regular pelvic floor muscle squeeze assists in bladder control, specifically after giving birth and towards the latter years of life. Dr Arnold Kegel highlighted the need for contracting and relaxing the pelvic floor muscles to aid women in childbirth, reduce urinary incontinence and increase the size and intensity of erections, as well as reduce premature ejaculatory occurrences in men."[8,9]

  Reference 8 is about premature ejaculation. Part of learning to control their pelvic floor muscle contractions (in a very small sample of 18 men) involved the insertion of anal electrostimulation and an anal pressure probe and not just "Kegel's exercises". This kind of intervention is unlikely to be available to men with premature ejaculation. No reference is made in this study to "increasing the size and intensity of erections". This must be the writer's imagination! The 2006 Cochrane review referred to in reference 9 has been updated to a 2010 review. The review does refer to bladder control – in women with mixed incontinence, but especially for those with stress incontinence (e.g. urinary leaking when coughing, sneezing, laughing). No connection with sex in women is explicit in the review.

 "HOR-MOAN-AL

Testosterone, progesterone and estrogen imbalances have been linked to age-related conditions such as stroke, bone fracture, coronary artery disease, type II diabetes, cancer and even sleep apnoea (a disorder characterised by abnormal pauses in breathing while sleeping), all of which can have an adverse affect on your sex life."[10]

The heading "Hor-moan-al" is placed just under the open mouth of a busty woman in a horizontal position looking downwards, possibly as if about to give oral sex. This is probably intentional.

The reference does not refer to "imbalances" of hormones but "ratios" and the study was done only in men and postmenopausal women who already had proven coronary artery disease. I was only able to access the abstract of the article. Proven coronary artery disease would presumably not be applicable to the majority of Health Intelligence readers. The abstract makes no reference to stroke, bone fracture, type II diabetes, cancer or sleep apnoea. There is also no mention of any effect on sex life through changes in sex hormone ratios. 

"With each orgasm reached, the hormone DHEA, linked to long life, increases as a response to sexual excitement and orgasm. DHEA also boosts the immune system, repairs tissue, improves mental alertness and keeps skin healthy."[11]

Reference 11 is not about DHEA but about DHEAS. (DHEAS is the sulphate ester of DHEA and is more stable than DHEA.) The reference concludes that the study's data "suggest that [a single] serum level of DHEAS is a strong predictor of 27 year longevity in [rural Japanese] men [but not women]." Health Intelligence gives no evidence for any of the other statements made in the sentence linked to this reference – particularly no evidence is given for the presumed properties of DHEA. The impression may be created in reading this that DHEA somehow accumulates ("increases") with sexual excitement and "each" orgasm. However DHEA is a precursor hormone (which gets converted into other hormones) and has a half life of 15-30 minutes (i.e. it's present at most for a couple of hours). So any increase from sexual excitement or orgasm is not particularly long lasting.

"Merely checking levels of these hormones isn't enough. It's imperative to look at the sex hormone-binding globulin (SHBG). Primarily produced in the liver, SHBG is also synthesised through the uterus, testes, brain and placenta and transports testosterone and estrogen throughout the body. SHBG levels steadily increase as you age, but sex hormones decrease, which deactivates testosterone in men and estrogen in women, so supplementing with a phytochemical from a nettle plant (known as 3,4-divanillyl-tetrahydrofuran) effectively counteracts this age-related imbalance."[12]

The word "deactivates" is used incorrectly here. The last reference in this article is used to support the statement that supplementing with 3,4-divanillyl-tetrahydrofuran effectively counteracts [the] age-related imbalance of sex hormone-binding globulin (SHBG). But the study referred to was not done in living human beings, it was done in laboratory "test tubes", so it is impossible (and not factual) to state that the chemical from the nettle plant is "effective". This is completely misleading.

"DO THE FANDANGO

It's all very well to wax lyrical about the benefits of sex, but if your libido leaves little to be desired, what's the first step in getting back on top?

A good, wholesome diet and specific supplementation can make all the difference. Marrena Lindberg, author of The Orgasmic Diet: A Revolutionary Plan to Lift Your Libido and Bring You to Orgasm, studied the effects of nutrients and exercise on the ability to reach orgasm and states that a healthy balanced diet sets the table for sexual satisfaction, but to get to the next level, a bit more work is required.

Supplementing with magnesium and zinc to increase the levels of testosterone in your blood assists in increasing desire. A good multivitamin with an extra dose of vitamin C, a mega dose of omega-3 fatty acids and taking the supplements listed in the protocol can produce explosive results. Naturally, not smoking, cutting back on caffeine and alcohol, and exercise. (sic)

Such a regime may not immediately set you off on a frisky jaunt, but it will certainly go a long way towards increasing overall wellness and reducing the effects of stress on your body – this will boost your levels of energy, self-esteem and then libido.

So, whip up a healthy dose of nutrients and supplements, gather together in a rush of cardio-pumping exercise and make a hearty dash for the bedroom."

Apart from recommending a good wholesome diet, not smoking, reducing alcohol and exercising" (all of which go without saying depending on the individual) supplements are recommended. It seems to be the rule that virtually every article in Health Intelligence should recommend supplements. The reference to the book by Lindberg is not included in the list of references. The Health Intelligence article says (unambiguously) that taking the supplements can produce "explosive" results. There is no evidence for this or that magnesium and zinc increase the levels of testosterone in the blood.

"LIBIDO-ENHANCING PROTOCOL

L-Arginine (1,400mg twice daily)
High potency multivitamin
Zinc (20mg daily)
Magnesium (200mg twice daily)
Omega-3 fatty acids (1,000mg twice daily)."

Squeezed in between the end of the article and the references is this "protocol". It would appear that all the components of the "protocol" should be taken together, but this is not made explicit. And as is now seen to be standard practice in this publication, no scientific evidence is provided for the efficacy (or safety) of such a "protocol" as a whole, and probably there is none. The publishers are welcome to contact me with any evidence for the whole protocol, and if they regard it as confidential, I will maintain that confidentiality.

No evidence is provided that an active sex life helps with hay fever, cancer prevention or a longer life. There is no doubt that an active sex life is a normal part of overall health and wellbeing, but most people do not need any supplements or other medications to assist them in this.

Once again Health Intelligence has produced an article littered with factual inaccuracies, misquotes, incorrect extrapolations, selective quoting, as well as pure fantasy and make believe.

Finally, South Africa has one of the highest, if not the highest, infection rates of HIV in the world. It is surely irresponsible not to mention this and how to protect yourself in an article of this nature.

 References (as listed in Health Intelligence) 
1. Fagarasan S, Honjo T. Intestinal IgA Synthesis: Regulation of Front-line Body Defenses. Nat Rev Immunology.
2003;3(1):63-72
2.  Komisaruk BR, Beyer-Flores, C. The Science of Orgasm. The Johns Hopkins University Press, Baltimore, US. 2006
3.  Marazziti D, Dell'Osso B, et al. A relationship between oxytocin and anxiety of romantic attachment. Clinical Practice
and Epidemoiogy in Mental Health 2006;2
4.  Uryvaev Y. Extremely low closes of oxytocin reduce pain sensitivity in men. Bulletin of Experimental Biology and
Medicine Nov 1996;122:487-89
5.  Bartholomew EF, Martini F, et al. Essentials of anatomy & physiology. Pearson/Benjamin Cummings. San Francisco.
US. 2007
6.  Giles GG, Severi G, el al. Sexual factors and prostate cancer BJU Int. Aug 2003;92(3):211-6
7.   See reference 1
8.   La Pera G, Nicastro A. A new treatment for premature ejaculation: the rehabilitation of the pelvic floor. Journal of
Sex & Marital Therapy. 1996;22(1 ):22-6
9.  Hay-Smith J, Dumoulin C. Pelvic floor muscle raining versus no treatment.or inactive control treatments, for urinary
incontinence in women. Cochrane database of systematic reviews (Online). 2006;1:CD005654
10. He H, Yang F, et al. Sex hormone ratio changes in men and postmenopausal women with coronary artery disease.
Menopause. May-Jun 2007;14(3 Pt 1):385-90
11. Enomoto M. Adachi H, et al. Serum Dehydroepiandrosterone Sulfate Levels Predict Longevity in Men: 27-Year
Follow-Up Study in a Community-Based Cohort (Tanushimaru study). Journal of the Ametican Geriatrics Society. 2008;56(6):994-8
12. Schöttner M, Spiteller G, et al. Lignans interfering with 5 alpha-dihydrotestosterone binding to human sex
hormone-binding globulin. J Nat Prod. Jan 1998;61(1):119-21

This analysis was prepared by Professor Roy Jobson. Professor Jobson is a medical doctor and Associate Professor of Pharmacology in the Faculty of Pharmacy at Rhodes University. He has previously served as a Council member of the Medicines Control Council (MCC), was the inaugural Chairperson of the MCC’s Pharmacovigilance Committee, and a member of its Clinical Trials and Complementary Medicines Committees. He is an Associate of the College of Clinical Pharmacologists of the Colleges of Medicine of South Africa. He is a Council member of the Allied Health Professions Council of South Africa as a community representative. His analysis of this article does not reflect an official viewpoint of any of these institutions.

 

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