Ejaculation: How Often for Good Health?

Will an orgasm a day really keep the doctor away?

Several years ago, men began showing up in my website's forum struggling to end compulsive porn use. Gradually, they worked out that a period of abstinence often helps reboot their brains. (Initially, their sexual arousal is so tightly wired to porn images and flashbacks that foregoing orgasm for a time can speed re-wiring and stave off binges.) 

Discussions naturally arose about whether frequent ejaculation is needed for health reasons. Surprisingly, there is no consensus on the answer. There is, however, a wide gap between popular lore and the views of most reproductive health experts.

Interestingly, men who cut back often remark on changes: more energy, better concentration, interacting with potential mates more easily, greater gains from workouts, stronger erections, healthy dietary changes, return to earlier sexual tastes, more optimism, seeing women differently—even deeper voices. As with other aspects of life, it seems that finding a middle ground pays. Yet when it comes to ejaculation, few people are talking about what might constitute a healthy middle ground.

In his book on American campus life, I Am Charlotte Simmons, Tom Wolfe remarked that, "Many boys spoke openly about how they masturbated at least once every day, as if this were some sort of prudent maintenance of the psychosexual system." More recently, British authorities campaigned to encourage kids to masturbate daily: "An Orgasm A Day Keeps the Doctor Away." They offered no evidence that daily masturbation is beneficial apart from a claim that it improves cardiovascular health. (So does walking up stairs.)

The absence of a reliable consensus could be a problem. Having heard that frequent ejaculation is vital to good health, many men now fear to cut back—even for a time, even when they have sound reasons. They may resort to risky sexual enhancement drugs or more intense sexual stimuli to increase/maintain ejaculation frequency. Some also mistake withdrawal discomfort (when rebooting) as evidence that avoiding ejaculation is harmful, rather than recognizing withdrawal discomfort as an unavoidable phase in the return to balance.

Intercourse is good for us, but the belief that the benefits are coming from ejaculation may also be changing the focus of some men's sex lives away from real partners. After all, today's ever-novel sexual stimuli can certainly produce more intense and frequent, and perhaps more draining, ejaculations than most partnered sex (because partners aren't always cooperative). For example, scientists have learned that masturbating to a novel porn star increases ejaculate volume and motile sperm. Also, the time it takes to ejaculate decreases significantly. In short, sexual novelty (many porn users report constantly seeking novel erotica) translates into expenditure of more fertile semen and faster ejaculation. Research also shows greater reward circuit activity in the brain when exposed to a novel sexual partner, increasing the risk of developing an addiction.

Today's stimuli also spare users the bother of mastering interpersonal skills. This may not be such a good thing. Primates are a funny bunch. Even the sexy bonobos and their cousins the macaque monkeys frequently don't ejaculate when they engage in sexual activity. It seems primates need sex for the social bonds that soothe their brains—rather than mere ejaculation. In fact, comforting contact may be even more vital for pair-bonding brains like ours. In any case, too much sexual stimulation can actually leave people less contented.

One thing is certain: It takes a lot of effort to uncover objective information about ejaculation and health. Said one young man,

On the men's sites that I frequent, the number one rationalization for masturbation is that it is good for the prostate. All you have to do is tell a guy that jerking off is good for his health and he's a lifer. Does frequent masturbation really prevent prostate cancer?

Curious, my husband and I began digging around for the answer. Results were, not surprisingly, inconsistent. As the researchers of a study frequently cited in support of the men's site statement said, "Nine studies observed a statistically significant or nonsignificant positive association; 3 studies reported no association; 7 studies found a statistically significant or nonsignificant inverse relationship; and 1 study found a U-shaped relationship." 

In one study, frequent masturbation alone was a marker for increased risk of prostate cancer in the 20s, 30s and 40s when researchers finally thought to distinguish masturbation activity from penile-vaginal intercourse (PVI). PVI proved to be protective of prostate health in older men and neutral in effect in younger men. A more recent study found 19% less non-lethal prostate cancer in more frequent ejaculators (lethal rates were unaffected). However, many questions remain unanswered, such as what else the researchers controlled for. For example, communicable disease may be a more likely prostate-cancer culprit than ejaculation frequency. Said one guy,

There are so many contradictory beliefs regarding masturbation (orgasm) out there. Such as, ‘Masturbation creates more testosterone;' ‘If you masturbate, you won't act so desperate (Something About Mary):' and ‘If you don't masturbate you will build up excess testosterone, and lose your hair.'

 Also of interest is a July, 2017 statement by Richard Wassersug PhD, prostate cancer expert and Faculty of Medicine Professor, Faculty of Medicine at the Department of Urologic Sciences at the University of British Columbia:

“There are no really good objective data that I know of showing a causal link (positive or negative) between ejaculation frequency and prostate cancer risk. Recently we reviewed the data for MtF, who have androgen deprivation and they, of course, have a very low incidence of prostate cancer and presumably depressed frequency of orgasm.”

Upon investigation, we learned that ejaculation is not, in fact, an important influence on testosterone levels (although normal testosterone levels support sexual performance). Testosterone is slightly higher when abstaining from orgasm. And it does rise slightly during sexual activity—before dropping back down to normal. (Orgasmic frequency and plasma testosterone levels in normal human males) It also spikes and then drops back around day 7 after ejaculation, indicating that orgasm triggers a subtle hormonal cycle that lasts at least a week.

That said, men often notice very real changes in libido and energy over the days and weeks following ejaculation. These shifts probably have more to do with changes in key neurochemicals and nerve cell receptors in the brain's reward circuitry than they do with serum testosterone levels.

What happens to sperm that aren't ejaculated?

According to Cambridge University's "NakedScientist" forum,

Sperm that have reached their sell-by-date get broken down in the same way that, let’s say, blood cells get broken down. And basically any of the nutrients and goodies in the sperm just get recycled back inside the body.

What is the ideal ejaculation frequency?

A forum member recently asked his urologist this very question. The doctor said that, in the absence of the "irritation of frequent masturbation," a man's wet dream interval would be a good guide. He advised his patient to wait until he had two wet dreams, without disrupting the cycle by climax. The resulting interval was suggested as a good guide for the sake of reproductive health, whatever one's age.

The doctor explained that glands are not muscles, and do not need exercise. Glands secrete fluids all on their own (e.g., wet dreams), and manual intervention is simply not needed. Therefore, if a man cares to take a time-out, he can rest assured that his body will meet his ejaculation needs  without his intervention. The forum member added:

Since I have not had a wet dream for a decade or more (always masturbated) I asked the doctor, "What if I don't have a wet dream?" His reply was, "Well then, you no longer need to ejaculate."

Is there such thing as too frequent ejaculation? The classic view of sexologists is that climax is self-regulating: No one can ever ejaculate too much, because he'll simply stop when his body has had enough.

Unfortunately, it looks like not all men automatically stop at that point; ejaculation becomes compulsive. (Just as one third of Americans don't automatically stop eating, and become obese.) For example, the online Onania support group is primarily made up of men who describe their masturbation as compulsive, and acknowledge its negative effects. The group even coined the term "copulatory impotence" for their resulting inability to ejaculate with real partners. Clearly, their bodies did not self-regulate with regard to ejaculation. The good news is that this phenomenon is likely reversible.

As we investigated, we discovered research showing that too much ejaculation can cause lingering physiological changes. When men engaged in a "ten-day depletion experience," ejaculating an average of 2.4 times per day, their sperm output remained below pre-depletion levels for more than five months. It's quite possible that there are other effects occurring in the brain, which haven't been uncovered yet. The research hasn't been done.

The absence of comprehensive information may be causing unnecessary suffering. For example, hundreds of men are now recording severe symptoms after ejaculation in the Post-orgasmic Illness Syndrome forum. Not long ago, a psychiatrist noted that the neurochemical changes after orgasm are sometimes associated with depression and anxiety in otherwise emotionally healthy patients. Might today's emphasis on frequent ejaculation be dysregulating brains?

Where can men find sound advice? What would a healthy middle ground look like?

• Although there is nothing wrong with masturbation, it may not be the health panacea touted by the popular press. This article from The Archives of Sexual Behavior, was produced after the above post - Masturbation is Related to Psychopathology and Prostate Dysfunction: Comment on Quinsey (2012)
• To explore the available science, organized into easily readable sections, check out Prostate cancer risk factors by Cancer Research UK.
• Rethinking the Wonders of Adult Masturbation - Reconsider these five popular myths about solo sex 
• Growing scientific evidence of a lingering post-orgasm cycle (studies)
• Studies on the overlap between sex and drugs in the brain