Masturbation: Will the Controversy Never Cease?

Some don't masturbate, but if you do, it’s fine, even daily, even if coupled.

Posted Jun 15, 2015

In a post last year, I summarized the sexological consensus on masturbation: Not everyone does it, but if you do, it’s fine at any age—even daily, and even if you’re happily coupled. Solo sex causes no physical damage, except possibly chafing of sensitive genital flesh. (Use lube.) And unless it interferes with school, work, family, or partner sex, it causes no psychological harm. Masturbation doesn’t use you up sexually, doesn’t deplete your orgasms or men’s sperm, and doesn’t ruin you for partner sex.

I did not expect that post to be controversial. Sexologists have been saying what I said for decades. I was simply attempting to assuage the guilt and confusion many people feel about solo sex. But you know what they say: Want an argument? Express an opinion.

One reader, in particular, flailed me. No, Castleman, you fool, masturbation is harmful. He cited articles in two leading sexological publications, the Journal of Sexual Medicine and Archives of Sexual Behavior, that linked masturbation to increased unhappiness, depression, erection difficulties, and risk of prostate cancer.

I analyzed the articles my critic referenced, and discovered that he'd made classic errors. He confused an association with cause-and-effect. And he chose to believe a study with poor methodology over one that was more rigorous.

Does Masturbation Cause Unhappiness, Depression, and Erection Loss?

My critic cited an article in the Journal of Sexual Medicine (2010) whose author analyzed studies that explored how people felt about themselves after penis-vagina intercourse (PVI) vs. solo sex: “PVI frequency was a significant predictor of both men’s and women’s satisfaction with their mental health. In contrast, masturbation was inversely associated with mental health. … Masturbation is associated with less happiness and more depression.”

I checked the source, and my critic summarized it accurately: Compared with masturbation, lovers gain more personal satisfaction from PVI, and yes, indeed, frequent masturbation is associated with an increased risk of mental health problems.

But my critic ignored the fact that masturbation has a long history of being heavily stigmatized: It’s a sin! You’ll go to hell! Hair will grow on your palms! You’ll go insane! If these lies echo in your mind, it makes perfect sense that masturbation would be associated with unhappiness and depression. But it’s not solo sex that causes these problems. It’s the fact that masturbation has been so demonized for so long.

The stigma also explains why masturbation is associated with erection difficulties. Engaging in demonized behavior causes anxiety, which boosts blood levels of the stress hormone, cortisol, which in turn constricts the arteries, including the ones that supply the penis, limiting blood flow through the organ and causing erection impairment.

So yes, solo sex is associated with mental health and erection problems, but it doesn’t cause them. The cause is society’s vilification of masturbation.

For comparison, consider the demonization of homosexuality. For centuries, most Western societies classified it as a sin, major deviance. Gay people were assaulted on the street, disowned by their families, hounded out of careers, imprisoned, tortured, and sometimes killed. Meanwhile, many studies linked homosexuality to mental health problems. Compared with straight people, gays reported much higher rates of unhappiness, depression, psychosis, alcoholism, drug abuse, and suicide.

But it wasn’t homosexuality per se that caused these problems. It was the stigma. Threaten any group with family shunning, financial ruin, imprisonment, torture, and death, and it should come as no surprise that they have higher rates of mental health problems.

Fortunately, in 1973, the American Psychiatric Association reclassified homosexuality from deviant to a normal sexual variation. Homosexuality is still stigmatized—witness the current controversy over gay marriage, and Uganda’s 2013 law making gay sex punishable by up to life imprisonment. But homosexuality is increasingly accepted, and where that's true, gay folks have become happier and less depressed.

Masturbation is our original sexuality, and it’s a normal part of sexuality throughout the lifespan. What’s harmful is not solo sex, per se, but its stigmatization.

Does Masturbation Increase Risk of Prostate Cancer?

Most research has shown that as ejaculations increase (from both PVI and masturbation), risk of prostate cancer decreases. In a Harvard-National Cancer Institute study, compared with men who reported four to seven ejaculations a month, those who reported 21 were 67 percent less likely to develop prostate cancer. The researchers concluded: “Frequency of ejaculation is not related to increased risk of prostate cancer.”

My critic didn’t mention that study. Instead, he fastened on a British report showing that frequent young-adult ejaculations (PVI and masturbation) were linked to an increased risk of prostate cancer. “Frequent masturbation during men’s 20s and 30s was a marker for increased prostate cancer risk” decades later.

So we have dueling studies. Which one should we believe? When studies disagree, it helps to review their methodology.

The larger the subject pool the more reliable the results. The Harvard-NCI study showing no increase in prostate cancer from masturbation had 222,426 participants, the British study showing a link between young-adult masturbation and prostate cancer years later had 840. The Harvard-NCI study is more believable.

Prospective studies are more reliable than retrospective research. Prospective studies examine participants at the outset and then re-examine them periodically for the duration of the study. Retrospective studies depend entirely on memory. But memory can play tricks, especially when you ask men in their fifties to estimate how much they masturbated during their twenties. The Harvard-NCI study was prospective, the British study retrospective. The Harvard-NCI study is more believable.

As biological plausibility increases, so does believability. Prostate cancer is to some extent sexually transmitted. A history of sexually transmitted infections (STIs) increases risk, and as the number of STIs increases, so does risk. Ejaculation flushes the prostate, removing pathogens that may contribute to cancer risk. As a result, we would expect frequent ejaculations to reduce risk across the lifespan. That’s what the Harvard-NCI study showed. But not the British report. It showed increased cancer risk from masturbation during men’s 20s and 30s but decreased risk from masturbation after 50. Huh? Why the change from increased risk to decreased? The British study strains credulity. The Harvard-NCI study is more reliable.

The score: The Harvard-NCI study, three. The British study, zero. The best evidence shows that masturbation does not increase prostate cancer risk.

All of which brings me back to my previous assertion, one endorsed by a clear consensus of sexologists: Masturbation causes no physical harm or psychological damage at any age, even if you do it daily, even if you’re happily coupled. Its main downsides are the guilt and shame it may cause. If you masturbate, try not to feel guilty about it. Solo sex is our original sexuality and a key element in learning how to be sexual with others. It’s fine. Its critics are misinformed. Enjoy yourself.

References

Brody, S. “The Relative Health Benefits of Different Sexual Activities,” Journal of Sexual Medicine (2010) 7:1336.

Brody, S. “Sexual Factors and Prostate Cancer,” BJU International (formerly British Journal of Urology)

Costa, R.M. “Masturbation is Related to Psychopathology and Prostate Dysfunction: Comment on Quinsey (2012),” Archives of Sexual Behavior (2012) 41:539.

Cyranowski, J.M. et al. “Lifetime Depression History and Sexual Function in Women in Midlife,” Archives of Sexual Behavior (2004) 33:539.

Dimitropoulou, P. et al. “Sexual Activity and Prostate Cancer Risk in Men Diagnosed at a Younger Age,” BJU International (2009) 193:178.

Frolich, P. and C. Meston. “Sexual Functioning and Self-Reported Symptoms Among College Students,” Journal of Sex Research (2002) 39:321.

Giles, G.G. et al. “Sexual Factors and Prostate Cancer,” BJU International (2003) 92:211.

Leitzmann, M.F. et al. “Ejaculation Frequency and Subsequent Risk of Prostate Cancer,” Journal of the American Medical Association (2004) 291:1578.

Oishi, K. et al. “A Case-Control Study of Prostatic Cancer Risk in Kyoto, Japan: Sexual Risk Factors,” Prostate (1990) 17:269.