Sexual activity and risk of prostate cancer: review of studies

Medical Mall Model: a consideration for Ghana?
Dr. Raphael Nyarkotey Obu---Professor of Holistic Medicine-Vinnytsia State Pedagogical University, Ukraine

This subject is very controversial as many health workers have reported on the subject from different perspective in Ghana.  I have tried everything possible to address this subject here. So now, what is this research about?


According to a report in JAMA, men who reported having more than 20 ejaculations per month were 33% less likely to develop prostate cancer than those who had fewer ejaculations. The study defined sexual activity as ejaculation from sexual intercourse, masturbation, or during sleep.

The researchers evaluated nearly 30,000 health professionals, of whom 1,449 developed prostate cancer. Assuming the men answered the survey questions honestly, the results indicated that an active sex life is not associated with a higher cancer risk in most men. (Leitzmann, 2004). This is the Harvard study and all the men are health care providers, including dentists, pharmacists, veterinarians, optometrists, ophthalmologists, and podiatrists. Most are white.

Other studies on sex and prostate health

Jacobsen et al 2003 study evaluate whether the symptoms associated with benign prostatic hyperplasia can be aggravated by infrequent sex, which has been suggested historically, using cross-sectional data from the Olmsted County Study of Urinary Symptoms and Health Status Among Men.  These cross-sectional data suggest that the frequency of ejaculation has no effect on lower urinary tract symptoms, peak urinary flow rates, or prostate volume; the apparent protective association appears to be an artifact caused by the confounding effects of age.

A University of Nottingham-Medical School study also addressed the question, is sex good for prostate problems? Researchers noted that frequent sexual activity (more than 10 encounters per month) bestows a “small” amount of protection against prostate cancer (Dimitropoulou, 2009). Interesting, the same study also found that men who are sexually active (more than 20 times per month) in their 20s and 30s are more likely to develop prostate cancer, especially if they masturbate often.

However, the researchers also found that frequent sexual activity by men in their 40s seemed to have little effect (Dimitropoulou, 2009). The investigators evaluated the sexual practices of more than 431 men who had been diagnosed with prostate cancer before age 60, and 409 cancer-free controls. Among the men with prostate cancer, 34% admitted they had masturbated frequently in their 20s, compared to 24% of controls. The results were similar for men in their 30s.

Men with prostate cancer also were more likely to have had an STD than those who were cancer-free. Some studies have asked, “is sex good for prostate problems?” and claimed that sexual activity can increase prostate cancer risk because it raises testosterone levels. Although testosterone and other male sex hormones are essential for prostate growth and development, another study reported that there is “little evidentiary support” that higher testosterone levels are a risk factor for prostate cancer (Imamoto, 2009).

In fact, some research describes a link between lower testosterone levels and more advanced prostate disease. More research is needed to answer the question, is sex good for prostate problems? as the results are mixed.

Neither of the main studies should influence whether you choose to have more or less sex. Even the head of the University of Nottingham study, Dr. Polyxeni Dimitropoulou, said that “Until the mechanisms are elucidated and are clearly established we cannot be certain about the outcome of any study.” Interesting from the studies, there are mixed results!

Total ejaculations rather than sexual intercourse and prostate cancer

This study looks at total ejaculations at the expense of sexual intercourse. These are different phases of sexual life.  The Australian study by Giles et al 2003 involved 2,338 men examined the impact of sexual factors on the occurrence of prostate cancer before the age of 70. Like the Harvard research, the Australian investigation evaluated total ejaculations rather than sexual intercourse itself.

Like the American men, the Australians who ejaculated most frequently enjoyed a reduced risk of prostate cancer. The effect was strongest for the frequency of ejaculations in young adulthood, even though prostate cancer was not diagnosed until many decades later. Even so, the apparent protection extended to all age groups. In all, men who averaged 4.6–7 ejaculations a week were 36% less likely to be diagnosed with prostate cancer before the age of 70 than men who ejaculated less than 2.3 times a week on average.

Recent Research

Jian et al 2018 Meta-analysis indicated that men with fewer sexual partner numbers, older age at first intercourse, and moderate frequent ejaculation were associated with a significantly decreased risk of prostate cancer. A meta-analysis published in 2002 reported that increased ejaculation frequency and having more sexual partners were associated with prostate cancer risk, but age at first intercourse was not.

Since then, more research has been conducted. The current study incorporated the newer studies and applied a dose-response analysis to the data to determine the roles of the above factors.

The research team searched relevant databases and identified twenty-two studies on the topic published through April 2018. Overall, the studies included 55,490 participants from nine countries. Most studies came from North America, but Europe, Australia, Asia, the Caribbean, and Cuba were also represented.

They found that men with fewer sexual partners were at lower risk for prostate cancer. For every 10 female partners the men had, their risk increased 1.10 fold. First intercourse at an older age also seemed to lower prostate cancer risk, which was decreased 4% for every five years of delay.

Number of sexual partners and prostate cancer risk?

The roles that number of sexual partners and age at first intercourse play might be explained by the “STIs hypothesis,” the authors said. Having an active sex life for a longer duration with many partners increases the likelihood of exposure to sexually transmitted infections and possibly “riskier lifestyle behaviors” which might contribute to cancer risk. However, hormonal levels, injury, and inflammation might also be involved, the authors noted.

They added that moderate ejaculation frequency – two to four times a week – “might play a certain role in protecting from [prostate cancer].” They suggested several explanations for this finding. For example, frequent ejaculation might decrease the amount of carcinogens in prostatic fluid or curb the development of prostatic intraluminal crystalloids, which have been linked to prostate cancer.

Geography and culture may also influence prostate cancer risk. The authors explained that prostate cancer rates are lower in west and south Asia (e.g., India and Iran) than in the United States. Because of religious traditions, men in those cultures may be older at their first intercourse and have fewer sexual partners than their North American counterparts.

Bio-mechanism of how sex protects the prostate

Notwithstanding the mixed results, there is a little bit of truth of the benefit of sex and Prostate Health.

  1. For instance, sex helps clear toxins through ejaculation by helping flushing out retained chemical carcinogens in the prostate glands. sex may reduce the development of tiny crystals that are associated with some cancers and enhance the immune system’s response to cancer.
  2. Sexual activity also reduces stress and quiets the central nervous system, which may contribute to cancer cell division and slow the growth of potentially cancerous cells in the prostate and overall wellness.
  • Frequent ejaculation may help prevent the development of mini-crystals that can block ducts within the prostate gland, reducing cancer risk.
  1. Sex is also important for prostate health in a number of other ways. Apart from the potential decrease in risk of prostate cancer, sex helps to maintain erectile function and healthy penile tissue, which is important for long-term recovery after prostate cancer treatment. Lack of frequent sex can also result in penile shortening in the absence of consistent nocturnal erections which may contribute to self-esteem issues and erectile dysfunction.

The negative though not conclusive

Sex can influence prostate health in other ways. For example, bacterial prostatitis can be caused by the transfer of bacteria between sexual partners in unprotected sex. Lower urinary tract infections may also be influenced by sexual activity and the transfer of infections that migrate to the prostate through the urethra.

Sometimes a cause of prostatitis is a sexually transmitted disease (STD), such as herpes, Chlamydia, gonorrhea, trichomoniasis, or Ureaplasma urealyticum. Sexually active men who have multiple sex partners are at an increased risk of STDs and prostatitis, especially if they do not use a condom. Also at high risk are men who engage in anal sex without using a condom. Acute prostatitis associated with STDs is typically seen in men younger than age 35.

A possible association between prostatitis, STDs, and prostate cancer has been researched. A study involving the California Men’s Health Study investigated this relationship among 68,675 men. They found that having an STD was not associated with overall risk of prostate cancer, but the results did “suggest that prostatitis and STDs may be involved in prostate cancer susceptibility” (Cheng 2010). It’s important to note, however, that these findings do not prove prostatitis causes prostate cancer, because it may be that men with prostatitis symptoms are more likely to go to a doctor and then are tested for prostate cancer.

Why use controlled ejaculation frequency?

The reasoning behind controlled ejaculation frequency, according to Taoists, is that the body has a limited supply of primordial energy. A man’s general lifespan, as well as his sexual lifespan, are determined by the lifestyle he lives and how quickly he uses up his energy. Certain lifestyle habits can replenish and strengthen that energy, and controlled ejaculation frequency is one of them.

Basically, men want to increase as much as possible the amount of age-defying hormones that are secreted during sexual excitement while simultaneously reducing as much as possible the loss of semen and the related hormones through ejaculation. The retention of these substances can be reused by the body to increase strength.

Taoist philosophy also maintains that this practice allows men to maintain consistently high testosterone levels and libido, along with greater levels of semen and sperm. Another reported benefit is that it strengthens the brain. Believers maintain that semen contains essential nutrients and hormones that are absorbed by the prostate. From there they enter the bloodstream and travel throughout the body, including the brain. It’s a scientific fact that both cerebrospinal fluids and semen contain the same basic ingredients, therefore the idea that semen can nourish the brain is not farfetched.

However, conventional Western medicine states that a man’s supply of semen is naturally replenished soon after he ejaculates and therefore there is no need to practice controlled ejaculation frequency. A side note on this though is that athletic coaches typically ask their athletes to avoid ejaculation the same day prior to competition because it’s been scientifically shown that testosterone levels decline immediately after ejaculation and athletic performance is negatively affected.

How often should men ejaculate?

According to a well-known doctor of traditional Chinese medicine, Sun Simiao: “A man may attain health and longevity if he practices an ejaculation frequency of twice monthly or 24 times a year. If at the same time he pays careful attention to proper diet and exercise he will have a long healthy life.” Exactly how often men should ejaculate as part of sexual activity depends on the man. Generally, men should identify their own frequency by determining how strong and refreshed they feel after and between intercourse sessions. Among the recommendations from Taoists theorists are the following:

  • Ejaculation only 20 to 30 percent of the time (2 or 3 times out of every 10 sessions)
  • Ejaculation no more than 1 time every 20 days for men older than 50 and no more than once every 100 days for men older than 60
  • Ejaculation based on the seasons: none during the winter, twice a month during summer and autumn, and no more than every 3 days during the spring. A 2003 study found that men who abstained from ejaculation for seven days showed a peak rise in serum testosterone of 145.7 percent of baseline. Scores of studies have demonstrated that low testosterone levels are associated with a variety of symptoms, including flagging libido, abdominal obesity, loss of muscle strength and tone, fatigue, and erectile dysfunction. Therefore, steps that help maintain or raise testosterone levels are probably desirable for many men and controlled ejaculation frequency may be one of those steps.

The right amount of sex

In a nutshell, the right amount depends on your own body. No two men are exactly alike. It depends on your genetics. And, what you eat. How well you sleep and exercise is also important. And so is stress management. Highly stressed men almost always develop sexual problems. For them, impotence is common. If you are in generally good health, this is the rule of thumb for frequency in Chinese medicine:

  • Teens: 1 to 2 times a day can be OK!
  • 20s: 3 to 7 times a week is normal
  • 30s: 3 to 4 times a week is maximum
  • 40s: 1 to 2 times a week
  • 50s: about 1 time a week
  • 70s and beyond: maybe once every 3 or 4 weeks.

For those who are incapable of ejaculation, prostate milking and correct prostate massage are recommended. The only way to find out what is right for you is by trial and error.

Questions frequently ask:

  • Does sex harm your prostate gland?
  • Is sex good for your prostate?
  • Is too much sex harmful?
  • Is too little sex harmful?
  • What about if you have a prostate problem?
  • What about sex after prostate surgery?
  • What about sex after prostate cancer?
  • What about prostate massage benefits?
  • Can prostate massage be non-sexual?
  • What about sexual prostate massage?
  • What erectile difficulties can happen?
  • What happens if we release sperm daily?
  • How often should a man release sperm?
  • How many times should a man release sperm in a day, week or month?
  • Are there side effects or disadvantages of not releasing sperm?
  • Does ejaculation differ in masturbation versus intercourse?
  • What happens if a man never releases sperm?
  • Does sex harm your prostate gland?

These questions trouble men and often men are afraid to ask them or share with other men.

The obvious answer is NO! Safe sex in general is beneficial to the prostate in many ways and the number of times is not a precursor to prostate health!

Nyarkotey’s findings from the studies:

  1. A 2008 study by Dimitropoulou et al determined that men were more likelyto develop prostate cancer if they were very sexually active in their 20s and 30s. The study also found no conclusive evidence that masturbation provide greater risk than intercourse.
  2. The Harvard study by Leitzmann et al 2004  did not support the age-related findings from the 2008 study. It found no increased risk of prostate cancer related to age of ejaculation, though it did show that the benefits increase as a man ages.
  • The Australian studyby Giles et al 2003 demonstrated a reduced risk of prostate cancer if frequent ejaculation occurred during young adulthood.
  1. Ejaculation also doesn’t seem to provide protection against advanced or aggressive prostate cancer.

Nyarkotey’s perspective on how much is your risk reduced by ejaculation?

  1. The Harvard study of nearly 30,000 health professionals determined that risk of prostate cancer was reduced by 20 percent for men who ejaculated 21 times a month, compared to men who ejaculated four to seven times a month.
  2. The Australian study found the risk was reduced by 36 percentwhen men ejaculated seven times a week.


  1. In a nut shell, ejaculation is beneficial to prostate health and the number of times is insignificant.
  2. one study by Dimitropoulou et al   suggests ejaculation is only an effective preventative measure in men age 50 and older and not the young men.
  • Basil H Aboul-Enein et al 2016 study is inconclusive on masturbation and prostate cancer risk.
  1. ‘Safe’ sex is what must be encourage!
  2. The most important thing about sex and prostate health is about ejaculation and not the frequency per se. Remember, Zinc is instrumental in prostate health and the more you ejaculate per se, the more zinc is also release in the semen which could be detrimental to your prostate health.

For more on this subject, get a copy of my 900-page book on the prostate. The book is out for GH¢500 only. Enquiries call (0241083423/0541234556). It is a well research book on the prostate health. Thank you

>>>The author is a renowned holistic doctor and Vinnytsia State Pedagogical University, Ukraine, honorary professor of holistic and Naturopathic Medicine and currently pursuing, LLB law. Dr. Nyarkotey is also a chartered Management Consultant-Chartered Institute of Management Consultants, Canada and President of Nyarkotey College of Holistic Medicine & RNG Medicine Research Lab, Tema community 18. He is the formulator of FDA approved Nyarkotey Hibiscus Tea for Cardiovascular Support and wellness, Men’s Formula for Prostate Health and Women’s Formula for wellness. Contact: 0241083423/0541234556

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