I have taken with keen interest the many reports in our media space educating men that frequent ejaculation reduces men’s risk of prostate cancer.

However, what the report also failed to do is to educate the men as well that studies also confirmed that more multiple sexual partners a man has increased his risk of prostate cancer. Sex and Prostate Health are important issues that need sound education. 

Also, whether too little can lead to stagnation and too much can weaken the body by depleting energy reserves is another issue. For instance, Monks and recluse meditators benefited from non-sexual prostate massage because otherwise, a stagnant prostate could not eliminate toxins in celibate monks. Prostate massage provides stimulus to the prostate resulting in increased blood flow, fluid movement, and improved prostate health.

Ronald M Bazaar, author of the Healthy Prostate notes that in the Tantric and Taoist traditions of the East, advanced sexual techniques were developed so that men could control their ejaculations. It was thought that frequent ejaculations would weaken a man. So techniques of injaculation were developed whereby semen is released internally and retained in the body.

Developing control of the male G-spot, the prostate gland, is how this was done. This spot is the perineum area just about an inch below the scrotum.  The question of how often to ejaculate is another issue.  In those Eastern traditions, the older a man became, it was recommended he ejaculate less ... But injaculations were fine. According to Traditional Chinese Medicine, one should ejaculate using your decade for the number of times per day: eg. If you are under 30, then every 3 days, if you are under 70 every 7 days.

In this article, I examined the literature attesting to the facts about men’s prostate health and sex from two perspectives: whether frequent ejaculation reduces men’s prostate cancer risk and also whether multiple sexual partners increase their prostate cancer risk as well.

Does sex harm your prostate gland?

The obvious answer is NO!

Sex in general is very good for your prostate. We were designed to have sex as a natural part of life. Releasing seminal fluids and ejaculation both produced in the prostate and other areas of the sexual organs is highly beneficial to the prostate because it moves fluids that can stagnate in the prostate.

However, that all said, there may be times when we have to be careful around the prostate. Sex and prostate health do go hand in hand!

Is sex good for your prostate?

Sex is a natural and very beneficial function for the prostate gland because it moves fluids and helps to reduce toxins that can build up in the prostate gland. Remember one of the functions of the prostate is to remove toxins. One of the reasons that prostate massage is recommended is to help in the removal of these toxins. Sex does this automatically as long as we ejaculate.

The question of Multiple Sexual Partners and Prostate Cancer Risk

I examined the first question on whether the more women men sleep with it increases their prostate cancer risk based on sound literature.  The first study was conducted by Rosenblatt et al.  (2001)   a 3-year population-based case-control study of prostate cancer performed in King County, Washington, in White men and Black men aged 40–64 years, between 1993 and 1996.  They found risk estimates increased directly with the lifetime number of female sexual partners a man has sex with.  I have much interest in this particular study because black men were involved and associations with more female partners were found.

Also, the second study was done by Dennis and Dawson(2002), a meta-analysis of the association between prostate cancer and aspects of sexual activity. These results indicate an association between prostate cancer and sexually transmitted infections, suggesting that infections may represent one mechanism through which prostate cancer develops. In this study, multiple sexual partners were not found.

Another study (Stark et al.2009) found a quarter of men with prostate cancer showed signs of trichomoniasis, and these were more likely to have advanced tumours. The study suggests how the sexually transmitted infection might make men more vulnerable to prostate cancer, although it is not definitive proof of such a link. So you will also note that in this study and Dennis and Dawson(2002), multiple sexual partners were not found but prostate cancer was linked to STDs.

Another review(Kotb et al. 2015) found multiple sexual partners may be protective against prostate cancer, excluding the risk of sexually transmitted infections. The study further held that Homosexual men are at a greater risk for the diagnosis of prostate cancer. Interestingly, this study rather contradicts those who found multiple sexual partners and prostate cancer risk and rather said the more women, men sleep with protects them from prostate cancer if and only if men can prevent contracting STDs from multiple partners.

A more recent study done by Cirakoglu et al.(2018) assessed the relationship between the number of sexual partners, age of first sexual experience, and age of first masturbation and prostate cancer incidence. The study was done between January 2013 and September 2016 and found that at younger ages and present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded.  They concluded that there may be an association between the number of sexual partners and prostate cancer. They concluded that avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer.

Another was done by Minas et al.(2018) who found that sexual activity may increase the risk of prostate cancer due to the contraction of sexually transmitted infections. This study, however, did not assess the number of lifetime female partners engaged.

Fast forward, (Grabovac et al. 2019) investigated this possibility and enrolled about 2,500 men and 3,200 women who were 50 or older (average age 64). Each person was surveyed about the total number of sexual partners they’d had throughout their lives. This information was compared with several medical conditions they’d developed, including cancer, heart disease, and stroke.

The study demonstrated that:

• Men who reported 10 or more sexual partners in their life were nearly 70% more likely to have developed cancer when compared with those reporting 0 or 1 lifetime sexual partner.
• For women, the findings were even more dramatic: women who reported 10 or more sexual partners in their life were nearly 91% more likely to have developed cancer when compared with those reporting 0 or 1 lifetime sexual partner.

Men were more likely than women to report having at least 10 partners (22% of men vs. 8% of women) while women were more likely to have fewer partners (41% of women and 28.5% of men reported having had 0 to 1 partner).

It’s worth noting this study was performed in England with health information initially collected in the late 1990s. The results could have been different if researchers had assessed the risk of a different population or at a different point in time. In addition, self-reporting was relied upon to assess sexual behavior, and no association was found.

Does this mean having sex leads to cancer?

The answer is almost surely no.

That’s because this type of study cannot assess whether sex causes cancer. It can only determine whether there is a correlation between the two. Also, we already know of ways that sexual behavior can indirectly affect cancer risk without actually causing cancer, especially through sexually transmitted infections. Some of the strongest connections are for:

• Human papilloma virus (HPV), which increases the risk of cancers of the cervix, mouth, penis, and anus
• Human immunodeficiency virus (HIV) infection, which increases the risk of cancers such as Kaposi’s sarcoma and lymphoma
• Hepatitis B and hepatitis C infection, which have been linked to liver cancer
• Gonorrhea, increases the risk of prostate cancer (particularly among African American men).

Though negative studies have been confirmed with multiple partners and prostate cancer risk, others (Spencer et al. 2014; Kotb et al. 2015)  ) contradict this assertion and found that males who had more than 20 female sexual partners had a decreased risk of prostate cancer. The study also found that males with more than 20 male sexual partners may have an increased risk of prostate cancer.

What are Multiple Sexual Partners?

Mutinta, G(2018) defines having multiple sexual partners as “having more than one sexual partner over some time.” This may mean having one sexual partner, then another. Or it may mean having more than one sexual partner within the same time frame. This article looks at the average number of sexual partners that people may have. It also explores some possible benefits and risks of having multiple sexual partners.

The Question on the frequency of ejaculation

Now that we are done with the first question on whether more women increase men's risk of prostate cancer. Let us now examine the science on whether the more we ejaculate increase or decrease our chances of prostate cancer.You may have heard of the prostate gland — part of the male reproductive system. It’s a small gland inside your body that makes fluid for your semen. This fluid gets carried out of your body when you ejaculate.

Because your prostate is involved in ejaculation, it’s natural to wonder: When it comes to getting prostate cancer, does ejaculation frequency matter? In other words, does ejaculating affect the risk of getting prostate cancer?

Here’s the short answer: It’s not clear. There’s some evidence that more frequent ejaculation might offer some protection against prostate cancer. But the reality is there isn’t enough research to say for sure. On the other hand, there’s clear evidence that sex does not cause prostate cancer. Ok, let's examine the literature.

The first study from Harvard was conducted by (Leitzmann et al. 2004) found that if you ejaculate frequently (21 times), your risk of getting prostate cancer may be reduced. Then, a previous study emerged from Australia ( Giles et al. 2003) points to seven times a week. But there is a catchphrase (Dimitropoulou et al. 2008) that says it is only a preventative mechanism in men aged 50 and older.

Aboul-Enein et al. (2016) also found that the age a man starts ejaculating is an important aspect of prostate cancer prevention. This study looks at ejaculation from the perspective of masturbation.

As age is important at the onset of ejaculation and prostate cancer reduction, Dimitropoulou et al. (2008) found that men were more likely to develop prostate cancer if they were very sexually active in their twenties and thirties. The study also found no conclusive evidence that masturbation provides greater risk than intercourse.

The Harvard study (Leitzmann et al. 2004) found no association with the age association findings from the 2008 study. It found no increased risk of prostate cancer related to the age of ejaculation, though it did show that the benefits increase as a man ages. 

The Australian study ( Giles et al. 2003) found a reduced risk of prostate cancer if frequent ejaculation occurred during young adulthood.  One study(Gottlieb, S. 2004), examined the sex life of over 50,000 American males between the ages of 40 and 75 and found that men reporting 21 or more ejaculations a month were less likely to get prostate cancer than men who ejaculated four to seven times a month.  Though the studies are conflicting on age and ejaculation and frequency.  It appears that the frequency of ejaculation benefits men in totality on a specific amount. How much?

One Harvard study, Rider et al.  (2016) reported similar findings with a 10-year follow-up study that reported that men who had frequent orgasms (defined as two or more a week) had a 20 percent reduced risk of prostate cancer and had a 50 percent lower mortality risk than those who had sex less often.  On the other hand, Giles et al.(2003) from Australia, found the risk was reduced by 36 percent when men ejaculated seven times a week.

In noting the difference, the first study was found in men who reported 21 or more ejaculations a month, and the second reported men who ejaculated two or more a week. So when we study the second study critically, it means that in a month these men also ejaculated about eight times and they also experienced a reduced risk of prostate cancer. This means that to reduce prostate cancer a man above 40years must ejaculate a minimum of twice a week.  In what accounts for the type of ejaculation, a previous review(Brody, S. 2010)  found that men who had more frequent penile-vaginal intercourse (PVI) had less risk of developing prostate cancer. This means not any type of ejaculation, but a man must have intercourse with a regular female partner to experience this reduced risk of prostate cancer.

Another study also found that men who averaged having 4.6 to 7 ejaculations a week were 36 percent less likely to receive a prostate cancer diagnosis before the age of 70. This is in comparison to men who reported ejaculating 2.3 or fewer times a week on average. This study is in support of Rider et al.  (2016) who attribute it to a minimum of twice per week.  For men, sex may even affect their mortality.  Although results are conflicting, the quality and health of our sperm may increase with increased sexual activity(Agarwal et al. 2016).

How sex reduces prostate cancer risk

One possible explanation for why frequent ejaculation might protect against prostate cancer is that it may help clear potentially cancer-causing substances from the prostate, 

Take Home

So does frequent ejaculation protect you from prostate cancer?There’s some evidence that ejaculating a lot is associated with a lower risk of prostate cancer, but the evidence isn’t good enough to say for sure one way or another. 

However, two studies present the best supporting evidence so far:

The first (Gottlieb, S. 2004), examined the sex life of over 50,000 American males between the ages of 40 and 75 and found that men reporting 21 or more ejaculations a month were less likely to get prostate cancer than men who ejaculated four to seven times a month.  Though the studies are conflicting on age and ejaculation and frequency.  It appears that the frequency of ejaculation benefits men in totality on a specific amount.

The second is Rider et al.(2016) analyzed about 30,000 men. This analysis found that people who ejaculated at least 21 days every month in the past had a 20% lower chance of getting prostate cancer — compared with those who ejaculated 4 to 7 times a month. 

As you can imagine, this study had some flaws. One problem was that the study relied on people to remember how much they ejaculated. The study used a survey — rather than analyzing the participants’ sexual activity going forward over time. This presented a problem because let’s face it, memory isn’t perfect. Though prostate cancer disparity exists, Sarma et al.(2006) explored the chronic inflammation hypothesis of prostate cancer development among black men by examining sexual activity, sexually transmitted diseases, and prostatitis in a population-based study of 129 patients and 703 controls 40 to 79 years old. Their findings support the significance of prior sexual practices, exposure to sexually transmitted microbial agents, and history of prostatic infection in the natural history of prostate cancer in black men.

Sex in general has health benefits. For instance, a recent study(Jackson et al. 2020)  found that increased frequency of sexual intercourse links to a lower risk of fatal heart problems, prostate cancer, and breast cancer. Among the 1,158 female and 1,046 male participants, who were 57–85 years old and lived in the U.S., the frequency and quality of sex had protective effects against cardiovascular problems in later life.

A more recent study(Gianotten et al. 2021) found that sexual activity releases endorphins, which researchers have linked to increased levels of natural killer cell activity. This activity involves helping to fight cancer cells and infections.

So the second question is does having a lot of sexual partners protect you from prostate cancer? Here also presents controversies and is not too clear. For instance, Spence et al.(2014) study found that men who had more than 20 female sexual partners in their life had a lower risk of getting prostate cancer.  A recent meta-analysis (Jian et al. 2018)   found the opposite — that the more female sexual partners someone had, the more their risk went up or put them at risk of getting prostate cancer.

Also, the Universite de Montreal(2014) study also found that men who have sex with men and who had 20 or more lifetime partners, had a higher risk of prostate cancer. The CDC held that these men are more likely to get STDs, and there may be a connection between STDs and prostate cancer in a recent study(Grabovac et al. 2020)

 — Though this hasn’t been proven yet, according to the American Cancer Society(2020).

Though it has been found that prostatitis (inflammation of the prostate gland) may be linked to an increased risk of prostate cancer, other studies have not found such a link. Inflammation is often seen in samples of prostate tissue that also contain cancer. The link between the two is not yet clear, and this is an active area of research.

Additionally, researchers have looked to see if sexually transmitted infections (like gonorrhea or chlamydia) might increase the risk of prostate cancer because they can lead to inflammation of the prostate. So far, studies have not agreed, and no firm conclusions have been reached.

To sum it up: Despite the research in this area, it’s just not clear how your number of sexual partners affects your cancer risk.  For instance, Ángeles-Garay et al.(2019)  found no association with the number of sexual partners or the frequency of sexual intercourse in the Mexican Population.  

Another interesting study examined marital status and how it relates to the incidence of prostate cancer. This study highlights elevated risks of incident prostate cancer among widowers, more often characterized by tumours that had spread beyond the prostate at the time of diagnosis(Salmon et al. 2021).

The bottom line

There’s not enough evidence to say for sure whether having a lot of sex — or ejaculating frequently — can protect you from prostate cancer. More research is needed in this area before we can provide a definitive answer.

So far there’s no evidence that sexual activity causes prostate cancer.  The augment is centered on the potential STDs men are more likely to contract from multiple sexual partners. Hence, it is advisable men with multiple partners use a condom to help protect them and their partner(s). For now, it’s safe to say that ejaculation won’t increase your risk, and it might even have protective effects in some cases.

What about sex after prostate surgery?

Sadly, sex after prostate surgery becomes a problem for many men who have gone under the knife. The reason is simple: the prostate erection nerves are easily damaged. Once this happens, normal sexual function can be compromised.

This new study proves the point:

• "Up to 10 years after treatment, more than 95 percent of men had some degree of sexual dysfunction, Taylor's team found. And about half had urinary symptoms."

What about sex after prostate cancer?

Similarly, sex and prostate health after prostate cancer depends a lot on the treatment type you have received. Prostate surgeries combined with chemotherapy are the worst in terms of sex after prostate cancer. Virtually all mainstream medical treatments for prostate cancer do not have good outcomes for sex and prostate health.

Remember that your prostate gland is crucial for so many functions and is easily compromised by modern treatments for prostate cancer. Studies now confirm that life expectancy is not improved by prostate cancer surgeries and interventions.

What about prostate massage benefits?

Prostate massage is very beneficial for sex and your prostate health. Why, because it removes toxins, allowing stronger and longer erections. Many men with erectile difficulties benefit from prostate massage.

Prostate massage can be non-sexual. It used to be routinely done by urologists up until about 30-40 years ago.

What about sexual prostate massage?

No doubt about it: for most men, sex and prostate health can be enhanced by sexual prostate massage. You get the release of maximum toxins this way as well as increased blood flow and flushing with the extra stimulation.

All that is needed is the intention to make the massage sexual, either done by yourself or your partner. The best way to do an internal sexual prostate massage is with a specially designed prostate massage device.

I hope this review helps you.

NB:

Prof. Nyarkotey has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations to justify his write-ups.  My articles are for educational purposes and do not serve as Medical advice for Treatment. I aim to educate the public about evidence-based scientific Naturopathic Therapies.

The writer is a Professor of Naturopathic Healthcare, President, of Nyarkotey College of Holistic Medicine & Technology (NUCHMT)/African Naturopathic Foundation. E-mail: collegeofholisticmedicine@gmail.com. For more information, contact: Stephanie(PRO)on 0244433553

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