Research paper
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Benefits of sexual activity for women
The content of this document is OFFICIAL.
Please note:
The research and literature reviews collated by our TAB Research Team are not to be shared
external to the Branch. These are for internal TAB use only and are intended to assist our
advisors with their reasonable and necessary decision-making.
Delegates have access to a wide variety of comprehensive guidance material. If Delegates
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The Research Team are unable to ensure that the information listed below provides an
accurate & up-to-date snapshot of these matters
Research questions:
What are the general health benefits of partnered sexual activity with a paid sex worker for a
single woman in their 30s, compared to benefits from partnered sexual activity within a
relationship?
What are the risks and harms for women who use the services of a sex worker?
What general health benefits are associated with sexual activity?
What is the frequency of sexual activity required to gain beneficial health outcomes?
Date: 20/05/2024
Requestor: Paula s22(1)(a)(ii) - irrelevant
s22(1)(a)(ii) - irreleva
Endorsed by: Jane
Researcher: Aaron s22(1)(a)(ii)
- irrelevant mat
Cleared by: Stephanie s22(1)(a)(ii) - irrelevant mate
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1. Contents
Benefits of sexual activity for women ......................................................................................... 1
1. Contents .......................................................................................................................... 2
2. Summary ......................................................................................................................... 2
3. Women who engage sex workers ................................................................................... 3
3.1
Risks ........................................................................................................................ 4
4. Health benefits of sexual activity ..................................................................................... 4
4.1
Quality of life ............................................................................................................ 5
4.2
Cardiovascular health .............................................................................................. 5
4.3
Immune system ........................................................................................................ 6
4.4
Pain .......................................................................................................................... 7
4.5
Sleep ........................................................................................................................ 7
4.6
Stress and mood ...................................................................................................... 8
4.7
Memory and cognition .............................................................................................. 8
5. References ...................................................................................................................... 9
2. Summary
There is consistent evidence that sexual activity is correlated with positive health outcomes for
women. However, the current evidence cannot establish causal direction. One recent review
summarises the available evidence “it cannot yet be proved that ‘good sex promotes good
health’ since good health also favors good sex” (Gianotten et al; 2021, p.478).
There is inconsistent evidence regarding frequency of sexual activity correlated with positive
health outcomes. Some studies indicate sexual activity at least once per week is associated
with more beneficial outcomes. However, this varies with outcome, relationship type, type of
sexual activity and other contextual factors.
Some studies speculate that positive outcomes related to sleep, stress, mood, and quality of
life that are correlated with sexual activity may be mediated through stable and committed
relationships. However, as evidence is not clear on direction of causation, it is difficult to
determine the most important factors contributing to positive outcomes.
To establish a causal role for sexual activity and to understand required frequency of sexual
activity for achieving positive outcomes would require further high-quality studies with
appropriately experimental and controlled study designs.
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Minimal research was found detailing the experiences of women who engage sex workers.
Qualitative studies note several self-reported benefits including pleasure, confidence, self-
efficacy, and convenience. Some women also report that engaging sex workers assists them
to heal and recover from physical or psychological injury or illness. No experimental studies
were found to establish positive or negative outcomes for women who engage sex workers.
3. Women who engage sex workers
Most health and social science research relating to sex work focusses on interactions between
female sex workers and male clients (Kingston et al, 2022; Kingston et al, 2020; Berg et al,
2020; Caldwell, 2018; Wotton, 2016). In their review, Berg et al (2020) found 25 articles that
focus on women as buyers of sex from men. Of these, 19 focussed on romance tourism, or the
practice of women engaging sex workers while travelling in other countries. There is a growing
research effort underway to understand the motivations and practices of women who engage
sex workers, though this research is still minimal (Kingston et al, 2022; Kingston et al, 2020;
Berg et al, 2020; Caldwell, 2018; Wotton, 2016). No experimental studies were found to
establish positive or negative outcomes for the women who engage sex workers.
Qualitative studies that discuss the motivations of women who engage sex workers note
several self-reported benefits. Study participants who prefer commercial sexual interactions
suggest they are more pleasurable, more satisfying, more therapeutic, more convenient, and
safer than non-commercial sexual interactions.
One primary reason for engaging sex workers is the desire for sexual and emotional
satisfaction, including feelings of intimacy and self-confidence (Kingston et al, 2022; Berg et al,
2020; Kingston et al, 2020; Caldwell, 2018; Wotton, 2016). Some women say they engage sex
workers because the worker is more responsive to their preferences and needs than non-
commercial sex partners. In addition, women can schedule the interactions to suit other
demands in their life. Study participants say this can be more convenient than sex within a
relationship or that it is a convenient means to access sexual pleasure when not in a
relationship. Study participants also note that this contributes to a sense of self-efficacy and
allows them to achieve a control over the situation that is not possible in non-commercial
interactions (Kingston et al, 2022; Berg et al, 2020; Kingston et al, 2020; Caldwell, 2018;
Wotton, 2016).
Some studies suggest women with disability may engage sex workers to overcome past
traumatic sexual experiences and to satisfy sexual needs in a way that is inaccessible in non-
commercial relationships (Kingston et al, 2022; Wotton, 2016). In her doctoral thesis, Caldwell
(2018) found the most common reason given for engaging a sex worker was to address
physical or mental health conditions (10 of 21 study participants). Several participants
conceptualised the practice as therapy. The author notes:
conditions indicating a need for therapy were, vaginismus (3), healing from intimate
partner violence (3), healing from childhood sexual abuse (2), “trans issues” (1), and
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depression and stress (1). The combined goals of therapy were, to achieve physical
penetration, to learn about bodies and sexuality, and to practise good sexual
communication around boundaries and consent (Caldwell, 2018, p.148).
3.1 Risks
No experimental studies were found that describe positive or negative outcomes for women
who engage sex workers. Qualitative studies mainly focus on motivating factors and reasons
to pursue commercial sexual interactions rather than risks, harms or reasons to avoid
commercial sexual interactions.
Lancaster University in the UK has released a health and safety guide containing advice for
woman who choose to engage a sex worker (Kingston et al, 2022). The authors note:
As with any sexual encounter, commercial or not, there are sexual safety strategies that
can employed to stay safe. While our study documented largely positive experiences of
purchasing commercial sex by women clients, this may not be the experience of all
women clients (Kingston et al, 2022, p.4).
Precautions and positive strategies used to maintain health and safety in commercial sexual
interactions are listed in detail in Women Who Buy Sex – Health and Safety Guide.
4. Health benefits of sexual activity
It is widely acknowledged that sexual activity is part of a healthy lifestyle. This is supported by
established correlations between more frequent sexual activity and positive outcomes such as
quality of life, longevity, strong relationships and better physical and mental health (Bagherinia
et al, 2024; Gianotten et al, 2021; Ueda et al, 2020). Online sources claiming a variety of
possible benefits of sexual activity for women including improvements to:
quality of life
fitness and muscle strength
blood pressure and cardiovascular health
immune
system
bladder
control
pain
sleep
self-esteem,
mood
and
emotional regulation
stress
levels
memory and cognition
relationships (Wilson & Rogers, 2023; Centre for Women’s Health, n.d.).
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While some studies support correlations of positive outcomes with frequency of sexual activity,
there is less clear evidence regarding the connections between types of sexual activity,
frequency of sexual activity, specific positive outcomes, and variables which might mediate the
connection between sexual activity and outcomes (Gianotten et al, 2023; Gianotten et al,
2021). For example, most studies have been unable to establish a causal role for sexual
activity. It may be that more frequent sexual activity promotes better health outcomes, or that
healthy people with strong relationships have the desire and opportunity for more frequent and
positive sexual experiences. It is also possible that sexual activity and positive health
outcomes are mutually reinforcing.
In their 2021 review, Gianotten et al summarise the available evidence, “For the time being, it
cannot yet be proved that ‘good sex promotes good health’ since good health also favors good
sex” (p.478). To establish a causal role for sexual activity in achieving positive outcomes would
require further high-quality studies with an appropriately experimental and controlled study
design (Bagherinia et al, 2024; Gianotten et al, 2021).
4.1 Quality of life
There is evidence of positive correlations between sexual activity and quality of life
(Boyacıoğlu et al, 2023; Gianotten et al, 2021; Smith et al, 2019; Flynn & Gow, 2015).
Boyacıoğlu et al (2023) found that more frequent sexual activity was associated with better
quality of life but not with psychological well-being in adults over 60 years old. This relationship
held for both men and women. A study of 558 menopausal women found quality of life was
significantly correlated with sexual activity and sexual self-efficacy (Jalali et al, 2021). Other
large sample observational studies have found more frequent sexual activity is correlated with
better quality of life in middle aged and older adults (Gianotten et al, 2021).
The functional and health domains including in the definition of quality of life can be a
complicating factor in assessing the relationship between sexual activity and quality of life.
Sexual expression is often included as a component of quality of life via the idea of sexual
quality of life (Bagherinia et al, 2024; McHugh et al, 2022):
Sexual quality of life is the person’s assessment of positive and negative aspects of their
sexual life and their response to this assessment. Sexual quality of life is tightly
interwoven with the extent of satisfaction with life and general level of quality of life. Low
Sexual quality of life can refect the health status and general quality of life (Bagherinia et
al, 2024, p.2).
4.2 Cardiovascular
health
Sources report a correlation between frequency of sexual activity, lower blood pressure and
better cardiovascular health (Wilson & Rogers, 2023; Gianotten et al, 2023; Gianotten et al,
2021; Ueda et al, 2020; Centre for Women’s Health, n.d). A large study of 15,269 adults with a
mean age of 40 years showed lower risk of death due to cardiovascular disease in people
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reporting sexual activity at least 52 times per year (Cao et al, 2020). In a large-scale
longitudinal study of older adults, Liu et al (2016) found
high frequency of sex is positively related to later risk of cardiovascular events for men
but not women, whereas good sexual quality seems to protect women but not men from
cardiovascular risk in later life. We find no evidence that poor cardiovascular health
interferes with later sexuality for either gender (Liu et al, 2016, p.276).
Several mediating factors may explain the associations between sexual activity and
cardiovascular health, e.g. quality of life, stress, relationship strength or other lifestyle factors.
One possible explanation for this correlation is that sexual activity can be good cardiovascular
exercise. A 2022 systematic review found evidence that partnered sexual activity can be
considered a moderate intensity exercise. Physical exertion and energy expenditure is
generally higher in men than in women, though this depends on several contextual factors
including duration, position, and health status (Oliva-Lozano et al, 2022).
4.3 Immune
system
Online sources which note the possible beneficial effect of sexual activity on the immune
system usually cite a single 2004 study (Wilson & Rogers, 2023; Gianotten et al, 2021;
Charnetski & Brennan, 2004; Centre for Women’s Health, n.d.). This study showed university
students who have sex 1 – 2 times per week have higher levels of salivary immunoglobulin A,
an antibody which is taken to indicate overall immune system health. This was not observed in
students who reported sexual activity 3 – 4 times per week. One explanation for this effect
hypothesises stress as a mediator, since there is evidence that lower stress levels is
correlated with high levels of immunoglobulin A (Gianotten et al, 2021; Charnetski & Brennan,
2004).
Lorenz et al (2018) suggest that it is likely that sexual activity does have some association with
immune response, though the relationship between sexual activity and immune response may
be more complex:
Several recent studies have suggested that sexual activity may moderate immune
responses in healthy individuals. These effects appear to be particularly relevant in
women’s immune responses, as there are trade-offs between immunity and
reproduction: Although the female immune system must defend against pathogens, it
cannot risk accidentally attacking or rejecting sperm or conceptus. Sexual activity may
thus serve as a trigger to modulate immune response, promoting defense during
nonfertile times but allowing a more permissive environment around ovulation, during
maximal fertility. Although beneficial for conception, this “window of opportunity” may
increase infection risk. Indeed, several studies have suggested that healthy sexually
active women show significant cycle-related variation in immune responses while
sexually abstinent women do not (Lorenz et al, 2018, p.2).
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4.4 Pain
Some women report sex, masturbation and orgasm as pain relief strategies (Wehrli et al,
2024; Wilson & Rogers, 2023; Gianotten et al, 2023; Gianotten et al, 2021; Centre for
Women’s Health, n.d). Several mechanisms might account for analgesic effect of sexual
activity:
Sexuality might alleviate pain by providing a source of distraction, but there might be
additional pathways. One study found that pressure stimulation of the anterior vaginal
wall and self-stimulation of the clitoris had an analgesic effect, reaching maximum effect
with orgasm. Endorphins might also explain the pain-reducing effect of sexual activity,
along with oxytocin. Women with higher oxytocin levels have a higher pain threshold.
Muscle relaxation might contribute to the pain-reducing effects of sexual activity: Clinical
practice in patients with multiple sclerosis and research in patients with spinal cord injury
show that sexual vibration and orgasm can produce reductions in spasm and muscle
relaxation that last for several hours (Gianotten et al, 2021, p.481).
Observational studies show mixed results. In a survey study of 370 women, 7 women reported
using masturbation for pain relief (Wehrli et al, 2024). Pain relief during or after sexual activity
was reported in a small proportion of migraine and cluster headache patients (Wilson &
Rogers, 2023; Hambach et al, 2013). Men were twice as likely to experience pain relief
compared to women and a larger proportion of patients reported that sexual activity worsens
pain symptoms (Hambach et al, 2013). Studies have found no significant association between
frequency of sexual activity and pain for menopausal women (Waetjen et al, 2022) and women
with fibromyalgia (Karpuz et al, 2024). Further research is required to determine the extent of
analgesic effect, types of pain, types of sexual activity and circumstances associated with an
analgesic effect (Wehrli et al, 2024).
4.5 Sleep
Frequency and quality of sexual activity are correlated with better sleep outcomes, though the
causal direction is unclear (Gianotten et al, 2021). Sracjer et al (2023) conducted a survey of
almost 800 people with a mean age of 34.5 years. They found more frequent orgasm, stable
relationships and emotional satisfaction with sex are all associated with falling asleep faster for
both men and women. A survey study of 224 people with a mean age of 22 years supports the
association of partnered sex with better sleep quality and reduced time to fall asleep
(Oesterling et al, 2022).
Several studies show women report using masturbation as a strategy to help fall asleep
(Wehrli et al, 2024). However, the same study complicates results related to orgasm and
masturbation:
both men and women perceive partnered sex and masturbation with orgasm to improve
sleep latency and sleep quality, while sexual activity without orgasm is perceived to
exert negative effects on these sleep parameters, most strongly by men... [However,]
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analyses revealed that only partnered sex with orgasm was associated with a
significantly reduced sleep latency and increased sleep quality. Sexual activity without
orgasm and masturbation with and without orgasm were not associated with changes in
sleep (Oesterling et al, 2022, p.1).
There are also good physiological reasons to suppose that sexual activity assists people to fall
asleep faster. The biochemical processes associated with sex and orgasm (increased
oxytocin, lower cortisol, endorphins etc.) have a calming and sedative effect (Wilson & Rogers,
2023; McHugh et al, 2022; Gianotten et al, 2021).
4.6 Stress and mood
Studies consistently show that sexual activity is correlated with lower stress levels and
increased mood:
Chronic stress has a significant negative impact on female sexual health. Chronic stress
is associated with decreased sexual thoughts, desire, and physiologic genital arousal.
Stress-related distraction from sexual stimuli, low mood, and anxiety all play a role.
Conversely, orgasm isfound to coincide with the release of prolactin, which may reduce
stress (McHugh et al, 2022, p.582).
Results from mixed-effects models suggest that being sexually active, having sex more
frequently, feeling okay with sexual frequency, and reporting better sexual quality were
all related to better mental health outcomes. Relationship quality partially explained the
effects of sex on mental health (Zhang & Liu, 2020, p.1772).
Women report using masturbation as a coping strategy to manage stress and distress (Wehrli
et al, 2024) and there is consistent evidence that depression scores are correlated with sexual
activity. People who are depressed have less partnered sex, and this is true of both women
and men (Karpuz et al, 2024; Yavuzkir et al, 2024; Wilson & Rogers, 2023; Gianotten et al,
2023; Li et al, 2022; Gianotten, 2021; Mollaioli et al, 2021; Centre for Women’s Health, n.d.).
The direction of causation between sexual activity and stress or mood is still unknown:
The physical act of sex may alleviate stress directly in the same way as does any
exercise. Sex may also work indirectly through the increased access to coping
resources such as emotional support from a sexual relationship, which may alleviate the
negative effect of stress. The efficacy of sexual activity for relieving stress may depend
on the quality of the experience, with only satisfying sex reducing stress, in much the
same way as only marriages of high quality improve physical health (Liu et al, 2016,
p.5).
4.7 Memory
and
cognition
There is minimal evidence indicating sexual activity is associated with better cognitive function
in later life, though the evidence is not straight forward. A large longitudinal study of older
adults found better quality sexual activity was associated with better cognitive functioning in
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people aged 62-74 but not in those aged 75 – 90. The authors also found more frequent
sexual activity was associated with better cognitive functioning in the 75 – 90 age group, but
not the 65 – 74 age group (Shen et al, 2023).
There is less evidence regarding cognitive function in younger people. Following on from
animal studies, a 2017 study investigated the relationship between frequency of sexual activity
and memory performance in of 80 women aged 18 – 29 (Maunder et al, 2017). The authors
found that frequency of male-female partnered sexual activity was associated with higher
scores on abstract word memory tests. The authors found no correlation with memory of faces.
5. References
Bagherinia, M., Dolatian, M., Mahmoodi, Z., Ozgoli, G., & Alavi Majd, H. (2024). Predictors of
social intermediate factors associated with sexual quality of life of women: systematic
review and meta-analysis.
BMC women's health,
24(1), 64.
https://doi.org/10.1186/s12905-024-02899-2
Berg, R. C., Molin, S. B., & Nanavati, J. (2020). Women Who Trade Sexual Services from
Men: A Systematic Mapping Review.
Journal of sex research,
57(1), 104–118.
https://doi.org/10.1080/00224499.2019.1624680
Boyacıoğlu, N. E., Oflaz, F., Karaahmet, A. Y., Hodaeı, B. K., Afşin, Y., & Taşabat, S. E.
(2023). Sexuality, quality of life and psychological well-being in older adults: A
correlational study.
European journal of obstetrics & gynecology and reproductive
biology X, 17, 100177. https://doi.org/10.1016/j.eurox.2023.100177
Caldwell, H. J. (2018).
Women who buy sex in Australia: From social representations to lived
experiences [Thesis]. University of New South Wales.
https://unsworks.unsw.edu.au/entities/publication/00ec4570-9691-46fc-8b5a-
39076cf298f3
Cao, C., Yang, L., Xu, T., Cavazos-Rehg, P. A., Liu, Q., McDermott, D., Veronese, N.,
Waldhoer, T., Ilie, P. C., Shariat, S. F., & Smith, L. (2020). Trends in Sexual Activity and
Associations With All-Cause and Cause-Specific Mortality Among US Adults.
The
journal of sexual medicine,
17(10), 1903–1913.
https://doi.org/10.1016/j.jsxm.2020.05.028
Centre for Women’s Health. (n.d.).
The benefits of a healthy sex life. Oregon Health and
Science University. https://www.ohsu.edu/womens-health/benefits-healthy-sex-life
Charnetski, C. J., & Brennan, F. X. (2004). Sexual frequency and salivary immunoglobulin A
(IgA).
Psychological reports,
94(3 Pt 1), 839–844. https://doi.org/10.2466/pr0.94.3.839-
844
Flynn, T-J. & Gow, A. J. (2015). Examining associations between sexual behaviours and
quality of life in older adults.
Age and Ageing,
44(5). 823–828.
https://doi.org/10.1093/ageing/afv083
Benefits of sexual activity
Page 9 of 11
OFFICIAL
Page 94 of 96
Research paper
FOI 23/24-1401
OFFICIAL
For Internal Use Only
Gianotten, W. L., Alley, J. C., & Diamond, L. M. (2021). The Health Benefits of Sexual
Expression.
International journal of sexual health,
33(4), 478–493.
https://doi.org/10.1080/19317611.2021.1966564
Gianotten, W. L. (2023).
The Health Benefits of Sexual Expression. In Geuens, S., Polona
Mivšek, A., & Gianotten, W. [Eds]Midwifery and Sexuality (p. 368). Springer Nature.
https://doi.org/10.1007/978-3-031-18432-1
Hambach, A., Evers, S., Summ, O., Husstedt, I. W., & Frese, A. (2013). The impact of sexual
activity on idiopathic headaches: an observational study.
Cephalalgia: an international
journal of headache,
33(6), 384–389. https://doi.org/10.1177/0333102413476374
Jalali, T., Bostani Khalesi, Z., & Jafarzadeh-Kenarsari, F. (2021). The Association between
Sexual Self-Efficacy and the Quality of Life among Menopausal Women.
Journal of
menopausal medicine,
27(2), 87–93. https://doi.org/10.6118/jmm.21006
Karpuz, S., Yilmaz, R., Akdere, E., Aksanyar, B., Tuncez, I. H., & Yilmaz, H. (2024). The Effect
of Frequency of Sexual Intercourse on Symptoms in Women with Fibromyalgia.
Medical
Bulletin of Sisli Etfal Hospital,
58(1). https://doi.org/10.14744/SEMB.2023.97254
Kingston, S., Hammond, N., & Redman, S. (2020).
Women who buy sex: Converging
sexualities? Routledge.
Kingston, S., Hammond, N., Redman, S., Stoops, S., Langley, S. (2022).
Women who buy
sex: Health and Safety Guide. The University of Central Lancashire.
https://clok.uclan.ac.uk/44330/
Lorenz, T. K., Heiman, J. R., & Demas, G. E. (2018). Interactions Among Sexual Activity,
Menstrual Cycle Phase, and Immune Function in Healthy Women.
Journal of sex
research,
55(9), 1087–1095. https://doi.org/10.1080/00224499.2017.1394961
McHugh, J., Alexander, M., Kudesia, R., Krant, J., Comander, A., Tollefson, M., & Geyer, C.
(2022). Living Your Best Life: Lifestyle Medicine for All Women.
American journal of
lifestyle medicine,
16(5), 577–588. https://doi.org/10.1177/15598276221087677
Mollaioli, D., Sansone, A., Ciocca, G., Limoncin, E., Colonnello, E., Di Lorenzo, G., & Jannini,
E. A. (2021). Benefits of Sexual Activity on Psychological, Relational, and Sexual Health
During the COVID-19 Breakout.
The journal of sexual medicine,
18(1), 35–49.
https://doi.org/10.1016/j.jsxm.2020.10.008
Oesterling, C. F., Borg, C., Juhola, E., & Lancel, M. (2023). The influence of sexual activity on
sleep: A diary study.
Journal of sleep research,
32(4), e13814.
https://doi.org/10.1111/jsr.13814
Shen, S., & Liu, H. (2023). Is Sex Good for Your Brain? A National Longitudinal Study on
Sexuality and Cognitive Function among Older Adults in the United States.
Journal of
sex research,
60(9), 1345–1355. https://doi.org/10.1080/00224499.2023.2238257
Benefits of sexual activity
Page 10 of 11
OFFICIAL
Page 95 of 96
Research paper
FOI 23/24-1401
OFFICIAL
For Internal Use Only
Smith, L., Yang, L., Veronese, N., Soysal, P., Stubbs, B., & Jackson, S. E. (2019). Sexual
Activity is Associated with Greater Enjoyment of Life in Older Adults.
Sexual medicine,
7(1), 11–18. https://doi.org/10.1016/j.esxm.2018.11.001
Sprajcer, M., O’Mullan, C., Reynolds, A., Paterson, J. L., Bachmann, A., & Lastella, M. (2022).
Sleeping together: understanding the association between relationship type, sexual
activity, and sleep.
Sleep Science,
15(S 01), 80-88. https://doi.org/10.5935/1984-
0063.20220005
Ueda, P., Mercer, C. H., Ghaznavi, C., & Herbenick, D. (2020). Trends in Frequency of Sexual
Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US,
2000-2018.
JAMA network open,
3(6), e203833.
https://doi.org/10.1001/jamanetworkopen.2020.3833
Waetjen, L. E., Johnson, W. O., Xing, G., Hess, R., Avis, N. E., Reed, B. D., Dugan, S. A.,
Neal-Perry, G., Gold, E. B., & Study of Women's Health Across the Nation (SWAN)
(2022). Patterns of Sexual Activity and the Development of Sexual Pain Across the
Menopausal Transition.
Obstetrics and gynecology,
139(6), 1130–1140.
https://doi.org/10.1097/AOG.0000000000004810
Wehrli, F. S. V., Bodenmann, G. J., Clemen, J., & Weitkamp, K. (2024). Exploring the Role of
Masturbation as a Coping Strategy in Women.
International Journal of Sexual Health,
1–20. https://doi.org/10.1080/19317611.2024.2344812
Wilson, D. R. & Rogers, P. (2023). The Health Benefits of Sex. Healthline.
https://www.healthline.com/health/healthy-sex-health-benefits
Wotton, R. A. (2016).
Sex workers who provide services to clients with disability in New South
Wales, Australia [Thesis]. University of Sydney. http://hdl.handle.net/2123/16875
Yavuzkir, Ş., Aslan, M., Yurt, N., & Baykara, S. (2024). Association between non-penetrative
sexual activities and depression in women with vaginismus: a cross-sectional study.
The Journal of international medical research,
52(4), 3000605241244762.
https://doi.org/10.1177/03000605241244762
Zhang, Y., & Liu, H. (2020). A National Longitudinal Study of Partnered Sex, Relationship
Quality, and Mental Health Among Older Adults.
The journals of gerontology.
Series B,
Psychological sciences and social sciences,
75(8), 1772–1782.
https://doi.org/10.1093/geronb/gbz074
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