'Oral sex helps women fight depression' claim

“Oral sex is good for women’s health and helps fight depression”, was the Daily Mail’s lurid headline today, while The Sun opted for a more straightforward “Semen is good for you”.

The “news” is based on research that is more than 10 years old. The facts used to support the lascivious claims come from a small study looking at depression scores of women students who used condoms during sexual activity compared with those who did not. It found that sexually active women who did not use condoms reported fewer depressive symptoms than those who did. From this the researchers seem to assume that semen may have antidepressant qualities.

This study is full of holes – and extreme caution should be used when interpreting anything from it. Researchers only gleaned information about depression symptoms (not diagnoses of depression), how often the women had sex, and whether they used condoms, via an anonymous questionnaire. All of these facts greatly limit the reliability of the results.

This type of cross-sectional study (symptoms and sexual behaviour assessed at the same time) cannot prove cause and effect – as the authors acknowledge. There are likely to be many other unmeasured personal factors in a woman’s life that influenced her depression scores and sexual behaviour. The researchers’ theory that semen may contain antidepressant compounds is speculation and is not supported by this study.

If the Mail’s report is taken seriously it could be seen as a green light for unsafe sex, leading to unwanted pregnancies and sexually transmitted infections – neither of which are normally associated with feeling more cheerful.

Where did the story come from?

The study was carried out by researchers from the State University of New York. The paper gives no information about any external funding.
The study was published in 2002 in the peer-reviewed journal, Archives of Sexual Behaviour.

Predictably, the Daily Mail and The Sun were determined not to let the study’s flaws get in the way of a good story. Both illustrated the story with photos of glamorous couples cavorting in their underwear. The Mail’s introduction claiming that oral sex is good for women’s health confused the issue further, since the study did not look at oral sex. It is also unclear why it has taken more than 10 years for the research to make it to the news pages.

Both papers only published the story on their websites, not in their print editions.

What kind of research was this?

This was a cross-sectional study of women students, which looked at their condom use as an indirect measure of semen in the reproductive tract. It compared both condom use and sexual activity to how the women scored on a standard depression questionnaire. The researchers say that previous researchers have hypothesised that semen may have an effect on mood in women – and that many of the hormones found in semen, including testosterone, oestrogen and prostaglandins, can be absorbed into the body through the vagina. They set out to test this hypothesis by measuring depressive symptoms in women and how it related to sexual activity and condom use.

A cross-sectional study provides a “snapshot” of certain factors in people’s lives at one point in time, but cannot show cause and effect. Viewing condom use as an indirect measure of the presence of semen in the vagina, or in the bloodstream, may sound logical but is unreliable. It is even possible that sexually active women who did not use condoms used a contraceptive method called coitus interruptus, in which the penis is withdrawn from the vagina before ejaculation. The researchers did not take account of this, or many other possible explanations for their results.

What did the research involve?

The researchers recruited 293 women undergraduates who answered an anonymous questionnaire designed to measure various aspects of their sexual behaviour, including:

• frequency of sexual intercourse
• number of days since their last sexual encounter
• types of contraceptives used

Among the sexually active women in the sample, the use of condoms was taken as an “indirect measure of semen in the reproductive tract”. Each woman was also asked to complete a standard questionnaire (the Beck Depression Inventory) which is widely used to measure depressive symptoms, including suicide attempts. Researchers then analysed the results using standard statistical methods.

What were the basic results?

Of the women participating in the research, 87% were sexually active. Their depression scores were found to vary in relation to their condom use.

• Women who had sexual intercourse, but never used condoms, had significantly lower depressive symptoms than those who usually used condoms.
• Women who had sexual intercourse, and who did not use condoms, had significantly lower depression scores than those who “abstained from sexual intercourse”.
• However, depression scores between women who used condoms and those who did not engage in sexual intercourse were not significantly different.
• For women who did not use condoms, or only used them some of the time, depression scores went up as the amount of time since their last sexual encounter increased.
• Of the women who had never used condoms, 4.5% had attempted suicide, compared to 7.4% in the “sometimes use” group, 28.9% in the “usually use” group and 13.2% in the “always use” group.

The researchers also found that women who did not use condoms had sex more often than those who used condoms most or all of the time.

Researchers also examined whether being in a relationship might be a factor which affected depression scores. They subdivided participants into two groups – those who were currently in a relationship with a member of the opposite sex and those who were not. They found no significant difference in depression scores between the two groups. Nor did the length of the relationship correlate with depressive symptoms.

They also found that use of oral contraceptives (used by 7 in 10 of the sexually active “never users” of condoms) made no significant differences to depression scores.

How did the researchers interpret the results?

The researchers say that although their study is only preliminary, the data is consistent with the possibility that semen may “antagonise” depressive symptoms. They also point out that the finding that women having sex without condoms scored lower on depression than those abstaining from sex shows that it is not sexual activity in itself that is associated with an antidepressant effect.

They say there is other evidence which shows that the vagina absorbs a number of components of semen into the bloodstream, some of which may have antidepressant properties. The researchers also suggest that it would be “interesting” to investigate the possible antidepressant effects of oral or anal ingestion of semen (or both) among both heterosexual couples and homosexual men.

Conclusion

It is difficult to know what to make of the study that the stories are loosely based on: why it was undertaken and what usefulness it could have in the real world. And apart from pure titillation and appealing to fans of ‘Fifty Shades of Grey’, it is difficult to see how these stories could be construed as news. It is possible that this story will become yet another of the many myths about sexual activity.

As a cross-sectional study it provides a snapshot of both women’s sexual activity, condom use and their reported depressive scores at one point in time, but it cannot show that not using condoms or having semen in the reproductive tract causes women to feel less depressed. Although the researchers did try and take account of other factors that might affect both depression scores and sexual behaviour – such as how often women had sex and whether they were in a relationship – there are many unmeasured factors which might have affected both of these things and influenced the association, including family and study problems, illness and personality.

Even though they questioned whether the women were in a relationship or not, it is still difficult to assess from this the stability or security of the relationship, which could be associated with reduced depression symptoms and increased likelihood of using alternative, or longer term, methods of contraception.

It is also worth noting that the study has also not assessed diagnoses of depression, only depression scores.

Overall, the researchers have not shown in this study that semen contains compounds with antidepressant qualities. They consider that both the oestrogen and prostaglandins found in semen may have this effect, but this is only speculation. Whether self-reported condom use is an accurate indicator of semen in the reproductive tract or the bloodstream is also open to doubt, because some couples may have practised “withdrawal”. As the authors point out, to investigate whether semen had any effect on mood would require a study which directly measured semen in the reproductive tract or ideally, in the bloodstream, and correlated this with women’s moods. Whether this would be a useful exercise is questionable, to say the least.

Most importantly, condoms protect against unwanted pregnancy and are the best way to protect against sexually transmitted infections. Even if further study were to demonstrate that semen did have some direct influence upon depression symptoms, this minor benefit would almost certainly be outweighed by the increased risk of unwanted pregnancy and sexually transmitted infections.