Reports that sex – the wrong kind of sex, too much of it – is linked to mental health problems are nothing new. In one form or another, this line has been peddled for decades. In recent years, with depression and anxiety on the rise, it was inevitable that researchers would question whether this was related to the fact that we're getting it on with twice as many people as our parents.
We've had foreboding headlines – " Casual sex can cause depression and lead to suicidal thoughts" – books like Donna Freitas' The End of Sex: How Hookup Culture Is Leaving a Generation Unhappy, Sexually Unfulfilled, and Confused About Intimacy and a growing body of received wisdom that shagging around is either a result of low self-esteem or its cause. Conversely, studies have popped up claiming the exact opposite; that casual sex is YAY! So which is it? If you know your mental health can be rocky, should you avoid Tinder?
I have a longstanding relationship with both casual sex and depression. There are times when the two coincide. There's no pattern. Some low points leave me so distant and disconnected from reality I feel numb. During those times sex is shit – pointless – but then so is conversation, work and everything else. I've had seriously long patches without sex because going to the shop seemed like a mission, let alone getting my kit off with someone, and other spells when fucking a stranger seems like the least hazardous, most guaranteed source of human connection out there. Like I said, there's no pattern.
We shouldn't be surprised at the conflicting reports. Depression isn't monolithic and neither is sex. Causal fucks mean one thing to one person, another to the next. It varies according to your age, your beliefs, your state of mind and what your mates think. It can depend on whether the shag was earth-rockingly brilliant or life-wastingly bad and whether you were really, genuinely up for it. Can casual sex trigger depression? Probably, but not alone.
"Vulnerability to depression exists before casual sex happens, whether genetic or passed down through example from parents," says therapist Tania Glyde. "Was the person brought up to have confidence and self-esteem, or were they undermined or even abused, entering the world of relationships with a fragile sense of self?
"Any situation which could involve rejection and therefore feeling like an impostor, being 'othered', shamed, exposed, feeling different from others, feeling you have to be the same as others, and be sexual in the same way, could potentially create a foundation for depression."
The nuances of this appear missing from some studies. Instead, a causal relationship has been suggested – either that people with depression are more likely to shag around, or vice versa. In fact, neither of these theories has been proven – though some researchers remain adamant.
"This study provides evidence that poor mental health can lead to casual sex, but also that casual sex leads to additional declines in mental health," said Sara Sandberg-Thoma, author of a study at Ohio State University which showed that teenagers with depressive symptoms were more likely to have casual sex as young adults and, later in life, were more likely to consider suicide.
Others ask wider questions. A recent study by researchers at Cornell University in the US revealed that, of the (admittedly small) sample of 810 mainly heterosexual college students, those who had lots of sexual partners were more likely to be discriminated against but also had more close friends. In other words, you may be called a slut but people will still like you.
A collaborative study by New York University and Cornell similarly chipped away at assumptions that casual sex unilaterally damages mental health, suggesting that for confident students with high self-esteem casual sex actually increases wellbeing, irrespective of gender. Meanwhile, this large-scale longitudinal study in New Zealand established an association between number of sex partners and subsequent substance abuse, especially for women, but found no link between number of sex partners and subsequent anxiety and depression.
Overly simplistic reports linking casual sex to depression are part of a wider trend: crap science around sex. This centuries-old phenomenon is the focus of a new book by Professor Sir David Spiegelhalter, Winton Professor of the Public Understanding of Risk at Cambridge University. Released this month, Sex by Numbers takes a scalpel to the endless stream of sex studies reported in the media. Most are found seriously wanting.
Spiegelhalter has said his book, while purportedly about sex, is really about statistical bias. Unrepresentative population samples, poorly designed studies, leading questions, bigoted hypotheses and participant lies skew results. Perhaps more than ever when the topic is sex.
Sex by Numbers rates popular sex-related statistics from 0-4 according to credibility. At 0* is "the sort of thing you might hear in the pub, on a radio phone-in or in parliament"; even the robust British National Surveys of Sexual Attitudes and Lifestyles (Natsal) only gets a 3*. Most reports you read in magazines and newspapers score between 0 and 2.
Centuries of (mainly white, male) brain power have gone into telling us which bits of sex are OK and which are Problematic. The time when " hysterical" women were warned off riding bicycles in case they enjoyed themselves too much is gone. So too are the days when homosexuality was included in the Diagnostic and Statistical Manual of Mental Disorders (until 1973). Masturbation and oral and anal sex have all been categorised as symptoms of mental disorders in the not-so-distant past.
Although there is some research on mental health and sexual behaviour, it is limited and doesn't explain the connection between them or show that one might influence the other – Sam Challis, Mind
More recently still, the US suffered an epidemic of panic over "hook-up culture". Some of it was funny: "Dorm Brothel: The new debauchery, and the colleges that let it happen" came courtesy of Christianity Today in 2005. Most were judgemental: a couple of years back the author Donna Freitas, who specialises in examining the relationship between faith and fucking, wrote that casual sex was all about women "serving" men, breeding a generation which is "emotionally empty" and "drained of feeling".
There's no avoiding the fact that the entire premise of many sex-depression works are loaded with moral assumptions. Researchers choose what to look for and definitions of casual sex vary wildly.
Sam Challis, Information Manager at Mind, told me: "There is little evidence to suggest there is any relationship between depression and casual sex. Many people with depression find that when they are unwell their sex drive actually decreases, and antidepressant medication can also affect both libido and sexual functioning."
Although there is some research on mental health and sexual behaviour, he says, it is "limited" and "doesn't explain the connection between them or show that one might influence the other". A lot of the research comes from the US, and so won't take into account the differing social attitudes towards sex and relationships over here in the UK – or indeed anywhere else in the world. "Reporting on these studies can be misleading and not fully communicate the complexity of these issues," Challis continues. "We'd need more large-scale, scientific, UK-based studies to find out if there was a link between depression and casual sex here."
One symptom you are likely to develop if you spend too much intimate time with sex surveys is a nasty feeling that you should be worried. Casual fucks do require navigation – you need to be safe; everyone involved must want to be there and be clear they're up for whatever you're going to do; even if you're never going to see each other again, be nice – but this also applies to the rest of Real Life. The difference is, few other areas of your existence come with such a heavy toll of stigma.
Having sex with someone you barely know can be bleak and grim, but so can a night listening to people's bullshit in a pub. On the other hand, both can be life-affirming and fun. There's no obligation to do either. Science is never going to serve up a single, solid link between sex and mental health; both sides of the equation are far too messy and complex. Whether or not casual fucks count as self-care is up to you.
Hypersexuality can occur alongside mania, a common symptom associated with some types of mental health problem, such as bipolar disorder (not discussed in this feature). If you're worried about your mental health, or are concerned about changes to your sexual behaviour, speak to your GP. You can get more information from Mind.
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