Ask the Doctors: Is Sex Necessary?

Are there health risks to NOT having sex? Being sensual without sex? How much is optimal? Is intercourse necessary? What would be the healthiest scenario?

It was the great humorist James Thurber (with E.B. White) who first posed this query in the book Is Sex Necessary? Or Why You Feel the Way You Do — though I am still waiting for Keith Olbermann to read from it on a Friday night. But here are some thoughts and guidelines about making healthy sexual choices that don’t rely on Thurber’s peculiar know-how.

First, sex with another person may not, strictly speaking, be necessary, but sex and sexual feelings and desire are natural, and most people have sexual feelings of one kind or another. Some people choose not to engage in sex acts with other people, or limit the activities they engage in, for all kinds of reasons — they still may have sexual feelings but choose only to masturbate or, in fairly rare cases, restrict their sexual outlets even further. Still, most people have a sexuality, and sexual feelings of some kind.

Sexual desire, and even sexual relationship, however, do not automatically require that one must engage in any particular kind of activity: like intercourse, for example, one of the things you ask about here. Even if you do have sex with other people (or one other person), the kinds of sex acts engaged in are open to the partners’ negotiation. (I may be reading more into your question than is there, but I can’t help flashing to the claim more than one guy has been known to make that he has to have intercourse –and come– if he and his partner are going to do anything sexual together at all, or else he’ll get “blue balls.” More about this below, as it’s one thing to consider in your “sensual without sex” scenario.)

So: You can certainly be healthy without having sex with another person, but sexual responses are part of healthy people’s physical/physiological make-up — so it isn’t necessarily healthy to repress desire (if you have it) and leave yourself no outlet at all. Masturbation is a fabulous strategy for young (and older) adults who don’t have, or want to have, sexual partners — this kind of solo pleasure-seeking keeps the genitals in working order (you could think of it as a type of exercise), and allows you to make decisions based on your own feelings and needs.

The drive for genital touch and orgasm isn’t, however, all there is to sex: for many people, there is also a drive for intimate contact, which is often what leads us toward relationships. There are many ways to incorporate sexual feelings into a relationship — you can postpone acting on them until marriage, jump right into bed and try out the whole Kama Sutra, and everything in between — and there are also people, including some asexually-identified people, who have a drive toward intimate connection with another person without sexual desire being part of their experience. And this desire for intimacy (and, sometimes, sensuality), with or  without erotic drive, is healthy too. I should note that while it’s a more complicated negotiation when one partner wants to be sexually intimate and the other doesn’t, any couple might have differing desires, at least sometimes. In fact, most probably do, as far as desire for specific acts, degree of libido, preferred time for sex, and so many other pieces of the erotic puzzle are concerned.

How much sex, and what kind, is healthy and optimal? It depends on the person, and the couple. The best sex is mindfully engaged in — desired and its consequences understood (safer sex, pregnancy possibility, trust level between the partners — all these things and more are related to the question of what the consequences of sex might be). You can choose to, and want to, have sex for all kinds of reasons — lust, love, boredom, fun, trying to get someone more interested in you — the list goes on and on) — but optimally, you do choose, and  you and your partner agree on when to have it and what kind of sex to have.

But if you don’t agree, the healthier option is to respect the limits of the partner who wants to go less far. If that’s not where you stop, you run the risk of one partner being pushed past their boundaries and into a situation where they’re having sex because of pressure. That’s not especially healthy (though it’s not uncommon) — and many people have developed pretty negative feelings about sex because this kind of boundary-pushing has been part of their experience.

What if someone is trying to tell you that a particular amount (or type) of sex is “normal,” and you really don’t want as much, or to go as far? That’s a form of pressure. If there’s something pleasurable you can do instead, great. Many couples fill the gap between what one partner wants and the other partner wants to do with masturbation and other kinds of sex — no intercourse, but petting and hand jobs are OK, for instance.

But some pairs are simply incompatible this way: if one member of a couple wants intercourse (or bondage, or whatever) and the other doesn’t, either one of them never gets what s/he wants, has to pressure the other person for it (not great, plus it’s not optimal to have a partner who’s not having fun having sex with you), or they have to open the relationship into polyamory or some other variation of non-monogamy. That can be the best option of the bunch — but if one partner wants it and the other doesn’t, again, it adds up to incompatibility. This is why it’s so important to talk about sex before you get into a serious relationship. Our culture’s biases about sex lead many of us to believe that if our feelings are true, good sex will follow. Good sex isn’t spontaneous if the people involved don’t know enough about sex and especially if they want different things and have different boundaries.

One more thing. Your questions might also indicate that you’re worried about that what’s healthy based on concerns about your own sex drive or desires. Plenty of us have been told we wanted too much, or the wrong things, or weren’t “normal,” or whatever. But the fact is, each of us is an erotic individual. We’re not all alike, and don’t all want, need, and desire the same things. It’s best to try to “know thyself” and figure out what you do want (and how much, how often, at what time of day, with what kind of partner), because having a sense of all those things helps you look for partners who are compatible. That way, you can move toward a life in which the sex you’re having is optimal for you — and the person/s with whom you’re having it — whatever the word “sex” means to you.

PS — Balls don’t turn blue, and sexual desire that doesn’t result in intercourse, or someone else getting you off, is a perfect time to 1) practice sexual negotiation skills, and 2) masturbate.

Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at

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