You often hear about the physical benefits of having sex. However, in psychology we
rarely read articles that critically examine this topic. As such, this post will look at some of the research done in this area.
Originally this post was going to focus solely on the physical and mental effects of sex. Unfortunately, there is not a ton of research that has been conducted on this topic. As such, this post will examine the effects of relationships more generally. The other posts in this series have focused on how physical factors such as genetics and healthy eating impact mental health. This post is slightly different in that it also looks at how social factors are interrelated with mental and physical health.
While most research has been conducted on the effects of marriage on health and wellness, first we will examine how nonromantic relationships impact physical and mental health.
Friends With Benefits and Sexual Activity Risk
An interesting study looked at looked at how sex with four different types of partners, namely romantic partners, friends, acquaintances, and ‘friends with benefits,’ was related to health 2.5, 4, and 5.5 years after high school . What this study found was that more sexual activity, regardless of who it was with, was associated with more substance use and risky sexual behavior (e.g., having unprotected sex). When looking at different types of relationships, friends with benefits relationships were strongly related to lower self-esteem, higher externalizing problems (i.e., substance use, aggression), and higher internalizing problems (i.e., depression, anxiety).
Interestingly, sexual activity with romantic partners was associated with both positive and negative outcomes. In terms of negative outcomes, sexual activity with a romantic partner was associated with more substance use and risky sexual behavior. However, sexual activity with a romantic partner was also associated with better self-esteem and lower internalizing problems.
Gender effects were also found; in general, women tended to have worse outcomes related to having sex with a nonromantic partner compared to men. This could be related to social norms that praise men for sexual activity but actively shame women who engage in identical behavior.
Overall, this study did not find that sexual activity predicted later negative outcomes and it is unclear how sexual activity and outcomes such as substance use are related to each other at the same timepoint. Does how much a person is drinking at any one time lead to more sexual activity or do people drink more after having more sex to try and feel better afterwards? Maybe it is a combination of the two or maybe some other variables that were not examined explains the relationship, such as a person’s personality, where that person is living (e.g., with college roommates versus with parents), etc.
Some of the negative findings related to having sex with friend with benefits is likely due to the decreased intimacy in the relationship compared to romantic relationships. Previous research has found that reduced intimacy is associated with relationship dissatisfaction as well as sexual dissatisfaction. Research on the impact of having friends with benefits is still in its infancy, so it will be important for future research to clarify what leads to positive or negative outcomes in these more casual relationships. Better understanding this can lead to better understanding of how other types of relationships impact us.
Monogamish: How Do Open Relationships Fare?
There was recently a New York Times article that covered couples who were in open relationships and their unique experiences in terms of navigating relationship problems and the impact of these relationships on the individuals in the relationships. It is a fascinating article that does a good job of having you look at monogamy and try to think about it in a different way. Definitely worth a read if you have not already done so.
It turns out that some research has also examined the impact of having open relationships on well-being. Research on open relationships can be slightly confusing as everyone defines these relationships in a slightly different way. However, let us examine one study that has looked at open relationships and their impact on well-being.
One research study  looked at gay and bisexual men who were either single, in a monogamous relationship, in an open relationship, or in a ‘monogamish’ relationship. In this study an open relationship was defined as a relationship where there is explicit communication and allowance of either partner to engage in sexual activity with individuals outside of the relationship. In contrast, a monogamish relationship was defined as a relationship where individuals only engage in sexual activity with someone outside of the relationship when both relationship individuals are present, such as for a threesome.
This study found that being in a relationship was associated with positive outcomes including lower depression, less substance use, higher life satisfaction, and less risky sexual behavior. Specifically, being in a monogamous relationship was associated with less substance use and reduced risky sexual behavior.
The novel finding of this study however, is that men in monogamish relationships had outcomes that were more similar to men in monogamous relationships compared to men in open relationships. For example, men in monogamish relationships had decreased depression and greater life satisfaction compared to single men. This indicates that relationships other than monogamous relationships can also provide psychological benefits and that different types of relationships may have different levels of benefits. It will be interesting for future research to tease apart what aspects of the relationship matter most.
Now this study looked at a pretty specific group of individuals, namely gay and bisexual men in New York City, so it is unclear how well these findings generalize to other groups. However, if more people are exploring relationships that are not entirely monogamous, it will be important for more research to examine any positive or negative consequences of these less traditional relationships.
Marital Quality Predicts Positive Outcomes
People often talk about the positive benefits of marriage. The question then becomes, why is marriage associated with positive outcomes? For example, is there something specific about marital status or is it the social support from a partner that accounts for these beneficial effects? Research suggests that both may be important.
In one study, married individuals had better life satisfaction and blood pressure than did single individuals . In addition, having high marital satisfaction was associated with better life satisfaction, lower blood pressure, less stress, and less depression. Interestingly, compared to individuals in a low quality marriage, single individuals had lower blood pressure indicating that it is better for one’s health to be single than in a poor marriage.
Lastly, having a supportive social network did not protect single and unhappily married individuals from negative outcomes. This is interesting as it suggests that there is a unique form of social support or bonding that occurs between happily married couples that is different from the support provided by friends. Or maybe it all comes down to how much sex someone is having, which this study unfortunately did not examine.
Now there are a number of issues with this study, including it not directly comparing married individuals with couples who are cohabitating but not married. As such, it is hard to say what benefit exactly comes from marital status. In addition, it does not appear that all the analyses accounted for age and none of the analyses appeared to control for income, both of which could very likely be related to the outcomes examined.
However, the study does highlight the importance of not merely looking at whether an individual is married or not, but that the quality of the relationship is largely what drives positive or negative outcomes. This study is just one of many that have been conducted on the topic. Other researchers have found that better marital quality is related to a wide variety of outcomes including better health more generally, including reduced stress response (measured by cortisol, a stress hormone), better cardiovascular response, and healthier behaviors such as healthier eating . Incredibly, poor marital quality is also associated with worse physical and mental recovery for breast cancer patients , which really indicates how important marital quality is for health. Given the importance of marital quality, the next question then becomes, what leads to a happier marriage?
What Predicts Marital Quality
With all this attention on the importance of marital quality, it is important to understand what predicts marital quality to know important aspects to target in interventions.
A study by researchers Galinsky and Waite  examined what predicts both positive and negative marital quality. In this study positive and negative marital quality were two parts of marital quality; positive marital quality questions asked about overall marital happiness, emotional satisfaction, closeness, etc., whereas negative marital quality questions asked about whether a partner criticizes, makes too many demands, or gets on the other partner’s nerves.
What the researchers found was that an individual’s negative physical health is related to less positive and more negative marital quality and that spouse negative physical health is related to less positive marital quality.
These researchers then looked what why physical health is related to marital quality and found that two factors help explain these relationships. First, they found that sexual activity partially mediates (explains) the relationship between an individual and his/her spouse’s physical health and positive marital quality. In other words, having poor physical health results in less sexual activity, which then leads to less positive marital quality.
In addition, the study found that both an individual’s and her/his spouse’s mental health partially mediated the relationship between physical health and marital quality. Again, this means that a partner’s poor physical health leads to worse mental health, which then leads to less positive and more negative marital quality. So it appears that marital quality is explained both by physical factors (i.e., how frequently the couple is having sex) and psychological factors (i.e., the mental health of both partners).
This is an interesting study because it shows how interrelated these different factors are. I would guess that there are bidirectional (going both ways) relationships between the factors examined here. For example, while this study found that poor physical and mental health predicted poor marital quality, the other studies already discussed found that poor marital quality predicts poor physical and mental health.
To sum it up, what can we say about relationships? Broadly, a significant connection appears to exist between the quality of a relationship and positive outcomes such as better life satisfaction, lower blood pressure, less stress, and less depression.
In modern society, there are many different types of relationships that people have. Studying clinical psychology, it is important that I remain open, aware, and non-judgmental about different people in the world and the relationships they have with others. I will admit that some of the concepts related to open relationships and non-traditional relationships more broadly took me some time to get used to.
Ultimately though, I think it is less about what type of relationship a person is in and more about how that relationship is working for that person. A person can be extremely dissatisfied with a traditional marriage and extremely happy with an open relationship (sometimes called ‘poly’ or polyamorous lifestyle). Conversely, just because someone is in an open relationship, does not mean that that relationship will be healthy for that person especially if they crave more intimacy and support from the partner.
Given all we know about the importance of quality relationships, hopefully more time and energy will be spent educating people about healthy relationships and develop brief, specific interventions to help couples with unhealthy relationships get back on track given that a person’s physical and mental health is negatively impacted by an unhealthy relationship.
Relationships are extremely complicated and can impact us in both positive and negative ways. It is always important for us to examine the relationships we are currently in and make sure that getting our needs fulfilled emotionally, physically, etc. Thanks again for reading and I look forward to joining together again for the next post that discusses research on yoga!
The Clinically Relevant Insights Blog, part of ShawnWilsonPhD.com, shares news and research related to psychology and wellness.
 Furman, W., & Collibee, C. (2014). Sexual activity with romantic and nonromantic partners and psychosocial adjustment in young adults. Archives of Sexual Behavior, 43(7), 1327-1341. doi:10.1007/s10508-014-0293-3
 Parsons, J. T., Starks, T. J., Dubois, S., Grov, C., & Golub, S. A. (2011, 12). Alternatives to monogamy among gay male couples in a community survey: Implications for mental health and sexual risk. Archives of Sexual Behavior, 42(2), 303-312. doi:10.1007/s10508-011-9885-3
 Holt-Lunstad, J., Birmingham, W., & Jones, B. Q. (2008, 03). Is there something unique about marriage? The relative impact of marital status, relationship quality, and network social support on ambulatory blood pressure and mental health. Annals of Behavioral Medicine, 35(2), 239-244. doi:10.1007/s12160-008-9018-y
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 Galinsky, A. M., & Waite, L. J. (2013). Sexual activity and psychological health as mediators of the relationship between physical health and marital quality. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(3), 482-492. doi:10.1093/geronb/gbt165