The disease perspective makes sense ultimately when considered against a background of healthy function. Disease is an aberration of healthy cells or physiological functioning. Therefore, the disease perspective on problems of sex must also consider issues relating to the healthy body and sex.

From the viewpoint of physical health alone, sexual activity is exercise and as such is good for the general health of the body. Circulation is increased, muscles stretched, and endorphins released. But as with any exercise, the question may become one of quantity. In other words, is too much sex harmful to the body?

For men, there is a refractory period after ejaculation when a subsequent ejaculation is not possible. The refractory period gradually increases with aging, from minutes in a young man to several hours in an older man. This serves as a natural limit-setting mechanism. For women, dyspareunia—pain with intercourse—is a marker that the vaginal tissue is not prepared for more penetrative activity. The friction of the penis is not assuaged by vaginal lubrication and so pain occurs. Pain may also occur in women and men who manually stimulate their genitals to excess. Pain from abrasions, usually around the glans penis or clitoris, suggests that the skin of the glans is being damaged by too much sexual activity. But apart from the helpful signals of pain—in sexual organs or in other parts of the body (e.g., chest pain)—the effects of sexual activity on a healthy body are comparable to other forms of physical activity: sexual activity is good for the general health of the body.

From the viewpoint of psychological health and social adjustment, the question of too much sexual activity is usually relevant and, to be candid, controversial. Our culture is not one that likes limits—especially sexual limits or limits on what one can do with one’s body. From abortion to use of protective headgear for cyclists, any attempt to suggest, let alone legislate, limits on individual choice will be met with heated opposition.

Nevertheless, there is a point at which sexual activity can be detrimental to psychological health and social adjustment. The parallel with exercise is again helpful here. The norm to be used in addressing the question of whether a level of sexual activity is too much is whether the activity interferes with one’s psychological maturation or occupational or social functioning. Hours and hours spent in the gymnasium or in a sporting activity daily must detract from the development of other intellectual and interpersonal skills and relationships. Hours and hours thinking about, pursuing, and/or consummating sexual activity must also detract from the development of other intellectual and interpersonal skills and relationships. In this situation, then, too much sex (including thinking about sex) is not healthy for the whole person. I will have more to say about this when discussing the “overvalued idea” in the behavior perspective.

Can too little sexual activity hurt the body? There is no evidence that too little or no sexual activity does physical harm to the body. We know that during rapid eye movement (REM) sleep, individuals have a sexual response in terms of vaginal lubrication and erection. It is hypothesized that one of the functions of the lubrication and erection during sleep is oxygenation of the tissues involved. Nighttime sexual arousal may act as a preservative of the tissues necessary for sexual health. In the same self-regulatory manner, nocturnal emissions and ejaculations in men maintain a comfortable level of seminal fluid.

It is common wisdom that most physical activities have a “use it or lose it” factor. Muscles should be stretched; psychological resistance to physical inertia should be routinely surmounted. The same wisdom applies to sexual activity. Especially for postmenopausal women, the normal stretching of vaginal tissues during intercourse serves to preserve suppleness in the vaginal walls. For both men and women, sexual activity usually involves more than the genitals. Torso and limbs move, breathing increases, and the body is exercised. From a physical viewpoint alone, the “use it or lose it” wisdom does have application to sexual activity. Studies of the sexual activity of older persons repeatedly report that the greatest predictor of the level of sexual activity in older age is the amount of sexual activity during the individual’s younger years.