In this guide
- The headline you have seen
- What the prostate actually does
- The Harvard study: 31,925 men
- The two studies before it
- What it cannot prove
- Semen retention and “saving it”
- The symptoms men ignore
- PSA tests and who should ask
- My take
I am not a doctor. This is not medical advice. The facts in this article come from the NHS, Mayo Clinic and peer-reviewed studies on PubMed. The opinions are mine.
I ejaculate for a living. I say it without drama because it is simply true: for 14 years, part of my job has been finishing on cue, sometimes more than once in a day. So when friends send me the headline “Ejaculating 21 times a month cuts prostate cancer risk”, they usually add a joke about me being immortal.
I am not immortal, and the study does not say that. But it is one of the more interesting pieces of research in men’s health, and most men have only read the headline. Here is the real version.
The headline you have seen
The figure that went viral is “21 times a month”. It comes from a large American study published in 2016. Newspapers turned it into advice: ejaculate more, avoid cancer. Social media turned it into a challenge.
The truth is more careful, and more useful. To understand it, you need to know what the prostate is and how this kind of study works.
What the prostate actually does
The prostate is a small gland, roughly the size of a walnut, that sits below the bladder and surrounds the urethra, the tube that carries urine and semen out of the body. Its main job is to produce part of the fluid in semen, which helps nourish and transport sperm (NHS: Prostate cancer).
Two things commonly go wrong with it as men age. The first is benign prostate enlargement, which is not cancer but can squeeze the urethra and cause urinary problems. The second is prostate cancer, which the NHS describes as the most common cancer in men in the UK. It mainly affects men over 50, and the risk is higher in men with a family history and in Black men. Many prostate cancers grow slowly and may never cause harm; some are aggressive (Mayo Clinic: Prostate cancer).
The Harvard study: 31,925 men
The famous figure comes from the Health Professionals Follow-up Study, a long-running Harvard project that follows tens of thousands of American male health professionals. In 1992, the men answered a questionnaire about how many times a month, on average, they ejaculated at different ages: in their 20s, in their 40s and in the year before the questionnaire. Then researchers followed them for up to 18 years to see who developed prostate cancer.
The results, published in European Urology in 2016, covered 31,925 men and almost 3,900 prostate cancer diagnoses (Rider et al., Eur Urol 2016):
- Men who reported 21 or more ejaculations a month had a lower risk of prostate cancer than men who reported 4 to 7 a month.
- The difference was about 20%, both for frequency reported in their 20s and in their 40s.
- The link was clearest for lower-risk, less aggressive tumours.
“Ejaculation” in the study included sex, masturbation and nocturnal emissions. It did not matter how it happened.
Twenty-one is not a magic number. It was simply the top category on a questionnaire. The real finding is a trend: more frequent ejaculation was associated with lower risk.
The two studies before it
The 2016 paper was an update. An earlier analysis of the same men, published in JAMA in 2004, already found that high ejaculation frequency was associated with lower prostate cancer risk and found no evidence that frequent ejaculation increased it (Leitzmann et al., JAMA 2004).
On the other side of the world, an Australian case-control study in Melbourne compared men with prostate cancer to men without it. Men who ejaculated more often in their 20s, more than five times a week, were less likely to develop prostate cancer later (Giles et al., BJU Int 2003).
Not every study agrees. Some research has found no link, and some older studies suggested more sexual partners or sexually transmitted infections might raise risk. That is one reason the experts are careful.
What it cannot prove
This is the part the headlines skip.
It is observational. The researchers did not assign men to ejaculate 21 times a month and others 4 times. They asked men what they did and watched what happened. That can show an association, but not cause and effect.
People remember badly. How many times did you ejaculate per month in your 20s? Be honest: you are guessing. So were they.
Healthier men may simply have more sex. Men with better general health, lower stress, normal weight and good relationships may ejaculate more often and also have different cancer risk for other reasons. The researchers adjusted for many factors, but you can never adjust for everything.
The participants were specific. Mostly white American health professionals. Results may differ in other groups.
The researchers themselves suggested possible explanations, such as clearing potentially harmful substances from the prostate, but these are hypotheses. The honest summary is: frequent ejaculation is safe, it is not harmful to the prostate, and it may be linked to a modestly lower risk. It is not a vaccine.
Semen retention and “saving it”
On the internet there is a whole movement telling men that ejaculating drains their energy and that holding it in, “semen retention”, will give them more testosterone, more confidence and better health. I get messages about this every week, usually from very young men.
There is no good scientific evidence that avoiding ejaculation protects the prostate or improves long-term health. The large studies above point in the opposite direction. If you want to take a break from porn or masturbation for psychological reasons, that is your choice, and I discussed porn habits in my guide to ED in young men. But do not do it because someone told you it protects your prostate.
Ejaculation is also not the enemy of your performance. The refractory period after orgasm is normal and temporary. Your body is designed to do this regularly.
The symptoms men ignore
Whatever your ejaculation habits, the most useful thing you can do for your prostate is notice when something changes. According to the NHS, symptoms of prostate problems can include:
- needing to pee more often, especially at night
- needing to rush to the toilet
- difficulty starting to pee
- straining or taking a long time to finish
- a weak flow
- feeling that your bladder has not emptied fully
- blood in urine or semen
Most of these are caused by benign prostate enlargement, not cancer. Early prostate cancer often causes no symptoms at all, which is exactly why age and risk matter. Mayo Clinic also lists erectile dysfunction and bone pain among possible signs of more advanced prostate cancer.
Many men ignore urinary symptoms for years because they think it is just age. It is worth a conversation with a doctor.
PSA tests and who should ask
The PSA test is a blood test that measures prostate-specific antigen, a protein made by the prostate. A raised level can be a sign of cancer, but also of enlargement, infection or even recent ejaculation or exercise. That is why it is not perfect.
In the UK there is no national screening programme for prostate cancer. The NHS says men over 50 can ask their GP for a PSA test after talking through the benefits and risks, including the risk of finding slow cancers that would never have caused harm. Men with a father or brother who had prostate cancer, and Black men, have higher risk and may want to discuss it earlier.
One practical detail I learned and that most men do not know: doctors usually advise avoiding ejaculation for a short time before a PSA test, because it can temporarily raise the result. Ask your doctor for the exact instructions.
My take
I like this research because it does something rare: it gives men good news about sex without selling them anything. Frequent ejaculation is not dangerous. It does not “drain” you. And in the biggest study we have, it was associated with a somewhat lower risk of prostate cancer.
But I do not like the way the headline is used. Men read “21 times a month” and think they have found a shield. They have not. The things that actually protect you are boring: knowing your family history, not ignoring urinary symptoms, keeping a healthy weight, not smoking and talking to a doctor about PSA testing at the right age.
So enjoy your sex life, alone or with someone, without guilt. Just do not confuse pleasure with prevention. Your prostate deserves a real check-up, not a viral statistic.
For the human stories behind this industry, read my columns on House of Maximo. Follow my work at maximogarciaworld.com, and for the 18+ side, fuckingpornstars.net.
Sources
- Rider JR et al. Ejaculation frequency and risk of prostate cancer: updated results with an additional decade of follow-up. European Urology, 2016.
- Leitzmann MF et al. Ejaculation frequency and subsequent risk of prostate cancer. JAMA, 2004.
- Giles GG et al. Sexual factors and prostate cancer. BJU International, 2003.
- NHS. Prostate cancer.
- NHS. Benign prostate enlargement.
- Mayo Clinic. Prostate cancer: symptoms and causes.
