Is Masturbation Harmful? Scientific Facts, Common Myths and When It Can Become a Problem

A man who has carried the warnings he heard as a teenager, “it will ruin your eyes”, “you will become infertile”, “it will wreck your back”, in the back of his mind for years may one day ask, online or in a consultation: “I did this a lot; have I harmed my body?” Some hesitate even to ask this question before marriage, others while planning a baby.

Masturbation is sexual self-stimulation of one's own body and usually ends in ejaculation; it is a common behaviour from adolescence onwards. This article covers what medicine knows about it, the most common myths, the link between ejaculation frequency and prostate cancer, situations in which it can become a problem, physical risks and the effect of guilt on mood.

Is masturbation an ordinary behaviour? What does medicine say?

Yes; large population surveys show that it is a common behaviour. In a national British survey of more than 11,000 people aged 16–44 (Archives of Sexual Behavior, 2008), about three quarters of men reported having masturbated in the previous four weeks.

The International Society for Sexual Medicine (ISSM) describes masturbation as an ordinary and healthy behaviour and states that claims of harm such as infertility, blindness or sexual dysfunction have no scientific basis. Religious, moral and cultural judgements belong to the individual and deserve respect; this article conveys medical information only.

Infertility, testosterone and penis size: are the most common myths true?

The worries heard most often in consultations rest on the idea that the body is being “used up”, and they are not supported by scientific evidence:

• Sperm does not “run out”: Sperm production in the testicles continues throughout life. With very frequent ejaculation, the amount of semen in the next sample may fall temporarily; however, this does not mean infertility.
• Testosterone does not fall: Masturbation has not been shown to lower testosterone levels permanently. The effect of ejaculation abstinence on sperm and testosterone is covered in a separate article on our site.
• The penis does not shrink or bend: Penis size is largely determined during puberty by genetic and hormonal factors. In adulthood, a penis that looks shorter or a newly developed curvature has other causes, such as weight gain or Peyronie's disease.

Are the claims about fatigue, aches, hair loss and premature ejaculation true?

There are other beliefs handed down from one generation to the next:

• Eye, lower back and knee pain: Masturbation has not been shown to damage eyesight or to cause pain in the lower back, back or knees; other causes of these complaints should be looked for.
• Hair loss: Male-pattern hair loss is largely related to inherited predisposition; no link with masturbation has been shown.
• Fatigue: Brief relaxation and sleepiness after orgasm are ordinary. Persistent tiredness, however, needs its other causes investigated. A separate, very rare condition in which flu-like symptoms last for days after ejaculation (post-orgasmic illness syndrome) has also been described.
• Premature ejaculation: There is no evidence that masturbation causes premature ejaculation. Myths about premature ejaculation are covered in a separate article on our site.

Is there a link between ejaculation frequency and prostate cancer?

In a study published in European Urology in 2016, in which about 32,000 men were followed for 18 years, men who reported 21 or more ejaculations a month were diagnosed with prostate cancer about one fifth less often than men who reported 4–7 a month. The association was clearest for low-risk tumours; no significant association was found with high-risk disease.

This finding is observational: it shows an association, not cause and effect. Ejaculation frequency was based on the participants' own reports, how ejaculation occurred was not asked, and frequent sexual activity may be a marker of good general health. For this reason, the finding is not a recommendation; prostate cancer screening should be discussed with a doctor separately.

Can a masturbation habit cause problems with a partner?

In some cases, yes. The European Association of Urology (EAU) guideline lists an atypical masturbation technique among the possible risk factors for delayed ejaculation. In a man who, over the years, has developed an idiosyncratic technique, such as a very tight grip, high speed or only one particular position, the stimulation that arises with a partner may not reach this level; the result is delayed ejaculation, no ejaculation at all, or strain. This is a habit that can be changed gradually; the topic is covered in detail in our article on delayed ejaculation.

Whether pornography causes erectile problems, on the other hand, is debated. A review published in the Journal of Clinical Medicine in 2019 reported that there is very little evidence that pornography on its own causes erectile problems or delayed ejaculation, and that most of the data are cross-sectional. The problem is thought to be related less to how often it is watched than to “problematic use”, which the person cannot control or which causes them distress.

When is it called a loss of control?

The frequency of masturbation is not, on its own, a criterion of illness; there is no medically defined “too much” threshold. Compulsive sexual behaviour disorder, defined in the World Health Organization's ICD-11 classification, is characterised by a failure to control intense, repetitive sexual urges over a long period (for example, six months or more), causing marked distress or impairment in functioning. Distress arising solely from moral judgements or a sense of disapproval is not sufficient for this diagnosis. The following signs are reason enough to seek support:

• The behaviour becoming central to life; health, responsibilities or other interests being neglected
• Repeated unsuccessful attempts to cut down despite wanting to
• Continuing despite adverse consequences at work, at school or in a relationship; no longer gaining satisfaction from it

This is not a weakness of character; it can be addressed with psychotherapy and with treatment of any accompanying depression or anxiety.

What physical problems can occur?

The most common problem is irritation due to friction. Prolonged or vigorous stimulation can cause redness, tenderness and slight swelling of the penile skin; this usually settles on its own within a day or two. Taking a break and using a suitable lubricant reduce irritation; sores, discharge or spreading itching, however, suggest another problem such as balanitis. Manoeuvres such as forcibly bending the erect penis can rarely cause a penile fracture; a cracking sound, sudden loss of erection and rapidly spreading bruising are an emergency.

Inserting an object into the urethra carries serious risks: the urethra can tear, the object can slip into the bladder and become stuck, bleeding and infection can develop, and a narrowing of the urethra can form later. Do not try to pull the object out yourself; delaying attendance out of embarrassment raises the risk of complications. The object can usually be removed with a closed (endoscopic) method. Blood in the semen or pain during ejaculation is not a “punishment” for masturbation either; its cause should be investigated. These topics are covered in separate articles on our site.

How do guilt and anxiety affect mood? How can you talk to your partner?

Often it is not masturbation itself but the misinformation and guilt surrounding it that weigh on a man. Warnings heard in adolescence, such as “you will use up your strength”, turn into anxiety lasting for years in some men; research shows that negative beliefs about masturbation are associated with sexual guilt. This anxiety can feed performance anxiety at first intercourse or in marriage; this cycle is covered in a separate article on our site.

Within a relationship, masturbation does not mean that interest in the partner has faded; it is ordinary in couples whose levels of desire differ. When talking to your partner, it helps to avoid blame, to express your concern using “I” statements and to treat a habit that makes intimacy difficult as a shared goal. Couples or sex therapy support can be sought when needed.

When should you see a doctor?

Urological and andrological assessment is advisable in the following situations:

• Ejaculation with a partner has been delayed or absent for several months, although ejaculation is possible with masturbation
• Erectile problems, painful ejaculation or blood in the semen
• Redness, sores, discharge or swelling that does not settle within a few days
• Recurrent fatigue or flu-like symptoms lasting for days after ejaculation
• Loss of control or marked guilt and anxiety; harm to work, relationships or mental health
• An object lost in the urethra, or sudden loss of erection with a cracking sound and bruising of the erect penis (emergency; 112)

Masturbation is a common and ordinary behaviour; the widely voiced beliefs about its harms are not supported by science. Problems arise less from the behaviour itself than from a habitual technique, loss of control, physical injury, or the guilt and anxiety created by misinformation. Assoc. Prof. Zülfü Sertkaya practises in urology and andrology in Istanbul; sexual health assessment is carried out on an individual basis and in confidence.

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