The Burden of Sex

For the first time, researchers have compiled a comprehensive tally of the health problems caused by sexual behavior in the United States, and it's not a pretty picture. Overall, they report that sexual behavior results in 3 times more premature death and disability in the U.S. compared to other wealthy countries.

Epidemiologists have assessed the disability and death caused by sexually transmitted diseases (STDs) in the past, but that's only one part of the picture, says Shahul Ebrahim of the Centers of Disease Control and Prevention in Atlanta. STD infections can also increase the likelihood of a second infection, up the risk of cervical cancer, and cause infertility.

Ebrahim and colleagues reasoned that taking these factors into account, plus disabilities related to pregnancy complications and the psychological distress of unintended pregnancies, would provide a more comprehensive view of disability resulting from sexual behavior. Using data from a variety of sources, the team estimated the number of problems that could be traced back to sex for the entire U.S. population for 1998. For the same year, they calculated the number of disability-adjusted life years (DALYs)--a measure of productive life lost due to premature death or disability.

The researchers found that U.S. women bear the brunt--roughly 60%--of the adverse health events and DALYs resulting from sex. About two-thirds of the DALYs for women resulted from curable infections like chlamydia and their consequences, particularly infertility, the team reports in the February issue of Sexually Transmitted Infections. For men, HIV was by far the leading bugbear, accounting for more than half of the DALYs. Overall, sexual behavior accounted for 6% of the total DALYs for the U.S. in 1998, about 3 times what's been reported for other industrialized countries.

That's probably not surprising, given the higher incidence of HIV and unintended pregnancies in the U.S., says epidemiologist Ward Cates, president of Family Health International, a nonprofit in Raleigh, North Carolina. Studies that attempt to calculate the overall health costs of certain types of behaviors are valuable tools for policy makers and educators, Cates says. The take-home message from the current study, says Ebrahim, is that the vast majority of the disability could be prevented by practicing safe sex.

Related sites
Information about STDs from the CDC
An article from the World Bank about how DALYs are calculated
Family Health International