Among people in their mid-50s or older who report having frequent, enjoyable sex, women are likely to have better than average heart health while men are more likely to have heart attacks and other problems, a U.S. study suggests.

"The results for women are consistent with our expectation, but the results for men were surprising," said lead author Hui Liu, an associate professor of sociology at Michigan State University in East Lansing.

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Older men may have more difficulties reaching an orgasm for medical or emotional reasons and may exert themselves to a greater degree of exhaustion and create relatively more stress on their cardiovascular system in order to achieve climax, Liu told Reuters Health by email.

"Another possibility is that men are more likely to use sexual medication or supplements to improve sexual function," she said. "Moreover, having quite a high frequency of sex may indicate problems of sexual addiction, sexual compulsivity or sexual impulsivity, related to psychological states such as anxiety or depression, which may lead to negative cardiovascular health."

Future research will need to investigate the mechanisms linking sex and health outcomes for older men, she said.

The researchers used survey answers from more than 2,000 people aged 57 to 85 in the National Social Life, Health and Aging Project, which began with one survey wave in 2005 and followed-up five years later. Events like heart attack, heart failure and stroke during those five years were recorded, and participants' blood pressure, heart rate and inflammatory proteins were measured.

At the start, 70 percent of men and 39 percent of women said they'd had sex with a partner over the previous year. A quarter of men said they had sex once a week or more, compared to 11 percent of women.

Men were more likely to say their sex was extremely physically satisfying or extremely emotionally satisfying, though less than half of the men or women said so.

Men who said they had sex at least once a week in the first survey were almost twice as likely to have experienced a heart attack, heart failure or stroke five years later than men who said they were sexually inactive. Those who felt sex was extremely satisfying were even more likely to suffer one of these events, according to the results in the Journal of Health and Social Behavior.

Women who said they found sex extremely pleasurable in the first survey, on the other hand, were at no greater risk than other women for heart problems, and were less likely to have high blood pressure five years later.

"Moderate frequent sex is good for older men, although high frequency of sex is risky for older men. For older women, good sexual quality is good for them," Liu said.

"I think it is important for older people to understand the risks and benefits of sex," she said. "It is not that all sex is bad for older people."

The researchers acknowledge that the study cannot prove a cause and effect relationship between the participants' sex lives and their heart health. They also note that future studies are needed to better understand the links and identify the mechanisms by which sexuality may affect heart health.

Noting that the current study did not define sexual activity very specifically, Stuart Brody, visiting professor at Charles University in Prague, who was not involved in the study, pointed out another weakness in the findings. "The results that they obtained might be due to sexual activities other than penile-vaginal intercourse."

A review of existing research found that specifically penile-vaginal intercourse, and corresponding orgasm, is tied to better physical and psychological health as well as better intimate relationship quality, Brody told Reuters Health by email.