The overall positive effects of coitus have not been estimated before. A systematic review and meta-analysis was conducted for coitus versus everything. A search was made in MEDLINE resulting in 1,121 hits. The authors screened studies and conducted a meta-analysis. Thirty publications randomising to coitus or something else were included. Pooled results showed a relative risk of 0.91 (95% CI: 0.86-0.96) favouring "everything else" over coitus. Subjective pleasure is not a primary outcome in any of the included studies, and trialists must have regarded this outcome as less important. In conclusion, coitus cannot be recommended based on the published randomised studies. Evaluation by evidence-based methodology makes it clear, that better alternatives exist.