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No strings attached? Maybe not: Casual sex is linked to mental distress, according to research in the Journal of Sex Research.

The study of nearly 4,000 college students connected hopping in the sack with a stranger to a 10 percent drop in life satisfaction, a 15 percent hike in depression, and a 17 percent jump in general anxiety. That’s bad news considering even mild mental stress is linked to a 29 percent increase in heart disease and stroke risk, finds research in the BMJ. But frivolous sex may not be the culprit; depressed, anxious, unsatisfied people might just be more likely to engage in casual sex, says study coauthor Melina Bersamin, Ph.D., of California State University, Sacramento. Everyone in the study was also 18 to 25 years old—a psychologically tender age, she cautions. No matter your age, “sexual regret”—sadness after hooking up with a rando—can occur, Bersamin adds. And past research has shown that sleeping with someone you have no intention of dating can significantly boost it. So if you’re going to have casual sex, remember these four rules from sex coach Amy Levine, M.A., C.S.E.: Confirm consent, use protection, be open about your sexual past, and make sure you and your hookup buddy express—and meet—each other’s desires. According to recent research in the Journal of Personality and Social Psychology, women are just as open to casual sex as men—as long as she thinks she’ll have a good time.