The nature of human orgasm: a critical review of major trends

Validation of the multidimensional model of the subjective orgasm experience in the context of same-sex relationships

Background/objective

The Multidimensional Model of the Subjective Orgasm Experience (MMSOE) has been validated in the context of heterosexual relationships, with no evidence in the context of same-sex relationships. This study aims to examine the association of its dimensions (Affective, Intimacy, Sensory, and Rewards) with the propensity for sexual excitation, rating of sexual arousal, rating of genital sensations, and genital response.

Method

Sixty-eight young adults (34 males and 34 females) who were sexually active with people of the same sex participated in a laboratory task in which they viewed content-neutral and sexually explicit gay films. Regression models were conducted to explain the dimensions of MMSOE from measures of sexual arousal.

Results

In males, the rating of sexual arousal explained the Sensory dimension, while the genital response explained the Affective dimension, with sexual arousal as a state gaining more prominence. In females, however, the propensity for sexual excitation explained the Sensory dimension, with more salience of sexual arousal as a trait.

Conclusions

The MMSOE is shown to be a valid theoretical framework for the study of orgasmic experience in the context of same-sex relationships, with clear implications for clinical practice.

And how do LGB adults rate their orgasms in a relational context?

BACKGROUND

Subjective orgasm experience (SOE) refers to the perception, assessment, and/or sensation of orgasm on a psychological level, with the particularity that the study of SOE in nonheterosexual populations is currently very scarce.

AIM

The study sought to analyze differences in SOE dimensions, comparing the intensity of each adjective of the Orgasm Rating Scale (ORS) and creating a ranking of the adjectives that better represent it in LGB men and women.

METHODS

In a sample of 1475 adults organized into 4 groups according to the type of sexual relationships reported, comparisons were made using multivariate analysis of variance and chi-square tests.

OUTCOMES

Differences were obtained in the intensity of all the SOE dimensions, and in 23 of the 25 ORS adjectives.

RESULTS

Lesbians and bisexual women reported higher intensity in SOE compared with bisexual and gay men.

CLINICAL IMPLICATIONS

Because the ORS has been established as a good tool for detecting orgasmic difficulties in nonheterosexual populations, this study could provide LGBT affirmative psychotherapy with evidence on how these individuals evaluate their orgasms in a relational context.

STRENGTHS AND LIMITATIONS

This study extends prior limited knowledge about how LGB people evaluate their orgasmic experiences in the context of sexual relationships. Despite this, the study poses limitations such as nonprobability sampling or the inclusion of exclusively cisgender and young individuals, making it difficult to generalize the results.

CONCLUSION

Although significant differences were found between LGB men and women, all groups agree on the adjectives they use to describe the subjective experience of orgasm in the context of sexual relationships; therefore, evidence is provided about how LGB people evaluate their orgasmic experiences in this context.

Effects of Subjective Orgasm Experience in Sexual Satisfaction: A Dyadic Analysis in Same-Sex Hispanic Couples

Subjective orgasm experience (SOE) is a component of sexual health that refers to the perception, sensation and/or appraisal of orgasm at a psychological level. This construct has scarcely been studied in non-heterosexual individuals and couples, and never before from a dyadic perspective. In this study, in which 104 same-sex Hispanic couples participated (48 male-male and 56 female-female), we explored the dyadic influence of SOE dimensions on sexual satisfaction, the mediating role of relationship satisfaction on the association of both phases of sexual response, as well as the explanatory capacity that discrepancies in these dimensions had on sexual satisfaction. The results indicated that the orgasmic dimensions that gained more prominence were Affective and Sensory. A dyadic influence of both on sexual satisfaction was observed only in male couples, as well as a detriment of sexual satisfaction when there were discrepancies in them, especially in women. Moreover, relationship satisfaction was a significant mediator between all dimensions of SOE and sexual satisfaction in both types of couples. This work highlights the need to take into account the SOE of both partners and how this individual experience can affect other dimensions of a more interpersonal nature, such as sexual or relationship satisfaction.

Development of the Italian version of the Orgasmic Perception Questionnaire (OPQ)

Orgasm is a phase of the human sexual response, and the possible discrepancies between male and female ways to experience it are still not clear in the literature. There is a lack of tools to adequately assess orgasm perception. This study aims to develop an instrument and verify possible differences between males and females. We constructed the Orgasmic Perception Questionnaire (OPQ) through different stages: first, 316 items selection was conducted on a sample of 96 people, where items came mainly from written descriptions of orgasm perception; second, an exploratory factor analysis was conducted on 674 Italian adults with a 63-item OPQ; finally, a confirmatory factor analysis was conducted on 1100 Italian adults with a 47-item OPQ. In the first study, 63 items fitted an equidistributional pattern and were to form the 63-item OPQ used for EFA. The EFA showed that five factors out of 47 explained 44.01% of the total variance and were named: Ecstasy, Contractions, Relaxation, Power, and Sensations. The confirmatory factor analyses run on the 47-item OPQ confirmed that the five-factor structure fits. Moreover, females scored higher than males with an adequate effect size in two factors: Contractions and Sensations. In conclusion, the OPQ could be a useful tool in both clinical settings and research studies to investigate the perception of orgasmic experience in its totality.

Looking Beyond the Chair: Psycho-Perceptual Predictors of Sexual Distress and Sexual Satisfaction in Individuals with Spinal Cord Injury

Despite a large body of biomedical research, little is known about the psychological and perceptual predictors of sexual satisfaction (SS) and sexual distress (SD) post spinal cord injury (SCI). Guided by a bio-psycho-perceptual framework, this cross-sectional research aimed at assessing SS and SD in a large SCI sample using validated patient-reported outcome measures (PROM). Significant correlates and predictors of SS and SD were also identified. Ninety-one men and women with SCI completed PROMs of SS and SD, as well as psychological (mood, sexual and body esteem) and perceptual (interoceptive awareness, trait mindfulness, sexual mindfulness) factors. Neurological profiles were also assessed, along with experience of orgasm. Correlates of SS and SD were first identified using Pearson's correlations, then multiple hierarchical regression models were computed to isolate predictors. Orgasm experience and psychological factors emerged as moderate correlates of both SS and SD, while neurological factors did not. Interoceptive awareness and trait mindfulness showed weak associations with SD and none with SS. Among the tested predictors, experience of orgasm emerged as the strongest for SS (β = -.29, p < .01), followed by mood, which predicted SS and SD. Sexual and body esteem was predictive of SD only. In sexually active participants, sexual mindfulness predicted both SS (β = 0.55, p < .001) and SD (β = -0.56, p < .001) above and beyond all other variables. This study reveals unique aspects of SS and SD postinjury and supports further consideration of psychological and perceptual dimensions of SCI sexuality in rehabilitation research.

Evaluating the Subjective Orgasm Experience Through Sexual Context, Gender, and Sexual Orientation

The subjective orgasm experience (SOE) is the psychological perception of orgasm sensations and closely related to sexual health. Here, SOE was studied through the context in which it is experienced (sexual relationships and solitary masturbation), gender, and sexual orientation. For this purpose, data were collected from 4255 people (1927 men and 2328 women) of different sexual orientations (heterosexual = 1545; bisexual = 1202; and gay = 1508) who completed two versions of the Orgasm Rating Scale (ORS) for both contexts (i.e., sexual relationships and solitary masturbation) along with a socio-demographic questionnaire. Results showed that the ORS in the context of solitary masturbation is an instrument invariant by gender and sexual orientation. Significant differences in SOE were found by context: it was more intense in the context of sexual relationships (vs. solitary masturbation); by gender: women (vs. men) reported greater intensity; and by sexual orientation, with heterosexual people (vs. gay and bisexual people) having a more intense experience.

Sex or Socialization? Replicating Heterosexual Couples' Gender Differences in the Association between Orgasm and Satisfaction in Same-Gender/Sex Couples

Orgasm is commonly considered an important aspect of sexual activity. The current study sought to replicate and extend prior work by examining gender/sex differences in the association between orgasm and satisfaction in a sample of same-gender/sex couples. We also examined how desire for an orgasm moderated this association. Although prior research found a curvilinear association between orgasm and satisfaction for heterosexual women (but not men), we found that orgasm curvilinearly predicted relationship and sexual satisfaction across genders/sexes, indicating more frequent orgasm was associated with higher satisfaction only to an extent for all individuals in our sample. We also found that when desire for orgasm was high, orgasm was associated with higher relationship and sexual satisfaction than when desire was low, suggesting that desire for orgasm may differentially affect how orgasm is related to satisfaction. We discuss our findings in terms of sexual scripting theory, contextualizing our results by considering the socially constructed nature of sexuality and how sexual scripts may vary across individuals with different sexual and gender identities.

Solitary Sexual Desire: Its Relation to Subjective Orgasm Experience and Sexual Arousal in the Masturbation Context within a Spanish Population

The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary sexual desire to explain the subjective orgasm experience (Study 1) and sexual arousal (Study 2) in the context of solitary masturbation. Study 1, composed of 2406 heterosexual adults (M age = 39.72, SD = 11.81), assessed for solitary sexual desire, dyadic sexual desire, and the intensity of the subjective orgasm experience obtained through solitary masturbation, along with other associated parameters. Study 2, consisting of 41 heterosexual young people (M age = 22.49, SD = 3.17), evaluated the genital response (penile circumference/vaginal pulse amplitude) and subjective arousal to sexually explicit films related to solitary masturbation. In both men and women, solitary sexual desire accounted for a significant percentage of the subjective orgasm experience obtained through solitary masturbation. In addition, in women, the propensity for sexual arousal was explained by solitary sexual desire. It is concluded that solitary sexual desire -as opposed to dyadic- is important to explain sexual arousal and orgasm in the solitary masturbation context. These results highlight the importance of addressing sexual desire in the solitary context, given its implications with other dimensions of sexual functioning.

How do heterosexual men and women rate their orgasms in a relational context?

The orgasm experience refers to the psychological self-evaluation of the orgasm. No previous research has compared the characteristics of the orgasm experience between men and women creating a ranking of the adjectives that better represent it. The main objective of this study was to analyze gender differences in the global orgasm experience, its dimensions, and its descriptive words to examine how do heterosexual people rate their orgasms. A sample of 1619 heterosexual adults (793 men, 826 women) completed a background questionnaire and the Orgasm Rating Scale. Results showed that there were significant gender differences in the global orgasm experience and three of its dimensions. Furthermore, fourteen of the 25 descriptive words showed differences between genders. In the ranking, the top five adjectives that better described the orgasm experience were the same in both genders. In conclusion, although differences across gender in the orgasm experience were observed, heterosexual men and women share similar adjectives to rate their orgasms.

Validation of the Orgasm Rating Scale in Context of Sexual Relationships of Gay and Lesbian Adults

Currently, no validated instrument exists for assessing the subjective experience of orgasm in the gay population. The Orgasm Rating Scale (ORS), previously validated in the heterosexual population, comprises four dimensions: Affective, Sensory, Intimacy, and Rewards. This study validated it for sexual relationships in the gay population by obtaining its factorial invariance by sexual orientation and sex, its internal consistency reliability, and evidence of validity in its relationship with other variables. We assessed 1600 cisgender Spanish adults–heterosexuals, gays, and lesbians–divided into 4, sex-based groups of 400 each, according to the Kinsey scale scores. Participants reported recent experiences of orgasm in the context of sexual relationships and responded to the ORS and other scales assessing attitude toward sexual fantasies and sexual functioning. The ORS structure showed a strict multigroup-level invariance by sexual orientation and sex, confirming its four-dimensional structure. The subjective orgasm intensity was associated with a positive attitude toward sexual fantasies and sexual functioning. Scores obtained on the Affective, Intimacy, and Rewards dimensions confirmed the ability to discriminate between gay people with and without orgasmic difficulties. The ORS’s Spanish version presents good psychometric properties as a validated scale to evaluate the subjective experience of orgasm in the gay population.

Psychosocial and Behavioral Aspects of Women's Sexual Pleasure: A Scoping Review

Objectives

To clarify the psychosocial and behavioral factors related to women's sexual pleasure.

Methods

A search was conducted on EBSCO and Web of Science databases using the key terms "female sexual pleasure" and "women sexual pleasure" and following PRISMA guidelines.

Results

76 articles were identified, referring to sexual practices, individual factors, interpersonal factors, societal factors, and ways of enhancing sexual pleasure.

Conclusions

Age, sexual experience, arousability, body-esteem, sexual autonomy, and sexual assertiveness seem to benefit women's sexual pleasure, while sexual compliance and a gender power imbalance seem to compromise it. Additional research regarding non-western and non-heterosexual women is still required.

Focusing on sexual rehabilitation besides penile rehabilitation following radical prostatectomy is important

Erectile dysfunction is commonly reported after radical prostatectomy. Besides the loss of erections, sexual life after prostatectomy is impacted by urinary incontinence, orgasmic dysfunction, and psychological stress. In this review, we describe classical medical therapies used for erectile function rehabilitation such as PDE5 inhibitors and injection therapy. A vast amount of data support the idea of focusing on restoration of sexual function on top of erectile function after prostatectomy. The important strategies described to rehabilitate sexual function include pelvic floor muscle therapy, couple therapy, appropriate preoperative counseling, and focusing on non-penetrative alternatives. A multidisciplinary approach and including the partner is important. Erectile function alone is not sufficient for satisfactory sexual experience and may not be used as a proxy for sexual quality of life. Adding full-spectrum sexual rehabilitation to a standard penile rehabilitation regimen has the highest chances of obtaining satisfactory sexual outcomes in men and their partners after radical prostatectomy.

Female Multiple Orgasm: An Exploratory Internet-Based Survey

Women's multiorgasmic capacity has long been mentioned in the human sexuality literature. However, due in part to the conceptual vagueness surrounding this phenomenon, few empirical studies have focused on this topic, and our scientific knowledge is currently limited. This exploratory research is mainly aimed at providing a much-needed assessment of the profiles of women reporting multiorgasmic experiences. For this study, 419 sexually diverse women ages 18 through 69 who identified as multiorgasmic completed an online survey assessing variables pertaining to sociodemographic background, context and characteristics of a recent/typical multiorgasmic experience, relationships between multiple orgasm and sexual/nonsexual aspects of life, and sexual and orgasmic history. Data reduction analyses using principal component analysis pointed out that 15 variables of interest were distributed across six components, accounting for a large proportion of the sample's variance. A k-means cluster analysis further revealed that four distinct groups of women could be parsed out. These four groups could be differentiated by three sets of variables-sexual motivation, sexual history, and multiple orgasm characteristics-suggesting that female multiple orgasm is not a unitary phenomenon. This research provides to date the most comprehensive picture of female multiple orgasm and helps refine our conceptual understanding.

Sexual desire and its relationship with subjective orgasm experience

Orgasm and sexual desire are components of the human sexual response. The main objective of this study was to examine the relationship between the sexual desire and dimensions of the subjective orgasm experience. A sample composed of 1161 heterosexual adults, distributed into three age groups (18-34, 35-49, and 50 years old or older), completed a background questionnaire, the Orgasm Rating Scale, and the Sexual Desire Inventory. First, the effect that sex and age have on the subjective orgasm experience was analyzed. Second, correlations between sexual desire and orgasm experience were examined. Also, the predictive capacity that dimensions of sexual desire have on the subjective orgasm experience in the context of sexual relationship was examined. Results showed that age had a significant effect on the intensity of the subjective orgasm experience perceived during sexual relationships with a partner and that this experience decreased as people get older. There was an association between the components of sexual desire and the dimensions of subjective orgasm experience. Furthermore, partner-focused sexual desire contributed in a relevant manner to the subjective orgasm experience. Implications for both research and clinical field are also discussed.

Challenging the Standard Model of Sexual Response: Evidence of a Variable Male Sexual Response Cycle

Historically the male sexual response cycle was seen as uniform and used as the standard for women. Recent research has suggested that men's sexual response cycle may vary more than previously thought. We asked 520 sexually active men between the ages of 18-73 to report on their sexual desire and arousal patterns during their last sexual experience. Using a latent class mixture model from retrospective sexual response data, we found five classes of desire and arousal patterns. These patterns were examined for associations with demographics, outcomes during the sexual experience, and outcomes for the global relationship. The experiences of arousal and desire appear to be indistinguishable for men in this sample. The Fluctuation sexual response class (19% of men) and the High sexual response class (40%) were significantly different from most of the other classes in duration of their sexual experiences and overall satisfaction with their sexual experiences. Still, most sexual response patterns were associated with healthy relational and sexual outcomes. Variability in the male sexual response cycle is important to acknowledge and normalize.

Factors Associated with Subjective Orgasm Experience in Heterosexual Relationships

The main objective of this study was to determine the predictive capacity of different variables, organized based on Ecological theory (i.e., personal, interpersonal, social, and ideological), in the intensity of the subjective orgasm experience within the context of heterosexual relationships. The sample was composed of 1,300 adults (547 men, 753 women). The proposed model for men showed that more intense subjective orgasm experience was predicted by age, sexual sensations seeking, sexual satisfaction, and partner-focused sexual desire. The model for women showed that more intense subjective orgasm experience was predicted by age, erotophilia, sexual sensation seeking, partner-focused sexual desire, and sexual satisfaction.

Ejaculatory and Orgasmic Dysfunction Following Prostate Cancer Therapy: Clinical Management

The majority of sexual health research has focused on erectile dysfunction following prostate cancer treatment. Ejaculatory and orgasmic dysfunction are significant side effects following the treatment of prostate cancer. Orgasmic dysfunction covers a range of issues including premature ejaculation, anorgasmia, dysorgasmia, and climacturia. This review provides an overview of prevalence and management options to deal with orgasmic dysfunction. A Medline Pubmed search was used to identify articles relating to these problems. We found that orgasmic dysfunction has a very large impact on patients’ lives following prostate cancer treatment and there are ways for physicians to treat it. Management of patients’ sexual health should be focused not only on erectile dysfunction, but on orgasmic dysfunction as well in order to ensure a healthy sexual life for patients and their partners.

When Orgasms Do Not Equal Pleasure: Accounts of "Bad" Orgasm Experiences During Consensual Sexual Encounters

Orgasms during consensual sex are often assumed to be wholly positive experiences. This assumption overshadows the possibility that orgasm experiences during consensual sex could be "bad" (i.e., negative and/or non-positive). In the present study, we employed an online survey to explore the possibility that orgasm experiences could be "bad" during consensual sex by asking participants of diverse gender and sexual identities (N = 726, M age = 28.42 years, SD = 7.85) about a subset of potential bad orgasm experiences. Specifically, we asked participants whether they have ever had an orgasm during coerced sex, compliant sex, and/or when they felt pressured to have an orgasm (i.e., orgasm pressure). We also asked participants who had such an experience to describe it, resulting in qualitative descriptions from 289 participants. Using mixed quantitative and qualitative analyses, we found compelling evidence that orgasm experiences can be "bad" during consensual sex. Specifically, many participants described their experiences in negative and/or non-positive ways despite orgasm occurrence, reported that their orgasms were less pleasurable compared to other experiences, and suggested that their orgasm experiences had negative impacts on their relationships, sexuality, and/or psychological health. Participants also suggested that social location shaped their bad orgasm experiences, citing gender and sexual identity, gender identity conflict, race/ethnicity, and religion as important to their perceptions of and responses to their experiences. Results directly challenge the assumption that orgasms during consensual sex are always and/or unilaterally positive experiences.

The embodiment of a floating signifier

As described in ethnographies, the 'floating signifiers' of social anthropology appear akin to similar categories in contemporary Western societies such as energy. Both may be embodied in actual experience. The practice of ritual orgasm, Pra-Na, and its relation to the group's cosmology, are intrinsic to a religio-therapeutic community in San Francisco whose ideas derive from reified Western notions of 'vital energy' along with popular Chinese medicine, and in which the second author conducted fieldwork involving participant observation between 2008 and 2009. The article examines closely the formulations of 'energy' in the Western world, and similarities to non-Western concepts such as Melanesian mana, and asks whether the experience of ritualised orgasm by members of the group leads to their notion of cosmic energy, or whether the understanding of embodied energy is purely arbitrary from a somatic perspective. With reference to Durkheim's ([1912]1976. The Elementary Forms of the Religious Life. London: Allen & Unwin) -effervescence, we suggest the former is most likely.

Not All Orgasms Were Created Equal: Differences in Frequency and Satisfaction of Orgasm Experiences by Sexual Activity in Same-Sex Versus Mixed-Sex Relationships

Which sexual activities result in the most frequent and most satisfying orgasms for men and women in same- and mixed-sex relationships? The current study utilized a convenience sample of 806 participants who completed an online survey concerning the types of sexual activities through which they experience orgasms. Participants indicated how frequently they reached orgasm, how satisfied they were from orgasms resulting from 14 sexual activities, and whether they desired a frequency change for each sexual activity. We present the overall levels of satisfaction, frequency, and desired frequency change for the whole sample and also compare responses across four groups of participants: men and women in same-sex relationships and men and women in mixed-sex relationships. While all participants reported engaging in a wide variety of activities that either could, or often did, lead to the experience of orgasm, there were differences in the levels of satisfaction derived from different types of orgasms for different types of participants, who also engaged in such activities with varying degrees of frequency. We discuss group differences within the context of sexual scripts for same- and mixed-sex couples and question the potential explanations for gender differences in the ability to experience orgasm during partnered sexual activity.

Psychometric Properties of the Orgasm Rating Scale in Context of Sexual Relationship in a Spanish Sample

BACKGROUND

The Orgasm Rating Scale (ORS) is one of the few self-reported measures that evaluates the multidimensional subjective experience of orgasm.

AIM

The objective of this study was to examine the psychometric properties of the ORS in context of sex-with-partner in a Spanish sample.

METHODS

We examined a sample of 842 adults from the general Spanish population (310 men, 532 women; mean age = 27.12 years, SD = 9.8). The sample was randomly divided into two, with a balanced proportion of men and women between each sub-sample. Sub-sample 1 consisted of 100 men and 200 women (33.3% and 66.6%) with a mean age of 27.77 years (SD = 10.05). Sub-sample 2 consisted of 210 men and 332 women (38.7% and 61.3%) with a mean age of 26.77 years (SD = 9.65). The ORS, together with the Sexual Opinion Survey-6 and the Massachusetts General Hospital-Sexual Functioning Questionnaire, was administered online. The survey included a consent form, in which confidentiality and anonymity were guaranteed.

OUTCOMES

Based on exploratory factor analysis, we obtained a reduced 25-item version of the ORS, distributed along 4 dimensions (affective, sensory, intimacy, and rewards).

RESULTS

We performed both exploratory factor analysis and confirmatory factor analysis. The Spanish version of the ORS had adequate values of reliability that ranged from .78-.93. The 4 factors explained 59.78% of the variance. The factor structure was invariant across gender at a configural level. Scores from the ORS positively correlated with erotophilia and sexual satisfaction. The scale was useful to differentiate between individuals with orgasmic difficulties and individuals with no difficulties. We found that individuals with orgasmic difficulties showed a lower intensity in the affective, intimacy, and sensorial manifestations of orgasm.

CLINICAL TRANSLATION

This version of the ORS could provide an optimum measure for the clinical assessment to identify individuals with difficulties in their orgasmic capacity, thus, it could be used as screening device for orgasmic dysfunction.

CONCLUSIONS

The ORS is an appropriate measure for its use for both research and clinical purposes. As limitations, quota sampling implies that the extent to which the results can be generalized is modest. Measurement invariance did not reach the level of weak invariance, and it was not tested across sexual orientation because most individuals identified themselves as heterosexual. The ORS is a multidimensional measure of the subjective experience of orgasm which has adequate psychometric properties; it is a reliable and valid scale. Arcos-Romero AI, Moyano N, Sierra JC. Psychometric Properties of the Orgasm Rating Scale in Context of Sexual Relationship in a Spanish Sample. J Sex Med 2018;15:741-749.

[Systematic review of the subjective experience of orgasm]

Orgasm is an essential component of the sexual response. Its study has generated results that point out its importance in human sexuality. The aim of the present study was to review the subjective orgasm experience, its evaluation and its association with personal, interpersonal and psychosocial variables. After conducting a literature search in major databases, we provide a total of 121 scientific articles published between 2000 and 2016, in which the subjective orgasm experience was the main variable. The analysis of the related variables shows that personal variables (for example, health and demographic factors) and interpersonal variables (for example, sexual functioning) are the most considered. To conclude, we observe the need to develop standardized instruments to evaluate specifically the subjective orgasm experience and the need to study jointly the associated variables in order to propose explanatory models of orgasm that are useful for clinical practice.

Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women

BACKGROUND

The differential role of psychological traits in the etiology and maintenance of female orgasm difficulties is yet to be consistently established.

AIM

To investigate the contribution of different psychological trait features (personality, sexual inhibition and excitation, and sexual beliefs) to predict female orgasm and to assess the degree to which these dispositional factors moderate the association between sexual activity and orgasm occurrence in a large community sample of Portuguese women.

METHODS

1,002 women (18-72 years, mean age = 26.27, SD = 8.74) completed questionnaires assessing personality traits (NEO-Five Factor Inventory), sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales-Short Form [SIS/SES]), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), sexual behavior (frequency of sexual activities and frequency of orgasm occurrence), and social desirability (Socially Desirable Response Set). Hierarchical multiple regression and moderation analyses were conducted while controlling for the effect of covariates such as social desirability, sociodemographic and medical characteristics, and relationship factors.

OUTCOMES

The main outcome measurement was orgasm frequency as predicted and moderated by personality, SIS/SES dimensions, and sexual beliefs.

RESULTS

Results of the hierarchical multiple regression analysis indicated a significant predictive role for sexual inhibition (associated with fear of performance failure [SIS1] and related to the threat of performance consequences) and body image beliefs in female orgasm occurrence. The significant predictive effect of extraversion and of sexual excitation on orgasm frequency ceased to be significant with the insertion of all trait predictors in the final model. Furthermore, SIS1 significantly moderated the relation between sexual activity and orgasm occurrence.

CLINICAL IMPLICATIONS

Attention should be given to individual factors impairing orgasmic response in women, particularly sexual inhibition processes. The development of clinical strategies to address and regulate them is recommended.

STRENGTHS AND LIMITATIONS

Although this study investigated a large community sample, this sample was composed of heterosexual, relatively young women and thus generalization of the present results demands some caution. Social desirability was controlled for in the analyses and questionnaires were not collected face to face, which constitutes a strength of this study because social desirability is lower in self-administered online questionnaires compared with paper-and-pencil questionnaires, particularly for more sensitive sexual issues.

CONCLUSION

SIS1 was found to be a vulnerability factor for female orgasmic difficulties. Future research should test these findings with different samples, particularly clinical samples of women with orgasmic problems, preferably with the use of longitudinal designs. Tavares IM, Laan ETM, Nobre PJ. Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women. J Sex Med 2018;15:361-372.

Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students

Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.

Distress, disease, desire: perspectives on the medicalisation of premature ejaculation

The discovery that certain selective serotonin reuptake inhibitors delay ejaculation and the later development and approval of dapoxetine as an on-demand treatment option has led to a dramatic increase in medical interest in premature ejaculation. This paper analyses the diagnostic criteria and the discussion within the medical community about suitable treatments against the backdrop of theories of science, sex and gender. Our conclusion is that the diagnosis itself and the suggested treatments contribute to normative models of sexual conduct and therefore reinforce the norms that cause patients' distress over ejaculating 'too soon'.

Orgasmic Dysfunction Following Radical Prostatectomy: Review of Current Literature

INTRODUCTION

The sexual problem after radical prostatectomy (RP) that has received the most focus in the current literature is erectile dysfunction. However, there are orgasmic complications that encompass orgasm-associated urinary incontinence (climacturia), anorgasmia, changes in orgasmic sensation, and painful orgasm (dysorgasmia). Although the body of research is still growing, there remains a need for physician and patient awareness of these potentially problematic complications.

AIM

To review the prevalence and management options for different orgasmic dysfunctions after RP.

METHODS

A Medline PubMed search was used to identify articles related to orgasmic dysfunction, including climacturia, dysorgasmia, anorgasmia, and altered sensation after RP.

MAIN OUTCOME MEASURE

Rates and types of orgasmic dysfunction after RP.

RESULTS

Orgasmic dysfunction encompasses a series of conditions that affect men after RP. These include climacturia, dysorgasmia, anorgasmia, and altered sensation. Although the etiologies and management options remain uncertain, their effect on the sexual health of patients is not negligible.

CONCLUSION

To provide proper counseling to patients, physicians should be aware of the prevalence of orgasmic side effects after RP. Post-prostatectomy sexual recovery should be focused not only on penile erectile function but also on a satisfactory and healthy sexual life for patients and their partners. Clavell-Hernández J, Martin C, Wang R. Orgasmic Dysfunction Following Radical Prostatectomy: Review of Current Literature. Sex Med Rev 2018;6:124-134.

Sexual Function after Surgery for Prostate or Bladder Cancer

Background

Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer.

Methods

The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems.

Results

Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation.

Conclusions

Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.

Validation of a Self-Report Questionnaire Assessing the Bodily and Physiological Sensations of Orgasm

INTRODUCTION

Despite a plethora of research on sexual functioning during the past decades, the field is still lacking standardized measurements specifically characterizing orgasm. Although several validated tools are available to assess sexual function in healthy and clinical populations, items on orgasm are limited to frequency or dichotomous responses. A neurophysiologic model of orgasm developed from previous research in able-bodied and spinally injured populations offers a promising framework for the construction of a new questionnaire.

AIM

To develop and validate a brief self-report measurement of orgasm by the assessment of bodily and physiologic sensations perceived during climax by able-bodied individuals. Although the currently available tool focuses on the phenomenological sensations associated with climax, the goal of this questionnaire was to capture the more specific genital and extragenital sensations associated with orgasm.

MAIN OUTCOME MEASURES

The current Bodily Sensations of Orgasm questionnaire and the Orgasm Rating Scale.

METHODS

Data from previous research conducted on individuals with spinal cord injury and the available empirical literature provided a pool of 45 items organized into four categories, which were reviewed by an expert panel. Upon review, a 28-item questionnaire was created and administered to a community sample of 227 participants, including men and women, 18 to 73 years old.

RESULTS

Exploratory factor analyses supported the four-factor model, in which orgasm is comprised of extragenital sensations, genital sensations and spasms, nociceptive sensations, and sweating responses. Overall, a high degree of internal consistency was found for the final 22-item questionnaire (Cronbach α = 0.87), with individual reliability coefficients showing moderate to high internal consistency (r = 0.65-0.79) for each dimension. Overall temporal stability of the measurement was acceptable (r = 0.74). Using the Orgasm Rating Scale, satisfying convergent validity was confirmed, thereby indicating that the two measurements are complementary.

CONCLUSION

The Bodily Sensations of Orgasm questionnaire allows for a brief evaluation of the physical and physiologic sensations associated with orgasm. Findings also suggest perceptual differences between men and women with regard to climax, with women reporting a larger repertoire of climactic sensations during orgasm.

The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A)

INTRODUCTION

The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects.

AIM

To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant.

CONCLUSION

Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.

Orgasmic Function after Radical Prostatectomy

PURPOSE

We examined postprostatectomy orgasmic function and assessed for potential predictors.

MATERIALS AND METHODS

Between 2005 and 2013, 499 men underwent radical prostatectomy and completed quality of life questionnaires prospectively before surgery and at regular postoperative intervals. We used mixed effects logistic regression models to evaluate average differences in followup measures and interactions with time.

RESULTS

At a median followup of 36 months orgasmic function was worse, stable or improved in 300 (60.1%), 152 (30.5%) and 47 men (9.4%), respectively. Orgasmic function recovery plateaued at 15 to 21 months. High postoperative orgasmic function was positively associated with younger age (50 years or younger vs 51 to 60 OR 3.40, 95% CI 1.56-7.41), nerve sparing (bilateral OR 7.11, 95% CI 2.55-19.77, modified 4.34, 95% CI 1.38-13.58 and unilateral OR 3.93, 95% CI 1.17-13.16), erectile function (OR 4.67, 95% CI 3.32-6.57) and sexual desire (OR 5.51, 95% CI 3.95-7.68) but negatively associated with lower urinary tract symptoms (OR 0.58, 95% CI 0.41-0.82) and urinary incontinence (OR 0.38, 95% CI 0.25-0.56). Although robotic status did not influence orgasmic function in the overall cohort, it was associated with faster recovery on subgroup analysis of 356 patients with long followup. On another subgroup analysis of 235 men with long followup and poor erectile function the association of high preoperative orgasmic function and bilateral nerve sparing with high orgasmic function persisted, suggesting an independent effect on orgasmic function apart from that on erectile function.

CONCLUSIONS

Orgasmic function recovery after radical prostatectomy is a lengthy process. Predictors of orgasmic function include preoperative orgasmic function, age, nerve sparing status, erectile function, sexual desire and urinary control and function.

Recognition and Construction of Top, Bottom, and Versatile Orientations in Gay/Bisexual Men

Research on gay and bisexual men's sexual position self-label (i.e., being a top, bottom, or versatile during anal sex) has revealed only independent snapshots of its development by focusing primarily on the influence of penis size. Moreover, the basic chronology of development of the sexual position self-label has barely been addressed. In response, we implemented a survey of 282 gay and bisexual men that measured demographics (including height and penis size), age of sexual recognitions, sexual position self-label, and attitudinal constructs suggested by previous literature as important (e.g., pleasure, control, anxieties, and gender typicality). Results suggested that men's sexual position self-label was learned over a 15-year timespan. Ages of first same-sex genital manipulation and first anal sex experiences were related to age at first self-labeling. With respect to predictors of labels, a multivariate path model was created. The model did not support the direct importance of penis size, but identified indirect paths that linked penis size to top/bottom identification (e.g., smaller penis sizes leading to topping-anxieties and thus, a bottom label). Finding bottoming to be pleasurable and the importance of sexual control dynamics were the only two direct predictors. The path model substantiated the reliance both bottoms and tops show towards seeking (or not seeking among tops) gender typical, sexually dominant partners. It also supported previous evidence regarding race; specifically, while race may activate differences in sexual behavioral dynamics, it is not a great predictor of the sexual position self-label. This study shows that sexual position self-labeling has enormous complexity and cannot be reduced down to penis size.

Sexual dysfunction among women with Schizophrenia-A cross sectional study from India

Sexual dysfunction among women usually has a multifactorial etiology and is also difficult to study in cultures where open discussions about sexuality are not common. Not much is known about sexual function in women with schizophrenia even though it may have a significant impact on their quality of life and maybe influenced by several factors.

AIMS AND OBJECTIVES

This study aimed to assess the frequency and nature of sexual dysfunction in women with schizophrenia and study its association with marital quality, illness, treatment, and socio-demographic factors.

METHODOLOGY

This was a cross sectional, hospital-based study conducted among 63 women with schizophrenia attending the outpatient services of a tertiary care psychiatric hospital. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI). Side effects of medications, psychopathology, and marital quality were assessed using standard scales.

RESULTS

Among the 63 women assessed, 44 (70%) reported sexual dysfunction. Impaired desire was reported by all women, impaired arousal by 58 (92.1%), poor lubrication by 30 (47.6%), impaired orgasm by 48(76.2%) poor satisfaction by 44(69.8%) and pain by 23(36.5%). Poor Marital quality ('p' value-0.001), higher scores on general psychopathology of the Positive and Negative symptoms scale of schizophrenia (PANSS) ('p' value-0.049) and side effects such as weight gain, menstrual disturbances, galactorrohea and dry vagina were significantly associated with Female Sexual Dysfunction (FSD) in univariate analysis. However, multivariate analysis found marital quality alone to be significantly related to FSD.

Measuring sperm backflow following female orgasm: a new method

BACKGROUND

Human female orgasm is a vexed question in the field while there is credible evidence of cryptic female choice that has many hallmarks of orgasm in other species. Our initial goal was to produce a proof of concept for allowing females to study an aspect of infertility in a home setting, specifically by aligning the study of human infertility and increased fertility with the study of other mammalian fertility. In the latter case - the realm of oxytocin-mediated sperm retention mechanisms seems to be at work in terms of ultimate function (differential sperm retention) while the proximate function (rapid transport or cervical tenting) remains unresolved.

METHOD

A repeated measures design using an easily taught technique in a natural setting was used. Participants were a small (n=6), non-representative sample of females. The introduction of a sperm-simulant combined with an orgasm-producing technique using a vibrator/home massager and other easily supplied materials.

RESULTS

The sperm flowback (simulated) was measured using a technique that can be used in a home setting. There was a significant difference in simulant retention between the orgasm (M=4.08, SD=0.17) and non-orgasm (M=3.30, SD=0.22) conditions; t (5)=7.02, p=0.001. Cohen's d=3.97, effect size r=0.89. This indicates a medium to small effect size.

CONCLUSIONS

This method could allow females to test an aspect of sexual response that has been linked to lowered fertility in a home setting with minimal training. It needs to be replicated with a larger sample size.

Multiple Orgasms in Men-What We Know So Far

INTRODUCTION

There is much popular discussion on strategies to facilitate multiple orgasms in men (ie, 100,000+ hits in Google), yet the topic has not received an objective comprehensive review in the literature.

AIM

To review the literature on male multiple orgasms.

METHODS

We searched the literature for publications on "male multiple orgasms" and factors influencing male multiple orgasms in Google, PubMed, and PsychINFO. This yielded 15 relevant publications.

MAIN OUTCOME MEASURES

A comprehensive overview on the topic of male multiple orgasms and factors that influence the propensity of men to experience multiple orgasms.

RESULTS

Few men are multiorgasmic: <10% for those in their 20s, and <7% after the age of 30. The literature suggests 2 types of male multiple orgasms: "sporadic" multiorgasms, with interorgasmic intervals of several minutes, and "condensed" multiorgasms, with bursts of 2-4 orgasms within a few seconds to 2 minutes. Multiple orgasms appear physiologically similar to the single orgasm in mono-orgasmic men. However, in a single case study, a multiorgasmic man did not experience with his first orgasm the prolactin surge that usually occurs with orgasm in mono-orgasmic men. Various factors may facilitate multiple orgasms: (1) practicing to have an orgasm without ejaculation; (2) using psychostimulant drugs; (3) having multiple and/or novel sexual partners; or (4) using sex toys to enhance tactile stimulation. However, confirmatory physiological data on any of these factors are few. In some cases, the ability to experience multiple orgasms may increase after medical procedures that reduce ejaculation (eg, prostatectomy or castration), but what factor(s) influence this phenomenon is poorly investigated.

CONCLUSION

Despite popular interest, the topic of male multiple orgasms has received surprisingly little scientific assessment. The role of ejaculation and physiological change during the refractory period in inhibiting multiple orgasms has barely been investigated.