Updating, correcting, and calibrating the narrative about premature ejaculation.

INTRODUCTION: The narrative surrounding premature ejaculation (PE) has developed and solidified over the past 25 years. Unfortunately, portions of that narrative are outdated and do not reflect more recent conceptualizations or empirical findings regarding this disorder. OBJECTIVE: In this review we sought to identify existing narratives about PE in need of updating and to provide revised narratives based on the recent research literature. METHOD: Five PE narratives in need of revision were identified, including: the prevalence of PE, age-related differences in PE prevalence, a validated ejaculation latency (EL) for diagnosing PE, differences between lifelong and acquired PE subtypes, and the application of PE definitions beyond penile-vaginal intercourse. Extensive literature searches provided information supporting both the original narrative and the need for a revised narrative based on both consideration of more recent studies and reinterpretation of studies conducted since the establishment of the original narratives. RESULTS: For each selected topic, the prevailing narrative based on the extant literature was first presented, followed by discussion of accumulating evidence that challenges the existing narrative. Each section ends with a suggested revised PE narrative. In 2 instances, the revised narrative required significant corrections (eg, PE prevalence, validated EL for diagnosing PE); in 2 instances, it expanded on the existing narrative (eg, PE subtype differences, inclusion of partnered sexual activities beyond penile-vaginal intercourse); and in 2 other instances, it backed off prior conclusions that have since required rethinking (eg, age-related changes in PE, PE subtype differences). Finally, a brief review of the 3-pronged criteria for PE (EL, ejaculatory control, and bother/distress) is presented and discussed. CONCLUSION: This review reiterates the dynamic state of research on PE and demonstrates the need for and value of ongoing research that not only addresses new issues surrounding this dysfunction but also challenges and revises some of the existing narratives about PE.

Do Ejaculation Latency and Other Sexual Measures Differ Between Men With Lifelong and Acquired Premature Ejaculation?

OBJECTIVE: To determine whether men with lifelong vs acquired premature ejaculation (PE) subtypes differ on their estimated ejaculation latencies (EL) and related sexual, relationship, and behavioral parameters. METHODS: Of 2679 men who responded to an online multinational survey about sexual health and met inclusion criteria, 540 reported "probable" or "definite" PE, as assessed by the Premature Ejaculation Diagnostic Tool. Lifelong and acquired PE subtypes were compared on multiple measures related to EL, as well as on sets of demographic, diagnostic, relationship, sexual behavioral, and sexual functioning measures during both partnered sex and masturbation. RESULTS: Nearly 73% of men with PE in this sample reported the lifelong subtype. No differences emerged in EL measures between subtypes, even when parsed according to age. Specifically, men 37years or under with either definite lifelong or acquired PE reported ELs of 1.9 minutes (SD=1.3). For men over 37, lifelong ELs were 2.0 minutes (SD=1.3), acquired ELs 2.4 minutes (SD=1.4). While the lifelong subgroup was younger and reported lower erectile functioning, these differences occurred only in the probable PE group and not the definite PE group. CONCLUSION: Our data do not support different EL criteria for men with acquired vs lifelong PE, as suggested by several professional definitions. Furthermore, differences in age and erectile functioning between the groups, often reported in clinical samples though not in our definite PE group, may be an artifact of the general health/patient characteristics that lead such men to seek medical assistance.

Similarities and differences between men with self-reported lifelong and acquired difficulty reaching ejaculation.

Men with delayed ejaculation are often categorized into lifelong and acquired subtypes, yet little is known about similarities and differences between these groups. In this study, we examined whether delayed ejaculation subtypes differed on various demographic, diagnostic, relationship, and sexual activity/satisfaction variables. We drew 140 men reporting moderately-severe to severe difficulty reaching ejaculation during partnered sex (occurring during ≥75% of sexual events) from a convenience sample of over 3000 respondents obtained through an opt-in, multinational, online survey. Respondents were further classified as having lifelong or acquired delayed ejaculation based on self-report. A series of alpha-adjusted analyses of covariance were then made between subtypes on subsets of variables. In addition, the extent to which two potential confounding variables, age and erectile function, might have been responsible for subtype differences was explored. Results indicated that compared with men with acquired delayed ejaculation, men with lifelong delayed ejaculation were younger (28.6 vs 44.7 years, η2p = 0.30, P < 0.001), reported greater delayed ejaculation symptomology (4.31 vs 3.98, P < 0.01, η2p = 0.02), were less likely to attribute their problem to a medical issue or medication (1.7% vs 12.2%, P < 0.05), and more likely to masturbate for anxiety/distress reduction than for pleasure. In contrast, delayed ejaculation subtype differences related to masturbation frequency, pornography use during masturbation, and condom use disappeared when age and erectile functioning differences were statistically controlled. Overall, lifelong and acquired delayed ejaculation subtypes showed more similarities than differences. Findings worthy of clinical note were the lower level of endorsement of medical issues/medication by the lifelong subtype, their higher level of delayed ejaculation symptomology, and-despite a high level of anxiety/distress reported by both groups-their particular vulnerability to anxiety/distress as indicated by their strong motive to masturbate for anxiety/distress reduction (44.3% vs 19.6%, P < 0.05). Other differences between delayed ejaculation subtypes were better explained by group differences in age and erectile function than by subtype membership per se.

Self-reported reasons for having difficulty reaching orgasm in men with diverse etiologies.

Background: Difficulty reaching orgasm/ejaculation during partnered sex, a primary characteristic of delayed or absent ejaculation, affects about 5% to 10% of men, but the reasons underlying this problem are poorly understood. Aim: The study sought to gain insight into possible etiologies of delayed ejaculation by assessing men's self-perceptions as to why they experience difficulty reaching orgasm. Methods: We drew 351 men reporting moderately severe to severe difficulty reaching orgasm during partnered sex from a sample of over 3000 respondents obtained through an online survey. As part of the 55-item survey, participants responded to 2 questions asking about their self-perceived reasons for having difficulty reaching orgasm and selected from a list of 14 options derived from the research literature, a series of men's focus groups, and expert opinion. The first question allowed respondents to select all the reasons that they felt contributed to the problem, the second to select only the most important reason. In addition, both men with and without comorbid erectile dysfunction were investigated and compared. Outcomes: Hierarchical ordering of men's self-pereceived reasons for having difficulty reaching orgasm, including typal reasons established through principal component analysis. Results: The major reasons for difficulty were related to anxiety/distress and lack of adequate stimulation, with relationship and other factors endorsed with lower frequency. Further exploration using principal components analysis identified 5 typal reasons, in descending order of frequency: anxiety/distress (41%), inadequate stimulation (23%), low arousal (18%), medical issues (9%), and partner issues (8%). Few differences emerged between men with and without comorbid ED other than ones related to erectile problems, such as higher level of endorsement of medical issues. Typal reasons showed correlations, albeit mostly weak, with a number of covariates, including sexual relationship satisfaction, frequency of partnered sex, and frequency of masturbation. Clinical Implications: Until supplemental medical treatments for delayed ejaculation are developed and approved, a number of men's purported reasons for difficult or absent ejaculation/orgasm-anxiety/distress, inadequate stimulation, low arousal, relationship issues-fall into areas that can be addressed in couples counseling by a trained sex therapist. Strengths and Limitations: This study is unique in scope and robust in sample size. Drawbacks include those associated with online surveys, including possible bias in sample selection, limitation to Western-based samples, and the lack of differentiation between men with lifelong and acquired difficulty. Conclusion: Men who have difficulty reaching ejaculation/orgasm identify putative reasons for their problem, ranging from anxiety/stress, inadequate stimulation, and low arousal to partner issues and medical reasons.

Why Men Masturbate: Reasons and Correlates in Men with and without Sexual Dysfunction.

Men purportedly masturbate for a variety of reasons, but systematic investigation of men's reasons has been lacking. We analyzed reasons why men masturbate (n = 2967, mean age = 37.7, SD = 12.9), whether men with and without sexual problems differ in their reasons, and whether those reasons vary with the frequency of masturbation and partnered sex. Results indicated that deriving pleasure, decreasing sexual tension, and reducing anxiety/stress were among the top motives, whereas partner issues were cited less frequently. Men with sexual dysfunctions showed only minor differences from men without sexual dysfunctions, the former more often citing anxiety/stress reduction as a motive. In addition, samples tapping participants from two world regions showed only minor differences in their patterns of responding. Motives for masturbation were also related to both the frequency of masturbation and the frequency of partnered sex. Overall, these findings indicate that men, like women, masturbate primarily for the positive reinforcing effects of pleasure, but in contrast with women, men are also more likely to use masturbation for the negatively reinforcing effects of reducing anxiety/distress. Unsatisfying sex with the partner and/or relationship issues were cited as a reason for masturbation in only a minority of men.

Identifying an optimal ejaculation latency for the diagnosis of men reporting orgasmic/ejaculation difficulty.

BACKGROUND: Criteria for the definition and diagnosis of delayed ejaculation (DE) are yet under consideration. AIM: This study sought to determine an optimal ejaculation latency (EL) threshold for the diagnosis of men with DE by exploring the relationship between various ELs and independent characterizations of delayed ejaculation. METHODS: In a multinational survey, 1660 men, with and without concomitant erectile dysfunction (ED) and meeting inclusion criteria, provided information on their estimated EL, measures of DE symptomology, and other covariates known to be associated with DE. OUTCOMES: We determined an optimal diagnostic EL threshold for men with DE. RESULTS: The strongest relationship between EL and orgasmic difficulty occurred when the latter was defined by a combination of items related to difficulty reaching orgasm and percent of successful episodes in reaching orgasm during partnered sex. An EL of ≥16 minutes provided the greatest balance between measures of sensitivity and specificity; a latency ≥11 minutes was the best threshold for tagging the highest number/percentage of men with the severest level of orgasmic difficulty, but this threshold also demonstrated lower specificity. These patterns persisted even when explanatory covariates known to affect orgasmic function/dysfunction were included in a multivariate model. Differences between samples of men with and without concomitant ED were negligible. CLINICAL IMPLICATIONS: In addition to assessing a man's difficulty reaching orgasm/ejaculation during partnered sex and the percent of episodes reaching orgasm, an algorithm for the diagnosis of DE should consider an EL threshold in order to control diagnostic errors. STRENGTHS AND LIMITATIONS: This study is the first to specify an empirically supported procedure for diagnosing DE. Cautions include the use of social media for participant recruitment, relying on estimated rather than clocked EL, not testing for differences between DE men with lifelong vs acquired etiologies, and the lower specificity associated with using the 11-minute criterion that could increase the probability of including false positives. CONCLUSION: In diagnosing men with DE, after establishing a man's difficulty reaching orgasm/ejaculation during partnered sex, using an EL of 10 to 11 minutes will help control type 2 (false negative) diagnostic errors when used in conjunction with other diagnostic criteria. Whether or not the man has concomitant ED does not appear to affect the utility of this procedure.

Characteristics of men who report symptoms of delayed ejaculation: providing support for empirically derived diagnostic criteria.

BACKGROUND: Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE). AIM: To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE. METHODS: A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported "difficulty reaching ejaculation/orgasm during partnered sex." Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation. OUTCOMES: Outcomes included the identified differences between men with and without DE symptomology. RESULTS: Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including "bother/distress" and (lack of) "orgasmic pleasure/sexual satisfaction" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001). CLINICAL IMPLICATIONS: Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified. STRENGTHS AND LIMITATIONS: In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated. CONCLUSION: This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.

Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men?

Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28-0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11-0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).

Motives that Mediate the Associations Between Relationship Satisfaction, Orgasmic Difficulty, and the Frequency of Faking Orgasm.

INTRODUCTION: Faking orgasm by women reportedly occurs quite frequently, with both relationship characteristics and orgasmic difficulty being significant predictors. AIM: We explored women's motives that might mediate the associations between orgasmic difficulty and relationship satisfaction on the one hand, with the frequency of faking orgasm on the other. METHODS: In a study of 360 Hungarian women who reported "ever" faking orgasm during partnered sex, we assessed the direct and indirect (mediated) associations between orgasmic difficulty, relationship satisfaction, and the frequency of faking orgasm. OUTCOMES: Determination of motives that mediate the association between orgasmic difficulty and the frequency of faking orgasm, and the association between relationship satisfaction and the frequency of faking orgasm. RESULTS: Increased orgasmic difficulty was directly related to increased frequency of faking orgasm (ß = 0.37; P < .001), and each variable itself was related to a number of motives for faking orgasm. However, the only motive assessed in our study that mediated the relationship between orgasmic difficulty and the frequency of faking orgasm was insecurity about being perceived as abnormal or dysfunctional (indirect effect: ß = 0.13; P < .001). A similar pattern emerged with relationship satisfaction and frequency of faking orgasm. These two variables were directly related in that lower relationship satisfaction predicted higher frequency of faking orgasm (ß = -0.15; P = .008). Furthermore, while each variable itself was related to a number of motives for faking orgasm, the only motive assessed in our study that mediated the relationship between the 2 variables was insecurity about being perceived as abnormal or dysfunctional (indirect effect: ß = -0.06; P = .008). CLINICAL TRANSLATION: Insecurity related to being perceived as abnormal or deficient, along with sexual communication, should be addressed in women with a history of faking orgasm but who want to cease doing so. STRENGTHS AND LIMITATIONS: The sample was relatively large and the online survey adhered to best practices. Nevertheless, bias may result in sample characteristics when recruitment is achieved primarily through social media. In addition, the cross-sectional sample prevented causal determination and represented Western-based values. CONCLUSIONS: The associations between orgasmic difficulty and faking orgasm, and between relationship satisfaction and faking orgasm, are both direct and indirect (mediated). The primary motive for mediating the indirect association between the predictor variables and the frequency of faking orgasm was the insecurity about being perceived as deficient or abnormal. Hevesi K, Horvath Z, Miklos E, et al. Motives that Mediate the Associations Between Relationship Satisfaction, Orgasmic Difficulty, and the Frequency of Faking Orgasm. Sex Med 2022;10:100568.

Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?

INTRODUCTION: The role of bother/distress in the diagnosis of premature ejaculation (PE) has received minimal investigation compared with the 2 other diagnostic criteria, ejaculatory control and ejaculatory latency (EL). AIM: This study assessed (i) the added variance explained by bother/distress to the diagnostic accuracy of PE and (ii) determined its overall contribution to a PE diagnosis. METHODS: The 3 diagnostic criteria for PE were assessed in 2,589 men (mean age = 38.2 years, SD = 13.5) in order to determine the contribution of each factor to a dysfunctional diagnosis. A series of regression and discriminant analyses were used to assess the value of bother/distress in explaining ejaculatory control and in predicting accuracy of PE group status. Commonality analysis was used to determine the relative contribution of each of these factors to the diagnosis of PE. MAIN OUTCOME MEASURE: The major outcome was the quantified contribution of "bother/distress" to a PE diagnosis. RESULTS: Bother/distress accounted for about 3-4% of the variation in ejaculatory control and added only minimally to the prediction accuracy of PE group status (no, probable, definite PE). Commonality analysis indicated that bother/distress comprised about 3.6% of the unique explained variation in the PE diagnosis, compared with ejaculatory control and EL which contributed 54.5% and 26.7%, respectively. Common variance among factors contributed the remaining 15.5% to the PE diagnosis. CLINICAL TRANSLATION: Bother/distress contributes least to the determination of a PE diagnosis. Its contribution is largely redundant with the unique and combined contributions of ejaculatory control and EL. STRENGTHS AND LIMITATIONS: Using a well-powered and multivariate analysis, this study parsed out the relative contributions of the 3 diagnostic criteria to a PE diagnosis. The study is limited by its use of estimated EL, a single item assessment of bother/distress, and the lack of differentiation of PE subtypes, lifelong and acquired. CONCLUSION: Bother/distress contributes minimally to the PE diagnosis, yet its assessment may be key to understanding the experiences of the patient/couple and to developing an effective treatment strategy. Rowland DL, McNabney SM, Hevesi K. Does Bother/Distress Contribute to the Diagnosis of Premature Ejaculation?. Sex Med 2022;10:100548.

Premature Ejaculation Measures During Partnered Sex and Masturbation: What These Findings Tell Us About the Nature and Rigidity of Premature Ejaculation.

Men with premature ejaculation (PE) during partnered sex (as defined by poor ejaculatory control) show significantly reduced PE symptomology during masturbation, but the reasons for this disparity are not clear. This study investigated the other two PE-related diagnostic criteria, namely ejaculatory latency (EL) and bother/distress, in order to explore possible explanations for this disparity between types of sexual activity. Specifically, 1,447 men with either normal or poor ejaculatory control were compared on EL parameters, bother/distress, and sexual satisfaction/pleasure during both partnered sex and masturbation. Results indicated that men with PE reported longer ELs during masturbation than partnered sex, in contrast with men without PE who reported shorter ELs during masturbation. Bother/distress was lower for both groups during masturbation, but bother/distress in men with PE during masturbation was comparable to that of men without PE during partnered sex. Minimal difference in these patterns was found across lifelong and acquired PE subtypes, whereas men with PE with comorbid erectile dysfunction appeared to represent a distinct group. These findings have implications for PE management or treatment as well as for the overall conceptualization of PE as a pathophysiological condition.

Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample.

INTRODUCTION: Men suffering from one sexual problem sometimes report having another sexual problem, but few studies have determined concordance rates among dysfunctions in non-clinical samples. AIM: This study determined comorbidities among sexual dysfunctions based on an internet convenience sample of 4432 men from Hungary, the USA, and other world regions that visit social media fora. METHOD: Participants completed an online 55-item questionnaire that included questions assessing erectile dysfunction (ED), premature ejaculation (PE), delayed ejaculation (DE), and lack of sexual interest (LSI). MAIN OUTCOME MEASURES: Concordance rates and odds ratios among sexual dysfunctions. RESULTS: Approximately 8% of men suffered from two or more sexual problems; men with a severe sexual problem were significantly more likely to suffer from a second sexual problem; concordance between PE and erectile dysfunction ranged from 23-29%, with subtypes of lifelong vs acquired PE showing patterns similar to one another; and most men with delayed ejaculation reported minimal problems with LSI, although LSI was generally key to understanding all other dysfunctions. CONCLUSION: The percentage of men with one sexual problem having a second sexual problem was substantial, ranging from 23-40%. These findings will help clinicians better understand the intertwined nature of sexual problems and assist them in developing management protocols that address concomitant inadequacies in sexual response. Rowland DL, Oosterhouse LB, Kneusel JA, et al. Comorbidities Among Sexual Problems in Men: Results From an Internet Convenience Sample. Sex Med 2021;9:100416.

Faking Orgasm: Relationship to Orgasmic Problems and Relationship Type in Heterosexual Women.

INTRODUCTION: Although faking orgasm among women appears quite common, the roles of orgasmic problems and relationship type in partnered sex and masturbation have not been fully explored. AIM: We assessed the relationship between orgasmic problems (separately in partnered sex and masturbation) and faking orgasm across various types of relationships while also considering the role of demographic and sexual function related covariates. METHODS: In this study of 1,168 Hungarian women, we assessed orgasmic problems, sexual functioning, and the prevalence and frequency of faking orgasm in 3 relationship types: romantic relationships, one-night stands, and continuing sexual relationships of more than one night. MAIN OUTCOME MEASURE: Differences in faking orgasm across 3 types of relationships; the association between faking orgasm in 1 type of relationship with faking orgasm in other types of relationships; and the relationship of "orgasmic problems" in partnered sex and masturbation to the presence and frequency of faking orgasm in various relationship types. RESULTS: A subset of women who faked orgasm in 1 relationship type were more likely to fake orgasm in other relationship types. Orgasmic problems predicted the occurrence and frequency of faking orgasm in all 3 relationship types, though to different degrees. Other factors, including orgasmic difficulty during masturbation, the frequencies of masturbation and partnered sex, and the self-rated importance of sex were also related to the frequency of faking orgasm. CONCLUSION: Our findings suggest that faking orgasm has both dispositional and situational elements. "Orgasmic problems" in partnered sex was a consistent and robust predictor of the occurrence and frequency of faking orgasm in different relationship types. Hevesi K, Horvath Z, Sal D, et al. Faking Orgasm: Relationship to Orgasmic Problems and Relationship Type in Heterosexual Women. Sex Med 2021;9:100419.

Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction.

INTRODUCTION: This study explored the role of body image dissatisfaction on orgasmic response during partnered sex and masturbation and on sexual relationship satisfaction. The study also described typologies of women having different levels of body image satisfaction. METHODS: A sample of 257 Norwegian women responded to an online survey assessing body image dissatisfaction, problems with orgasm, and sexual relationship satisfaction. Using structural equation modeling and factor mixture modeling, the relationship between body image dissatisfaction and orgasmic response was assessed, and clusters of sexual response characteristics associated with varying levels of body image dissatisfaction were identified. MAIN OUTCOME MEASURE: Orgasmic function during partnered sex and masturbation, along with sexual relationship satisfaction, were assessed as a function of body image. RESULTS: Body image dissatisfaction, along with a number of covariates, predicted higher levels of "problems with orgasm" during both partnered sex and masturbation, with no significant difference in the association depending on the type of sexual activity. Varying levels of body image dissatisfaction/satisfaction were associated with differences in orgasmic incidence, difficulty, and pleasure during partnered sex; with one orgasmic parameter during masturbation; and with sexual relationship satisfaction. CONCLUSION: Body image dissatisfaction and likely concomitant psychological distress are related to impaired orgasmic response during both partnered sex and masturbation and may diminish sexual relationship satisfaction. Women with high body image dissatisfaction can be characterized by specific sexual response patterns. Horvath Z, Smith BH, Sal D, et al. Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction. Sex Med 2020;8:740-751.

Effects of Pornography Use and Demographic Parameters on Sexual Response during Masturbation and Partnered Sex in Women.

The effect of pornography on sexual response is understudied, particularly among women. A multinational, community-based sample of 2433 women at least 18 years of age completed a 42-item, opt-in questionnaire collecting information on demographic and sexual history characteristics, use of pornography during masturbation, frequency of pornography use, and sexual response parameters. Pornography use and average frequency were compared across demographic variables. We also examined how pornography frequency predicted differences in self-reported arousal difficulty; orgasmic difficulty, latency, and pleasure; and the percent of sexual activities ending in orgasm during both masturbation and partnered sex. On average, women using pornography were younger, and reported more interest in sex. Pornography frequency differed significantly by menopausal status, sexual orientation, anxiety/depression status, number of sexual partners, and origin of data collection. During masturbation, more frequent pornography use predicted lower arousal difficulty and orgasmic difficulty, greater pleasure, and a higher percentage of masturbatory events leading to orgasm. Frequency of pornography use predicted only lower arousal difficulty and longer orgasmic latencies during partnered sex, having no effect on the other outcome variables. Pornography use frequency did not predict overall relationship satisfaction or sexual relationship satisfaction. Overall, more frequent pornography use was generally associated with more favorable sexual response outcomes during masturbation, while not affecting most partnered sex parameters. Several demographic and relationship covariates appear to more consistently and strongly predict orgasmic problems during partnered sexual activity than pornography use.

Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress.

BACKGROUND: About 50% of women who report orgasmic difficulty (OD) during partnered sex are distressed by their condition, yet why some women are distressed and others are not is unclear. AIM: To determine whether sexual distress is related to women's perceived causes of their OD during partnered sex. METHODS: We established homogenous subgroups of women based on their attributions for OD during partnered sex, and these groups were validated by comparing them on variables relevant to sexual response. We then predicted OD-related distress from subgroup memberships as well as from a number of sociodemographic, control, and empirically supported sexual response variables. RESULTS: 3 distinct OD subgroups emerged: type 1-high psychological-high somatic reasons; type 2-partner-related reasons; and type 3-moderate psychological-low somatic reasons. These groups also differed on independent parameters related to sexual frequency and arousal. Subgroup membership, along with age, sexual relationship satisfaction, and frequency of partnered sex predicted sexual distress related to OD. CLINICAL IMPLICATION: Particular perceptions regarding the causes for OD help predict women's sexual distress, and such factors might be considered in identifying sexual issues and managing them within the context of a sexual relationship. STRENGTHS & LIMITATIONS: A large sample size drawn from a multinational population powered the study, while the cross-sectional nature of the sample could not rule out bidirectional associations between predictor covariates (including OD subgroup) and the outcome measure (sexual distress). CONCLUSION: Type 1 membership (high levels of psychological and somatic attributions) predicted greater levels of OD-related distress than type 2 (partner-related attributions) or type 3 (moderate psychological and low somatic attributions) membership, with type 1 women having a greater likelihood of internalizing (accepting responsibility/blame for) OD attributions. Hevesi K, Miklós E, Horváth Z, et al. Typologies of Women With Orgasmic Difficulty and Their Relationship to Sexual Distress. J Sex Med 2020;17:1144-1155.

Why and How Women Masturbate, and the Relationship to Orgasmic Response.

Masturbation, as a significant sexual activity within its own right, has garnered substantial interest as a research topic only within the past 10-20 years. In this in-depth analysis of masturbation in women, we examined relationships among frequencies of, reasons for, and activities during masturbation, and investigated how such parameters predict orgasmic pleasure, latency, and difficulty. Participants were 2215 women at least 18 years of age participating in a 42-item opt-in online survey that collected detailed information about women's orgasmic response during masturbation and partnered sex. Higher frequency of masturbation was related to lower satisfaction with partner, greater importance of sex, and higher levels of general anxiety/depression. Frequency of, reasons for, and activities during masturbation predicted both orgasmic pleasure and orgasmic difficulty during masturbation. The pattern of results enabled the development of three typologies of women who differ systematically with respect to their masturbation and partnered sex behaviors.

Self-reported reasons for having difficulty reaching orgasm during partnered sex: relation to orgasmic pleasure.

Purpose: This study investigated women's perceived causes for orgasmic difficulty during partnered sex and their relation to orgasmic pleasure.Method: From a community sample of 1843 women, we investigated 814 women's attributions for their orgasmic difficulty during partnered sex. Frequencies of 18 attributions were generated and subsequently reduced to eight principal variables through dimension reduction. Women with and without distress were compared across these eight principal variables. These variables, along with relevant covariates, were then used to predict orgasmic pleasure through regression analysis.Results: The most frequently endorsed reasons for orgasmic difficulty were, in descending order, general stress/anxiety, arousal difficulty, sex-specific anxiety and issues with the partner. Women reporting high distress were more likely to cite partner issues and less likely to report general stress/anxiety as reasons for their difficulty. Regression analysis, however, indicated that the reasons most frequently endorsed by women were not necessarily those accounting for the greater variance in orgasmic pleasure, such reasons including inhibition/lack of interest, insufficient experience and partner-related issues. Difficulty reaching orgasm during masturbation as well as relationship satisfaction also explained differences in orgasmic pleasure.Conclusion: Women cite various reasons for orgasmic difficulty, most commonly general anxiety/stress, inadequate arousal, sex-specific stress and partner issues. Women who were distressed by their condition more frequently cited partner issues. Variance in orgasmic pleasure was most related to partner issues, sexual inhibition/lack of interest and insufficient experience. Overall, partner issues and relationship satisfaction played important roles in attributions for both orgasmic difficulty and orgasmic pleasure.

Relationship Between Masturbation and Partnered Sex in Women: Does the Former Facilitate, Inhibit, or Not Affect the Latter?

INTRODUCTION: The relationship between masturbation activities and their effect on partnered sex is understudied. AIM: The aim of this study was to assess the alignment of activities between masturbation and partnered sex, and to determine whether different levels of alignment affect orgasmic parameters during partnered sex. METHODS: 2,215 women completed an online survey about activities during masturbation and reasons for orgasmic difficulty during masturbation, and these were compared with activities and reasons for orgasmic difficulty during partnered sex. MAIN OUTCOME MEASURE: Degree of alignment between masturbation activities and partnered sex activities was used to predict sexual arousal difficulty, orgasmic probability, orgasmic pleasure, orgasmic latency, and orgasmic difficulty during partnered sex. RESULTS: Women showed only moderate alignment regarding masturbation and partnered sex activities, as well as reasons for masturbation orgasmic difficulty and reasons for partnered sex orgasmic difficulty. However, those that showed greater alignment of activities showed better orgasmic response during partnered sex and were more likely to prefer partnered sex over masturbation. CLINICAL IMPLICATIONS: Women tend to use less conventional techniques for arousal during masturbation compared with partnered sex. Increasing alignment between masturbation and partnered sexual activities may lead to better arousal and orgasmic response, and lower orgasmic difficulty. STRENGTH & LIMITATIONS: The study was well-powered and drew from a multinational population, providing perspective on a long-standing unanswered question. Major limitations were the younger age and self-selection of the sample. CONCLUSION: Women that align masturbation stimulation activities with partnered sex activities are more likely to experience orgasm and enhanced orgasmic pleasure, with sexual relationship satisfaction playing an important role in this process. Rowland DL, Hevesi K, Conway GR, et al. Relationship Between Masturbation and Partnered Sex in Women: Does the Former Facilitate, Inhibit, or Not Affect the Latter? J Sex Med 2020;17:37-47.