Postcoital Dysphoria: Prevalence and Psychological Correlates

Discrimination, Internalized Sexual Prejudice and the Post-Sex Experience Among Members of Sexual Minorities

Postcoital dysphoria (PCD) refers to a counter-intuitive experience of sadness, tearfulness, irritability or dysphoria following an otherwise satisfactory and consensual sexual experience. Research to date has primarily focused on heteronormative samples. The current study explored the prevalence of PCD, and potential correlates of internalized sexual prejudice, perceived discrimination, and sex life satisfaction within a LGBTQIA+ population. One hundred and seventy-two adults identifying as LGBTQIA+ completed an online survey. Main outcome measures included the Post Sex Experience Scale (p-SES), Everyday Discrimination Scale (EDS), Internalized Homophobia Scale (IHS), Satisfaction with Sex Life Scale (SWSLS), and study specific questions. Prevalence of PCD was 42% of males attracted to other males and 81% of participants identifying as bisexual/sexual fluid. A significant and a moderate inverse correlation was found between sex life satisfaction and PCD (r = -.75) for individuals identifying as bisexual/fluid sexual orientation. Significant correlations were found between perceived discrimination and PCD (weak positive correlation, r = .28), and sex life satisfaction and PCD (moderate negative correlation, r = -.59) in men attracted to men. This research suggests being a member of a sexual minority is associated with sex-related dysphoria and dissatisfaction. Further research is needed to further elucidate PCD.

Further Exploration of the Correlates of Post-Coital Dysphoria and Its Prevalence within Different Sexual Contexts

The current study investigated the correlates of post-coital dysphoria (PCD) in men and women. Moreover, the study explored the PCD prevalence in the sexual contexts of a relationship, casual sex, and masturbation. An online survey was completed by 156 participants, 51 males and 105 females. All participants were over 18 and have had sex in and out of relationships, as well as having engaged in masturbation. Results showed that PCD was prevalent in each of the three sexual contexts, for both males and females. Furthermore, some previously identified correlates were replicated and found to be statistically significant predictors of PCD. A previously unexplored variable that was also found to significantly predict PCD were negative attitudes toward masturbation. The current research established that PCD occurs in multiple sexual contexts - something previously unknown. Prevalence rates of PCD after sex within a relationship, casual sex, and masturbation, for males were 21.6, 49 and 72.5, respectively. For females, prevalence rates were 11.4, 77.1 and 51.4%, respectively. Additionally, it identified which factors predict the experience of PCD for each of the different sexual contexts for each gender. This has potentially huge implications in formulating a focus for the treatment of PCD, dependent upon the gender and sexual context it is experienced in.

Clinical characteristics, allergic response to autologous semen, and desensitization in patients with postorgasmic illness syndrome

Introduction

Postorgasmic illness syndrome (POIS) is rare and includes a cluster of physical and cognitive symptoms that occur after ejaculation. The pathogenesis and effective treatments remain unclear.

Aim

This study aimed to characterize the symptomatology of POIS, study the allergic response of autologous semen in patients and controls, and evaluate the effects of desensitization therapy.

Methods

The clinical characteristics of 24 Chinese patients with POIS were analyzed. Skin prick tests, intracutaneous tests, and specific IgE detection were performed with autologous semen. Five patients were desensitized via subcutaneous injections of autologous semen.

Outcomes

Evaluated outcomes included the clinical features of POIS; scores of the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and visual analog scale (VAS) of symptoms; skin reactions; desensitization with diluted autologous seminal fluid; and the IgE reactivity patterns of immunoblotting and enzyme-linked immunosorbent assay in vitro.

Results

The most common symptom cluster was the general cluster, and the most prevalent symptoms were extreme fatigue and inattention. A total of 66.67% (14/21) of the patients had no symptoms or milder symptoms after nocturnal emission than after intercourse or masturbation. Of the patients, 87.5% (21/24) had psychiatric symptoms and 53.85% (7/13) had abnormal sex hormone levels. The SAS and SDS scores of the high and low VAS groups were significantly higher than those of the control group. Pearson analysis showed that the correlation coefficient between the SAS and VAS was 0.607 (P < .01) and that between the SDS and VAS was 0.490 (P < .05). The patients and healthy donors all had positive intracutaneous test results with their own semen, negative skin prick test results, and no IgE specific to autologous semen. Most patients (4/5) did not achieve ideal therapeutic effects with desensitization.

Clinical Implications

Allergy is not the main pathogenesis of POIS, and desensitization with autologous semen is not effective for most patients.

Strengths and Limitations

This project included the largest number of patients with POIS in China and assessed the allergic response to autologous semen and the effect of desensitization therapy. There is no objective method for evaluating the efficacy of desensitization with autologous semen.

Conclusions

IgE-mediated semen allergy is not the main pathogenesis of POIS, and there is a positive chance that POIS is related to psychological factors. Most patients do not respond to desensitization with autologous semen, and POIS treatment should be individualized, especially in cases with uncertain causes.

The Sexual Incentive Motivation Model and Its Clinical Applications

Sexual motivation (desire) requires the simultaneous presence of an active central motive state and a stimulus with sexual significance. Once activated, sexual motivation leads to visceral responses and approach behaviors directed toward the emitter of the sexual stimulus. In humans, such behaviors follow cognitive evaluation of the context, including predictions of the approached individual's response. After successful approach and establishment of physical contact, manifest sexual activities may be initiated. Sexual interaction is associated with and followed by a state of positive affect in most animals, whereas aversive consequences may be experienced by humans. The affective reactions may become associated with stimuli present during sexual interaction, and these stimuli may thereby alter their incentive properties. Here we show how the incentive motivation model can be used to explain the origins and possible treatments of sexual dysfunctions, notably disorders of desire. We propose that associations formed between negative outcomes of sexual interaction and the salient stimuli, for example, the partner, underlies hypoactive desire disorder. Highly positive outcomes of sexual interaction enhance the incentive value of the stimuli present, and eventually lead to hyperactive sexual desire. Treatments aim to alter the impact of sexual incentives, mainly by modifying cognitive processes.

Development and validation of the Male Post-coital Affect Scale for heterosexual men

OBJECTIVE

The aim of this study was to examine the reliability and validity of the Male Post-coital Affect Scale (MPAS), which was developed to assess positive post-coital feelings in men.

METHODS

After a pilot study, we validated our scale on a sample of American heterosexual men, who answered our questionnaire on the internet through Amazon Mechanical Turk. We tested the reliability using internal consistency. The validity was examined by assessing content, face and construct validity by testing the association between our scale, the Experience in Close Relationships Scale and other instruments.

RESULTS

A total of 484 volunteers were included in the study. Cronbach's α for the scale was 0.83. Our scale was negatively correlated with attachment avoidance, r(482) = -0.36, p < 0.001) and Perceived Stress Scale, r(482) = -0.18, p < 0.001, and positively correlated with sexual satisfaction, r(482) = 0.18, p < 0.001.

CONCLUSION

The MPAS is a reliable and valid tool to assess positive post-coital feelings in men.

Decreased Sexual Desire among Middle-Aged and Old Women in China and Factors Influencing It: A Questionnaire-Based Study

Objective

This survey was designed and conducted with an aim to present data on sexual desire and activity in Chinese women.

Methods

Between October 2013 and December 2013, we surveyed 3000 women (aged 40–65 years) at Beijing No. 2 Hospital and the Yuetan Community Health Service Center using a questionnaire. The primary outcomes included determination of sexual desire in the past 4 weeks, reasons for stopping sexual activity, and postmenopausal syndrome. The secondary outcome was determination of factors for low sexual desire.

Results

A total of 2400 women (mean age 54.33 ± 6.25 years; mean menopausal age 50.11 ± 3.31 years) returned the questionnaire, with 58% of women reporting lowered sexual desire and 39.3% reporting stoppage of sexual activity. Compared with the postmenopausal group, the incidence of anxiety, depressive, somatic, and vasomotor symptoms was higher in the perimenopausal group. Muscle and joint pain (45.8%) and vaginal pruritus (21.5%) were the most commonly reported menopausal and vulvovaginal symptoms, respectively. The odds of decrease in sexual desire were significantly higher with older age, menopause, presence of gynecological disease, menopausal depression symptoms, menopausal vasomotor symptoms, and vulvovaginal atrophy; only cesarean delivery (odds ratio = 0.887, P=0.018) was associated with lesser reduction in sexual desire compared with the aforementioned factors.

Conclusion

This survey showed that a high proportion of Chinese middle-aged and old women have lowered sexual desire and activity. Lack of sexual desire is associated with multiple factors and affects the quality of life of women.

Sexual dysfunction in patients with adult attention deficit hyperactivity disorder: A pilot study

Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.

Development and Validation of the Postsex Experience (P-SES) Scale

Introduction

There is little systematized research on the postsex phase of the sexual cycle, due in part to the absence of literature on the period immediately following sexual activity.

Aim

The paper describes the development and validation of the Postsex Experience Scale (P-SES), an instrument designed to measure the psychological dimensions of the postsex period of the human sexual response cycle.

Methods

Scale development involved (a) item construction, selection, and subsequent validation through item analysis, and (b) a factor analysis of the item intercorrelations of the P-SES and the establishment of its factorial validity, based upon an online survey of 4,217 respondents.

Results

In the exploratory factor analysis of the psychometric structure of the scale, structures for males and females differed. 3 factors emerged, which captured the male postsex experience. These factors were labeled Sense of Sexual Alienation, Positive Connection with Self, and Feeling Connected with Partner. 4 factors best captured the female postsex experience and were labeled Self-Loathing, Positive Connection with Self, Sense of Being Emotionally Overwhelmed, and Feeling Connected with Partner.

Clinical Implications

There is strong evidence for acknowledging a wide variation in postsex experience in both men and women across sexual orientations.

Strengths & Limitations

Strengths include a large heterogeneous sample leading to the provision of a metric to investigate novel aspects of human sexuality. Limitations include the potential underreporting of experiences due to the structure of the scale and its reference to “general experiences” and presentation bias.

Conclusions

The P-SES provides a framework for assessing the postsex experience in women and men, providing opportunities to gain a better understanding of the variations in postsex experience.

Schweitzer RD, du Plessis G, Maczkowiack J, et al. Development and Validation of the Post Sex Experience (P-SES) Scale. Sex Med 2021;9:100291.

Postcoital Symptoms in a Convenience Sample of Men and Women

INTRODUCTION

Postcoital dysphoria (PCD) is a condition characterized by inexplicable feelings of tearfulness, sadness, and/or irritability. Previous research has mostly focused on these 3 symptoms, failing to explore other symptoms that can occur after sexual activity.

AIM

The aim of the present study was to get a more in-depth understanding of postcoital symptom variety, to compare the type and frequency of these symptoms in men and women, and to explore the context in which they manifest.

METHODS

A convenience sample of 223 women and 76 men filled in an online survey consisting of a list of 21 symptoms and a set of additional questions.

MAIN OUTCOME MEASURE

The study outcomes were obtained using a study-specific questionnaire to assess postcoital symptoms, consisting of a list of 21 symptoms that form 4 domains and 2 additional questions that assess personal and interpersonal distress.

RESULTS

Of all participants, 91.9% reported any postcoital symptom over the past 4 weeks and 94.3% ever since they had been sexually active. The most common symptoms in women were mood swings and sadness, whereas in men, it was unhappiness and low energy. Men and women differed in the frequency of postcoital symptoms experienced ever since being sexually active, with women reporting more sadness, mood swings, frustration, and worthlessness. For 73.5% of individuals, the postcoital symptoms were present after consensual sexual intercourse, for 41.9%, after general sexual activity, and for 46.6% also, after masturbation. Of all participants, 33.9% said that they only experienced the symptoms after orgasm.

CLINICAL IMPLICATIONS

Postcoital symptoms are clearly more varied than previously suggested and are not related to classic "dysphoria" only. Hence, we propose to cease calling the phenomenon "postcoital dysphoria" and suggest to simply use the term "postcoital symptoms."

STRENGTH & LIMITATIONS

This is the first study ever to provide a more in-depth exploration of postcoital symptom variety. The sample was relatively small, and the representativeness and, therefore, generalizability of the results was limited, given that a convenience sample was used.

CONCLUSION

Our results indicate that postcoital symptoms are a multifaceted phenomenon which shows similar expression in men and women. The symptoms are clearly more varied not related to classic "dysphoria" only. Burri A, Hilpert P. Postcoital Symptoms in a Convenience Sample of Men and Women. J Sex Med 2020;17:556-559.

Post orgasmic illness syndrome: what do we know till now?

BACKGROUND

Peri orgasmic dysfunctions are very rare and little information exists on their diagnosis and treatment. One of these conditions is post-orgasmic illness syndrome (POIS), manifesting by a debilitating cluster of symptoms affecting men within seconds, minutes, or hours after ejaculation. The aim of this article is to do a thorough literature review about POIS, in order to elucidate the pathophysiology, the diagnosis and the management of this rare disease.

RESULTS

Updated literature review on Pubmed was done, using the following terms: "orgasm illness", "post-orgasmic" and "postorgasmic illness syndrome". The references of the 17 identified publications were also reviewed for additional 8 relevant articles that were all included in the results.POIS has 5 preliminary diagnostic criteria and criterion 1 has 7 described clusters. Pathophysiological hypotheses include: immunological phenomenon (most relevant), opioid-like withdrawal, neuroendocrine response, transient deregulation of the autonomic nervous system, hypersensitivity and disordered cytokines. Differential diagnoses include: chronic prostatitis, orgasmolepsy, benign orgasmic cephalgia, sneezing and rhinorrhea, postcoital dysphoria, post-coital asthma and rhinitis. Patients have been symptomatically treated with antihistamines, non-steroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and benzodiazepines. A trial of hyposensitization therapy with autologous semen was successful.

CONCLUSION

POIS is a rare condition that is underdiagnosed, most probably because of its unclear pathophysiology leading to a lack of treatment options. Further studies are warranted to investigate the prevalence, pathophysiology, and management of this debilitating condition.

Postcoital Dysphoria: Prevalence and Correlates Among Males

Consensual sexual activity is believed to be associated with a positive emotional experience, however, postcoital dysphoria (PCD) is a counterintuitive phenomenon characterized by inexplicable feelings of tearfulness, sadness, or irritability following otherwise satisfactory consensual sexual activity. Prevalence of PCD has been reported among females, but not among males. The present study utilized an anonymous online questionnaire to examine the prevalence and correlates of PCD among an international sample including 1,208 male participants. Forty-one percent reported experiencing PCD in their lifetime and 20.2% reported experiencing PCD in the previous four weeks. Between 3% and 4% of the sample reported experiencing PCD on a regular basis. PCD was found to be associated with current psychological distress, childhood sexual abuse, and several sexual dysfunctions. Results indicate that the male experience of the resolution phase may be far more varied, complex, and nuanced than previously thought and lays a foundation for future research investigating PCD among males. Findings have implications for therapeutic settings as well as the general discourse regarding the male sexual experience.

What is orgasm? A model of sexual trance and climax via rhythmic entrainment

Orgasm is one of the most intense pleasures attainable to an organism, yet its underlying mechanisms remain poorly understood. On the basis of existing literatures, this article introduces a novel mechanistic model of sexual stimulation and orgasm. In doing so, it characterizes the neurophenomenology of sexual trance and climax, describes parallels in dynamics between orgasms and seizures, speculates on possible evolutionary origins of sex differences in orgasmic responding, and proposes avenues for future experimentation. Here, a model is introduced wherein sexual stimulation induces entrainment of coupling mechanical and neuronal oscillatory systems, thus creating synchronized functional networks within which multiple positive feedback processes intersect synergistically to contribute to sexual experience. These processes generate states of deepening sensory absorption and trance, potentially culminating in climax if critical thresholds are surpassed. The centrality of rhythmic stimulation (and its modulation by salience) for surpassing these thresholds suggests ways in which differential orgasmic responding between individuals-or with different partners-may serve as a mechanism for ensuring adaptive mate choice. Because the production of rhythmic stimulation combines honest indicators of fitness with cues relating to potential for investment, differential orgasmic response may serve to influence the probability of continued sexual encounters with specific mates.