From the Guidelines
There is a correlation between sexual arousal and orgasm intensity in males, with treatments such as PDE5i and testosterone therapy showing improvement in both erectile function and orgasmic function.
Key Points
- PDE5i treatment has been shown to improve the symptoms of ED and be well tolerated, with many studies also showing the efficacy and tolerability of PDE5i for treating ED in patients with cancer and survivors 1.
- Testosterone therapy may relieve symptoms of ED, problems with ejaculation, or problems with orgasm for survivors with hypogonadism, with the addition of testosterone to PDE5i therapy in individuals with low serum testosterone levels also improving ED 1.
- Treatment of psychosocial problems, with referral to sex and couples therapy as appropriate, can also alleviate symptoms of sexual dysfunction, with small studies in survivors of prostate cancer suggesting that these approaches can be helpful in the survivorship population 1.
- Other treatments, such as pelvic physical therapy and vibratory therapy, may also improve sexual function in males, with cabergoline, a dopamine agonist, showing subjective improvement in orgasm 1.
Mechanism of Action
- PDE5i works by increasing blood flow to the penis, allowing for an erection to occur, with daily, low-dose treatment showing effectiveness in addition to on-demand treatment 1.
- Testosterone therapy works by replacing low levels of testosterone, which can contribute to ED and other sexual problems, with the goal of improving libido, erectile function, and overall sexual function 1.
Important Considerations
- PDE5i is contraindicated in patients taking oral nitrates, as it can lead to a dangerous decrease in blood pressure 1.
- Testosterone therapy should not be used if contraindicated by the primary oncologic diagnosis, such as prostate cancer on active surveillance or androgen deprivation therapy (ADT) 1.
From the Research
Correlation between Sexual Arousal and Orgasm Intensity in Males
- The study 2 found that in men, the affective, sensory, and rewards dimensions of the orgasm experience significantly correlated with the propensity for becoming sexually excited.
- Another study 3 found that orgasm induced transient increases in heart rate, blood pressure, and noradrenaline plasma levels in men, indicating a physiological response to sexual arousal and orgasm.
- The study 4 found that orgasmic pleasure and satisfaction in men were related to the cognitive-affective and sensory aspects of the orgasm experience, as well as the overall physical and psychological intensity of orgasm.
- A study 5 found that in men, all measures of sexual arousal and desire increased significantly during masturbation, with a greater buildup leading to a more pleasurable orgasm, and that after orgasm, sexual arousal and desire decreased more quickly and consistently in men than in women.
Physiological and Psychological Factors
- The study 3 found that prolactin plasma levels increased during orgasm and remained elevated 30 minutes after orgasm in men, suggesting a hormonal response to sexual arousal and orgasm.
- The study 2 found that the intimacy dimension of the orgasm experience correlated with the genital response in men, indicating a relationship between psychological and physiological factors.
- The study 4 found that relationship satisfaction was a significant predictor of orgasmic pleasure and satisfaction in men, highlighting the importance of psychosocial factors in the orgasm experience.
Comparison with Female Orgasm
- The study 6 found that female orgasm from sexual intercourse is highly variable and under little selective pressure, whereas male orgasms are under strong selective pressure as they are coupled with ejaculation and contribute to male reproductive success.
- The study 5 found that women's orgasmic pleasure was related to a postorgasmic decrease in genital temperature, but unexpectedly, the maintenance of subjective sexual arousal and desire, whereas men's orgasmic pleasure was related to a greater buildup of sexual arousal and desire leading to orgasm.