Anal Sphincter Pressure Is Not Required for Male Orgasm or Arousal
Perfect baseline pressure of the internal anal sphincter (IAS) or external anal sphincter (EAS) is not necessary for male orgasm and sexual arousal. 1
Physiological Independence of Sphincter Pressure and Sexual Function
The anal sphincters serve a fundamentally different physiological role than sexual function:
The IAS maintains resting anal tone for passive fecal continence, while the EAS provides voluntary squeeze pressure 1—neither mechanism is involved in the neurological or vascular pathways required for erection, arousal, or orgasm 1
Men who retain fecal continence despite lowered IAS/EAS pressures typically maintain erectile rigidity sufficient for vaginal penetration 1, demonstrating that reduced sphincter tone does not impair sexual performance
Research in anoreceptive homosexual men found significantly lower resting anal pressures (70.7 vs 91.4 mmHg) with no complaints of sexual dysfunction or fecal incontinence 2, confirming that reduced baseline sphincter pressure does not compromise sexual function
When Sexual Dysfunction Does Occur After Pelvic Surgery
Sexual problems following anorectal or prostate procedures stem from autonomic nerve injury, not sphincter pressure changes:
Injury to pelvic autonomic nerves during surgery causes bladder sensory loss and sexual arousal deficits that are mechanistically separate from sphincter dysfunction 1
When sexual dysfunction persists beyond six months after pelvic surgery, irreversible autonomic nerve damage should be suspected 1, and rehabilitation efforts should focus on adaptation strategies rather than expecting full recovery
After prostatectomy, climacturia (orgasm-associated urinary incontinence) occurs in 20-93% of men 3, but this represents urethral sphincter dysfunction during orgasm, not a requirement for anal sphincter pressure to achieve orgasm
Clinical Assessment Approach
When evaluating men with reduced anal sphincter pressure who report sexual concerns:
Apply standard erectile dysfunction evaluation and treatment protocols 1, as the sphincter pressure itself is not the causative factor
Review medications such as antidepressants or antihypertensives that may impair orgasm independently of sphincter function 1
Offer psychosexual counseling for patients experiencing true anorgasmia 1, recognizing that psychological factors frequently contribute when organic causes are excluded
Common Clinical Pitfall
Do not attribute sexual dysfunction to anal sphincter pressure changes unless there is clear evidence of concurrent pelvic nerve injury from surgery or trauma. The high resting pressures seen in anal fissure patients (114 vs 73 cmH2O) 4 cause pain and ischemia of anal tissue but do not enhance or impair sexual function.