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POSTCOITAL DYSPHORIA IN MALES
Postcoital dysphoria: Prevalence and correlates among males
Joel Maczkowiack and Robert D Schweitzer
1. Queensland University of Technology
School of Psychology and Counselling
Kelvin Grove, Australia.
Corresponding Author: Professor Robert Schweitzer
School of Psychology and Counselling
Queensland University of Technology
O Block B Wing Room 523, Kelvin Grove Campus, QUT,
Victoria Park Road, Kelvin Grove 4059 Australia.
Phone: +617 3138 4617
Fax: + 617 3138 0486
Email: r.schweitzer@qut.edu.au
POSTCOITAL DYSPHORIA IN MALES
Abstract
Consensual sexual activity is believed to be associated with a positive emotional experience,
however, Postcoital Dysphoria (PCD) is a counter-intuitive 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 amongst an international sample including 1,208 male
participants. Forty one percent reported experiencing PCD in their lifetime and 20% reported
experiencing PCD in the previous four weeks. Between 3 - 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 lay 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.
Key words: Dysphoria, Postcoital, Gender, Males, Resolution
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POSTCOITAL DYSPHORIA IN MALES
Postcoital Dysphoria: Prevalence and Correlates among Males
The first three phases of the human sexual response cycle (excitement, plateau,
orgasm) have been the focus of the majority of research on the human sexual response to
date. The experience of the resolution phase, however, remains under-researched and
therefore poorly understood. It is commonly believed that males and females experience a
range of positive emotions including contentment and relaxation immediately following
consensual sexual activity (Sadock & Sadock, 2008; Sewell, 2005), a view which is
supported by models of the human sexual response (Basson, 2001; Masters & Johnson, 1966;
Sadock & Sadock, 2008; Sewell, 2005). However, there is evidence that a counter-intuitive
phenomenon known as Postcoital Dysphoria (PCD) may occur following otherwise
satisfactory consensual sexual activity and is characterized by inexplicable feelings of
tearfulness, sadness, or irritability (Sadock & Sadock, 2008). PCD occurs immediately
following a sexual experience that in all other aspects was regarded as satisfactory, therefore,
the dysphoria experienced is an unexpected emotional reaction. The psychological
phenomenon of PCD is distinct from a rare physiological condition experienced by males
called post-orgasmic illness syndrome which is believed to be an auto-immune response to
semen (Serefoglu, 2017; Waldinger, 2016; Waldinger & Schweitzer, 2002).
The female experience of PCD has been recognized in the literature, but to date, no
studies have been identified which have examined the existence or prevalence of this
phenomenon among males. Initial studies on the postcoital experience of females showed that
up to 46.2% of females had experienced PCD in their lifetime, and between 5% and 10% had
experienced PCD in the previous four weeks (Bird, Schweitzer, & Strassberg, 2011;
Schweitzer, O'Brien, & Burri, 2015). Interestingly, approximately 2% of females reported
experiencing PCD on a regular basis throughout their lifetime (Bird et al., 2011; Schweitzer
et al., 2015). Among females, PCD has been associated with current psychological distress,
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POSTCOITAL DYSPHORIA IN MALES
past abuse, and several sexual dysfunctions (Bird et al., 2011; Schweitzer et al., 2015), which
is consistent with literature regarding the influence of these factors upon sexual functioning
in general.
While no empirical studies were identified concerning PCD among males, (Sadock &
Sadock, 2008) assert that PCD may be more common among males than females, yet provide
no evidence to support this claim. Anecdotal evidence from clinical settings as well as
personal accounts posted on online blogs suggest that PCD does occur amongst males and
has the potential to interfere with couple interactions following sexual activity (Friedman,
2009; R. Schweitzer, personal communication, May 14, 2016). For example, it has been
established that couples who engage in talking, kissing, and cuddling following sexual
activity report greater sexual and relationship satisfaction, demonstrating that the resolution
phase is important for bonding and intimacy (Denes, 2012; Muise, Giang, & Impett, 2014).
Therefore, the negative affective state which defines PCD has potential to cause distress to
the individual, as well as the partner, disrupt important relationship processes, and contribute
to distress and conflict within the relationship, and impact upon sexual and relationship
functioning.
To provide context, in Western cultures, males face a range of expectations and
assumptions about their preferences, performance, and experience of sexual activity (Farvid
& Braun, 2006; Wiederman, 2005; Zilbergeld, 1999). These assumptions are pervasive within
masculine sub-culture and include that males always desire and experience sex as pleasurable
(Farvid & Braun, 2006; Murray, 2017; Zilbergeld, 1999), and that “real” sex must involve
penetration and orgasm (Bignell, 1993; Sakaluk, Todd, Milhausen, & Lachowsky, 2014;
Torun, Torun, & Özaydin, 2011; Zilbergeld, 1999). Furthermore, all sexual activity is
commonly believed to be accompanied by a sense of accomplishment, achievement and
invariably followed by a positive emotional experience and a general sense of wellbeing
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POSTCOITAL DYSPHORIA IN MALES
(Mosher, 1980; Murray, 2017; Sadock & Sadock, 2008; Sakaluk et al., 2014). The experience
of PCD is counter-intuitive as it contradicts these dominant cultural assumptions about the
male experience sexual activity and of the resolution phase.
As PCD has not previously been studied among males, its prevalence and correlates in
this population are currently unknown. Aligned with literature on sexual functioning and
PCD, this exploratory study will examine the prevalence of PCD among males, as well as the
association of PCD with various demographic, mental health, history of abuse, and sexual
functioning variables. This will provide insight into the prevalence of PCD among males and
the unique and common factors with which PCD is associated.
Aims
The first objective of this study was to determine the lifetime and four week
prevalence of PCD among a sample of males. The second objective was to explore the
associations between PCD over the lifetime and in the previous four weeks and a range of
demographic, mental health, history of abuse, and sexual functioning variables. In line with
the literature on PCD among females (Bird et al., 2011; Schweitzer et al., 2015), the
following correlations were associated with PCD: more frequent experiences of PCD over the
lifetime and in the previous four weeks would be associated with higher psychological
distress; experiencing sexual abuse before the age of 16, and higher rates of sexual
dysfunction.
Method
Participants
An international sample of 1,635 males were recruited via social media, online
articles, and psychological research websites to voluntarily complete a cross-sectional online
questionnaire. Of the males who began the questionnaire, 414 (25.32%) were excluded from
the current study due to withdrawing before completing all questions relevant to the analyses,
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POSTCOITAL DYSPHORIA IN MALES
resulting in study sample of 1,208 participants. The demographic information for the sample
is shown in Table 1 in the results section.
Procedure
Ethical approval was provided by the University Human Research Ethics Committee
(Approval Number: 1600000961). The data for this study was drawn from a larger
questionnaire examining the postcoital experience of both males and females. Participants
were eligible to participate if they were 18 years or over and sexually active. The online
questionnaire was designed using Qualtrics, with branch and display logic ensuring
participants only answered questions relevant to them and with the exception of open
response questions, participants were required to respond to every item. Before accessing the
questionnaire, participants were made aware of the purpose, risks and benefits of
participation and provided consent. Data was collected from February to June 2017 and the
questionnaire took approximately 30 minutes to complete. Participants were recruited online
via social media, university email lists, psychological research websites, press releases from
the university and subsequent articles about PCD on the websites of newspapers, magazines,
and blogs both in Australia and internationally
Measures
Demographics
The questionnaire contained 14 items assessing age, sex, gender, sexual orientation,
country of residence, and level of education. Status, length, and satisfaction within current
sexual relationship were also assessed.
Postcoital dysphoria. Two items assessing lifetime and four week prevalence of PCD
were embedded within the sexual dysfunction section of the questionnaire. The items asked
participants whether in their life or in the past four weeks, they had “experienced inexplicable
tearfulness, sadness, or irritability following consensual sexual activity?” (Bird et al., 2011;
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POSTCOITAL DYSPHORIA IN MALES
Sadock & Sadock, 2008; Schweitzer et al., 2015). Responses were graded on a five-point
Likert-type scale from 0 = Never to 4 = All of the time with higher scores indicating greater
prevalence of PCD. Final scores represented the frequency endorsed.
Previous and current psychological distress
The Kessler Psychological Distress Scale (K10; Kessler et al., 2002) was employed to
evaluate current psychological distress among participants over the previous four weeks. The
emotional, cognitive, behavioral, and physiological symptoms of depression and anxiety were
assessed using ten items scored on a five-point Likert-type scale ranging from 1 = None of
the time to 5 = All of the time. For example, “During the past 4 weeks, how often did you feel
that everything was an effort?” A summed total score was calculated ranging from 10 (low
distress) to 50 (high distress). This scale is used widely in community and clinical samples
(Andrews & Slade, 2001) and has been found to be internally consistent, achieving with a
Cronbach’s α of .89 (Kessler et al., 2002). The Cronbach’s α found in this study was .92,
revealing excellent internal consistency. Three items assessed history of depression, anxiety,
and bipolar disorder. The wording was as follows: “Have you ever suffered from or been
diagnosed with [depression/anxiety/bipolar disorder]?”. Responses were coded
dichotomously as 1 = No, 2 = Yes.
Past abuse. Six items assessing sexual, emotional, and physical abuse in childhood
and as an adult were included. Two items assessing sexual abuse have been used in previous
studies assessing PCD (Bird et al., 2011; Schweitzer et al., 2015): “Before the age of 16, were
you ever forced or frightened into doing something sexually that you did not want to do?”
and “Since the age of 16, have you ever been forced or frightened into doing something
sexually that you did not want to do?”. Emotional and physical abuse in childhood and
adulthood were assessed with the following items: “Before the age of 16, were you ever
exposed to [emotional or physical] abuse?”. and “Since the age of 16, have you ever been
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POSTCOITAL DYSPHORIA IN MALES
exposed to [emotional or physical] abuse?”. All items regarding past abuse were coded
dichotomously as 1 = No, 2 = Yes.
Male sexual dysfunction. Eight items assessed lifetime and four week prevalence of
four common male sexual dysfunctions: Hypoactive Sexual Desire Disorder (HSDD),
Erectile Dysfunction (ED), Delayed Ejaculation (DE), and Premature Ejaculation (PE).
Replicating the technique used by Bird et al. (2011), item wording was based on diagnostic
criteria from the DSM-5 (American Psychiatric Association, 2013). For example, for ED, the
item asked participants if they had “difficulty maintaining or keeping an erection?” and for
PE, whether the participant had “prematurely ejaculated (ejaculated very quickly after only a
minimal amount of stimulation)?”. A five-point Likert-type scale was used where 0 = Never
to 4 = All of the time and final scores represented the frequency of each dysfunction. As these
were assessed as single items, no psychometric properties were calculated.
Statistical analysis
While the present study primarily utilizes male data, some analyses (i.e., prevalence
of PCD) compare males and females. Statistical analysis was undertaken using SPSS (version
24 for Windows) and a p-value < .05 was considered statistically significant. As participants
were required to answer all items in the questionnaire, there were no missing data. Standard
linear multiple regression analyses were used to explore the correlates of PCD. Normality
was assessed via visual inspection of histograms and skewness and kurtosis statistics as
statistical tests of normality (e.g., the Shapiro-Wilk test) are sensitive to large sample sizes
(Field, 2014). Distributions of several variables including prevalence of lifetime and four
week PCD were found to deviate from normality. Logarithmic transformation of variables
and the removal of outliers did not meaningfully alter the interpretation; therefore, raw data
was used and all cases were retained. Bootstrapped confidence intervals (Bias Corrected and
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POSTCOITAL DYSPHORIA IN MALES
accelerated [BCa], based on 1000 samples) are shown for all analyses to provide a robust
interpretation (Field, 2014).
Results
Demographic Information and Relationship Characteristics
The demographic information of the sample (N =1,208) is shown in Table 1.
Participants ranged in age from 18 to 81 years (M = 36.92, SD = 14.93), the majority had
completed tertiary education and identified as heterosexual. The sample contained
participants from 78 countries and religion was unimportant to the majority of participants, M
= 26.7, SD = 34.1 (0 = not at all important, and 100 = very important). Only 15.9% described
themselves as not being in a sexual relationship at the time of completing the questionnaire.
Of the participants who were in a relationship, the majority had been in that relationship for
over one year. The majority of participants reported being sexually satisfied (M = 74.32, SD =
23.87) in their current relationship/s (0 = extremely unsatisfied, and 100 = extremely
satisfied).
Table 1 goes about here.
Psychological Distress, Past Abuse, and Sexual Dysfunction
Table 2 presents the prevalence of abuse and current psychological distress among the
sample. The most commonly reported mental health concern was the experience of having
ever suffered from or diagnosed with depression (36.9%), followed by anxiety (32.5%), and
bipolar disorder (3%); 25.3% of the sample reported more than one of these concerns. Sexual
abuse in childhood was reported by 12.7% of participants (n = 154), and sexual abuse in
adulthood by 8.9% (n = 107), 3.5% (n = 42) reported sexual abuse in childhood and
adulthood. Emotional abuse was the most commonly reported form of abuse both before and
after age 16. In terms of current psychological distress, as assessed by the K10, the mean
score (20.05, SD = 7.72) indicated that the sample displayed slightly higher scores than the
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POSTCOITAL DYSPHORIA IN MALES
general (non-clinical) population (Slade, Grove, & Burgess, 2011). A summary of the
prevalence of the sexual dysfunctions assessed is presented in Table 3. Over the lifetime, DE
was the most common experience for males, whereas over the previous four weeks, HSDD
was most prevalent.
Tables 2 and 3 go about here
Prevalence of Postcoital Dysphoria
The prevalence of lifetime and four week PCD is presented in Table 4. For
comparative purposes, data regarding the prevalence of PCD among females (N = 2,093)
which was collected as part of the larger study is also presented. As shown, 41% (n = 495) of
males reported experiencing PCD at some point in their lifetime, whereas 20.2% (n = 245)
reported some experience of PCD in the previous four weeks. PCD that was experienced on a
regular basis (most of the time or all of the time) over the lifetime was reported by 4.4% (n =
53) of males, and 4.1% (n = 51) of males over the previous four weeks. Further investigation
showed that 36 males (3.1% of the sample) reported regularly experiencing PCD in their
lifetime and in the previous four weeks.
Table 4 goes about here.
Associations between PCD and other variables
A correlation matrix displaying the Pearson correlations between all variables
included in the present study is presented in Table 5. With the exception of age, positive
correlations were present between PCD and all other variables. The large sample size allowed
for all variables to be included in the subsequent standard linear multiple regression analyses
with sufficient power to detect a small effect (Field, 2014). The first standard linear multiple
regression (Table 6) was conducted with lifetime PCD as the criterion and it produced a
statistically significant model, F(20, 1187) = 20.80, p < .001. Overall, 26% of the variance in
lifetime PCD in this sample was accounted for. Current psychological distress accounting for
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POSTCOITAL DYSPHORIA IN MALES
largest portion (3.3%) of unique variance in lifetime PCD over and above the other variables.
This was followed by four week HSDD, which uniquely accounted for 2.6% of the variance.
Sexual orientation was the third most influential variable associated with lifetime PCD, with
homosexual males experiencing PCD more frequently, uniquely accounting for 1.4% of the
variance. Child Sexual Abuse (CSA), four week PE, and age were the weakest variables in
the model, uniquely accounting for 0.8%, 0.4%, and 0.2% of the variance respectively, with
age showing a negative relationship with lifetime PCD.
A second standard linear multiple regression analysis was conducted to explore the
associations between four week PCD and the same demographic, life history, mental health,
as well as sexual functioning variables (shown in Table 6). The model accounted for 22.4% of
the variance in four week PCD in this sample, and was statistically significant F(20, 1187) =
17.120, p < .001. Current psychological distress was most strongly associated with PCD,
accounting for 4.6% of the variance. Four week HSDD, PE and DE were the next strongest
associations, uniquely accounting for 2%, 1.3%, and 1.1% of the variance respectively. The
weakest association in the model which showed significance were CSA and sexual
orientation, uniquely accounting for 0.7% and 0.5%, of the variance in four week PCD
respectively.
Tables 5 and 6 go about here
Discussion
This study sought to explore the prevalence and potential correlates of PCD among
males. Assessing lifetime prevalence, 36.6% of the sample reported experiencing PCD
intermittently (a little of the time or some of the time) and 4.4% reported experiencing PCD
regularly (most of the time or all of the time). When assessing four week prevalence, 16% of
the sample reported experiencing PCD intermittently and 4.3% reported experiencing PCD
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regularly. In total, 41% of males reported experiencing PCD in their lifetime and 20.2% in the
previous four weeks.
As this is the first study to assess the prevalence of PCD among males, there is no
prior research with which to compare the present results. While there are estimates of the
prevalence of PCD among females (see Bird et al., 2011; Schweitzer et al., 2015), the most
reliable prevalence comparisons can be made with female data collected as part of the larger
exploratory questionnaire due to the large sample size, similar characteristics, and consistent
methodology. The prevalence of PCD was lower for males compared to females at all levels
of PCD (a little-, some-, most-, and all- of the time) over the lifetime, and the previous four
weeks. Odds ratios revealed that compared to males, females were up to 2.87 times more
likely to experience PCD in their lifetime, and up to 1.83 times more likely to experience
PCD in the previous four weeks.
Overall, the prevalence rates found in the current study reveal that PCD occurs in a
substantial proportion of males which has implications for the general discourse regarding the
male experience of the resolution phase (and perhaps sex in general) as it diverges from
popular assumptions about the experience of the time immediately following sexual activity
(Farvid & Braun, 2006; Sakaluk et al., 2014; Sewell, 2005; Zilbergeld, 1999). The experience
has been variously described by male participants who report PCD in terms of: hard to
quantify but after sexual activity I get a strong sense of self-loathing about myself, usually I’ll
distract myself by going to sleep or going and doing something else or occasionally laying in
silence until it goes away; I feel a lot of shame; I usually have crying fits and full on
depressive episodes follow[ing] coitus that leave my significant other worried, and every
once in a while she has crying spells after the act, but hers are rarer. Because I typically don’t
want my partner worried, however, sometimes I hold in the sadness for hours until she leaves
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POSTCOITAL DYSPHORIA IN MALES
as we do not live together, and I sometimes have negative feelings which are difficult to
describe (Direct quotes from open-ended survey questions).
These results demonstrate that the male experience of the resolution phase is not
always positive and can at times be negative without explanation, indicating that it may be far
more varied, complex, and nuanced than previously thought (Sewell, 2005).
In addition to prevalence, this study aimed to assess various demographic factors, past
abuse, psychological distress, and sexual dysfunction as possible correlates of PCD among
males. The first hypothesis, that higher levels of psychological distress would be associated
with more frequent experiences of PCD, was supported. Current psychological distress, as
measured by the K10, emerged as the strongest variable associated with lifetime and four
week PCD, where higher levels of psychological distress was more strongly associated with
PCD. This finding is consistent with previous studies investigating the correlates of PCD
among females (Bird et al., 2011; Schweitzer et al., 2015), as well as the literature
surrounding the correlates of sexual difficulties in general (Laurent & Simons, 2009). Current
psychological distress uniquely accounted for 4.6% of the variance in four week PCD and
3.4% of the variance in lifetime PCD, representing a small to medium effect. This finding
supports the suggestion by (Burri & Spector, 2011) that one’s current psychological state
influences the experience of the resolution phase. Therapists working with individuals and
couples facing current psychological distress may wish to consider the role of PCD as a
potential contributor to distress. Future research may explore the relationship between
psychological distress and PCD.
The second hypothesis, that CSA would be associated with more frequent experiences
of PCD, was supported. CSA correlated with lifetime and four week PCD, however, it
uniquely accounted for less than 1% of the variance in PCD in both models and the
magnitude of the effect was small. This finding is consistent with PCD research among
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females (Bird et al., 2011; Schweitzer et al., 2015). In total, 12.6% of males reported
experiencing CSA, which is consistent with general prevalence estimates (Stoltenborgh, van
Ijzendoorn, Euser, & Bakermans-Kranenburg, 2011). This result provides further evidence
that sexual abuse in childhood negatively impacts sexual functioning in adulthood (Dube et
al., 2005). Future qualitative research may broaden knowledge regarding the impact of CSA
on the postcoital experience in general, and PCD specifically.
The third hypothesis, that PCD would be positively associated with sexual
dysfunctions, was supported. In addition to significant small to moderate positive correlations
between sexual dysfunctions and PCD four week HSDD and PE emerged as displaying
significant relationships with lifetime PCD over and above that of the other variables in the
model. While this may indicate that PCD increases the risk of future sexual dysfunction, the
cross-sectional design of this study does not allow for causation to be established. An
alternative interpretation may be that males display a tendency to reflect on past sexual
encounters through the lens of their current sexual experiences, where encountering more
sexual difficulties in the previous four weeks may result in an increased likelihood of
recalling previous sexual encounters which resulted in negative affect. This interpretation is
consistent with literature reporting males value their ability to perform sexually and are
sensitive to self-perceived failure (McCarthy & Thestrup, 2009; Zilbergeld, 1999).
Overall, the relationship between PCD and sexual dysfunction is complex. On the one
hand, positive correlations between each of the sexual dysfunctions measured and PCD,
together with the fact that HSDD and PE were significant correlates of PCD, suggest that
sexual dysfunctions and PCD are related. This supports the understanding that sexual
difficulties tend to co-occur, with problems in one area of sexual functioning resulting in an
increased likelihood of problems in other areas (Ramlachan & Campbell, 2014). On the other
hand, the correlations between each sexual dysfunction and PCD were small to medium in
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magnitude and sexual dysfunctions over the lifetime were not associated with either lifetime
or four week PCD. This suggests that PCD occurs in the absence of sexual dysfunctions,
supporting the notion that PCD occurs without obvious explanation. The definition of PCD
necessitates that dysphoria occurs following an otherwise satisfactory sexual experience, yet
males with more experience of sexual dysfunction experienced higher rates of PCD. Previous
research amongst females (see Bird et al., 2011) found similar results inferring that PCD is
related to, yet also occurs independently of, sexual dysfunction (Bird et al., 2011).
For the majority of males, PCD appears to occur infrequently and may therefore
represent normal variation within the human experience of the resolution phase. This view is
aligned with the good-enough sex model (Metz & McCarthy, 2007), which suggests that
rather than having expectations of perfect performance (Zilbergeld, 1999), variation within
sexual experience is normative and should be anticipated, rather than pathologized. When
applied to PCD and resolution phase, the good-enough sex model may suggest that PCD,
when experienced infrequently and without excess distress, may be an ordinary human
response to sexual activity (Metz & McCarthy, 2007).
As the first study to focus on PCD among males, the results have implications for
research and therapy. In keeping with suggestions from previous researchers (see Burri &
Spector, 2011; Schweitzer et al., 2015), it is recommended that future research take a
biopsychosocial approach. Secondly, investigations of the interplay between PCD and
interpersonal or partner related variables such as relationship quality may be conducted, as
these factors have been shown to influence sexual functioning and satisfaction (McCabe et
al., 2010). Thirdly, biological correlates, such as hormone levels which have recently been
found to influence partner interactions following sexual activity (Denes, Afifi, & Granger,
2016), and their possible relationship to PCD may be explored. Future research on PCD may
also be extended by examining its occurrence specifically in the presence and absence of
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POSTCOITAL DYSPHORIA IN MALES
orgasm or following masturbation (i.e., without a partner), as well as analysis of the possible
relationship between psychotropic medication use and PCD.
The results have implications for the general community’s understanding that the
male sexual experience varies and that the time immediately following sex may not always be
experienced positively, Males who experience PCD, and their partners, may find it
comforting to know that they are not alone in their experience and that negative postcoital
experiences may simply reflect normal variation in human sexual response.
Strengths and Limitations
Several sampling, operationalization, and design limitations are noted. While the
sample is large, it may not be representative due to the nature of the topic and method of
recruitment. Evidence suggests that differences exist between self-selected participants and
non-participants of sexuality research (Dunne et al., 1997, Strassberg & Lowe, 1995).
However, the anonymity of online surveys has been shown to be of value in sexuality
research.
Sampling may also have been biased by attracting participants who had or were
experiencing PCD, and deterred those who had not heard of or experienced PCD. Conversely,
because PCD is unfamiliar, participants may have answered without sufficient contemplation
on their own experience or in a way that reflects dominant cultural assumptions about the
experience of the resolution phase (Farvid & Braun, 2006; Sakaluk et al., 2014; Sewell, 2005;
Zilbergeld, 1999). Thus, there may also be reason to suspect that PCD may be more common
among males than was reported in this study.
Potential limitations were also present in the operationalization of abuse history, PCD,
and sexual dysfunction within the questionnaire. Firstly, emotional and physical abuse were
assessed using single item questions which were open to participant interpretation of what
constitutes emotional or physical abuse. Secondly, as the study of PCD is in its infancy, a
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POSTCOITAL DYSPHORIA IN MALES
scale for its measurement does not yet exist. While the items used to assess PCD in this
questionnaire were consistent with previous studies (Bird et al., 2011; Schweitzer et al.,
2015), future research would benefit from the use of a nuanced and precise definition of PCD
to ensure participants understand the distinct experience. This may be achieved by developing
a valid and reliable scale assessing distinct facets of PCD such as frequency, severity,
persistence, and distress.
The retrospective nature of this study may have led to misrepresentation due to recall
bias (Eisenhower, Mathiowetz, & Morganstein, 2004). Future research may consider a mixed
methods approach, incorporating an anonymous online measure as well as qualitative data to
assess the prevalence and subjective phenomenology of PCD.
Conclusion
Results indicate that a proportion of males have experienced PCD, that PCD most
often occurs intermittently, and that a small percentage of males will experience PCD on a
regular basis. Among males, PCD appears to be associated with current psychological
distress, sexual abuse during childhood, and with several sexual dysfunctions. Taking the
view of Metz & McCarthy’s (2007) good-enough sex model, for the majority of males, PCD
which occurs intermittently may represent natural variation in the human experience of the
resolution phase rather than a sexual dysfunction. The results challenge the dominant cultural
discourse by showing that the male experience of the resolution phase may be far more
varied, complex, and nuanced than previously thought.
17
Addis, M. E., Reigeluth, C. S., & Schwab, J. R. (2016). Social norms, social construction,
and the psychology of men and masculinity. In Y. J. Wong, S. R. Wester, Y. J. Wong,
& S. R. Wester (Eds.), APA handbook of men and masculinities. APA handbooks in
psychology series (pp. 81-104). Washington, DC, US: American Psychological
Association. doi:https://doi.org/10.1037/14594-004
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Arlington: American Psychiatric Publishing.
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress
Scale (K10). Australian and New Zealand Journal of Public Health, 25(6), 494-497.
doi:https://dx.doi.org/10.1111/j.1467-842X.2001.tb00310.x
Baker, C. D., & Silva, P. D. (1988). The relationship between male sexual dysfunction and
belief in Zilbergeld' s myths: An empirical investigation. Sexual and Marital Therapy,
3(2), 229-238. doi:https://doi.org/10.1080/02674658808407714
Basson, R. (2001). Human sex-response cycles. Journal of Sex & Marital Therapy, 27(1), 33-
43. doi:https://doi.org/10.1080/00926230152035831
Bignell, C. (1993). Improving the sexual health of the nation: Time to break the impregnable
silence on men and sex. BMJ: British Medical Journal, 307(6897), 145-146.
doi:https://doi.org/10.1136/bmj.307.6897.145
Bird, B. S., Schweitzer, R. D., & Strassberg, D. S. (2011). The prevalence and correlates of
postcoital dysphoria in women. International Journal of Sexual Health, 23(1), 14-25.
doi:https://dx.doi.org/10.1080/19317611.2010.509689
Burri, A. V., & Spector, T. D. (2011). An epidemiological survey of post-coital psychological
symptoms in a UK population sample of female twins. Twin Research and Human
Genetics, 14(3), 240-248. doi:https://dx.doi.org/10.1375/twin.14.3.240
Denes, A. (2012). Pillow talk: exploring disclosures after sexual activity. Western Journal of
Communication, 76(2), 91-108. doi:https://dx.doi.org/10.1080/10570314.2011.651253
Denes, A., Afifi, T. D., & Granger, D. A. (2016). Physiology and pillow talk. Journal of
Social and Personal Relationships, 34(3), 281-308.
doi:https://dx.doi.org/10.1177/0265407516634470
Denes, A., Dhillon, A., & Speer, A. C. (2017). Relational maintenance strategies during the
post sex time interval. Communication Quarterly, 65(3), 307-332.
doi:https://dx.doi.org/10.1080/01463373.2016.1245206
Dube, S. R., Anda, R. F., Whitfield, C. L., Brown, D. W., Felitti, V. J., Dong, M., & Giles, W.
H. (2005). Long-term consequences of childhood sexual abuse by gender of victim.
American Journal of Preventive Medicine, 28(5), 430-438.
doi:https://dx.doi.org/10.1016/j.amepre.2005.01.015
Dunne, M. P., Martin, N. G., Bailey, J. M., Heath, A. C., Bucholz, K. K., Madden, P. A., &
Statham, D. J. (1997). Participation bias in a sexuality survey: Psychological and
behavioural characteristics of responders and non-responders. International Journal
of Epidemiology, 26(4), 844-854. doi:https://dx.doi.org/10.1093/ije/26.4.844
Farvid, P., & Braun, V. (2006). 'Most of us guys are raring to go anytime, anyplace,
anywhere': male and female sexuality in cleo and cosmo. Sex Roles, 55(5-6), 295-310.
doi:https://dx.doi.org/10.1007/s11199-006-9084-1
Field, A. P. (2014). Discovering statistics using IBM SPSS statistics: and sex and drugs and
rock 'n' roll (4th ed.). London: SAGE.
Friedman, R. A. (2009). Sex and depression: In the brain, if not the mind. Retrieved from
http://www.nytimes.com/2009/01/20/health/views/20mind.html?mcubz=1
18
Kessler, R C., Andrews, G., Colpe, L J., Hiripi, E., Mroczek, D K., Normand, S. L T., . . .
Zaslavsky, A M. (2002). Short screening scales to monitor population prevalences and
trends in non-specific psychological distress. Psychological Medicine, 32(6), 959-976.
doi:https://doi.org/10.1017/s0033291702006074
Laurent, S. M., & Simons, A. D. (2009). Sexual dysfunction in depression and anxiety:
Conceptualizing sexual dysfunction as part of an internalizing dimension. Clinical
Psychology Review, 29(7), 573-585. doi:https://dx.doi.org/10.1016/j.cpr.2009.06.007
Masters, W. H., & Johnson, V. (1966). Human sexual response. Boston: Little, Brown.
McCabe, M., Althof, S. E., Assalian, P., Chevret-Measson, M., Leiblum, S. R., Simonelli, C.,
& Wylie, K. (2010). Psychological and interpersonal dimensions of sexual function
and dysfunction. The Journal of Sexual Medicine, 7(1pt2), 327-336.
doi:https://dx.doi.org/10.1111/j.1743-6109.2009.01618.x
McCarthy, B., & Thestrup, M. (2009). Men, intimacy, and eroticism. The Journal of Sexual
Medicine, 6(2), 588-594. doi:https://dx.doi.org/10.1111/j.1743-6109.2008.01051.x
Metz, M. E., & McCarthy, B. W. (2007). The “Good-Enough Sex” model for couple sexual
satisfaction. Sexual and Relationship Therapy, 22(3), 351-362.
doi:https://dx.doi.org/10.1080/14681990601013492
Mosher, D. L. (1980). Three dimensions of depth of involvement in human sexual response.
The Journal of Sex Research, 16(1), 1-42.
doi:https://doi.org/10.1080/00224498009551060
Muise, A., Giang, E., & Impett, E. A. (2014). Post sex affectionate exchanges promote sexual
and relationship satisfaction. Archives of Sexual Behavior, 43(7), 1391-1402.
doi:https://dx.doi.org/10.1007/s10508-014-0305-3
Murray, S. H. (2017). Heterosexual men’s sexual desire: supported by, or deviating from,
traditional masculinity norms and sexual scripts? Sex Roles.
doi:https://dx.doi.org/10.1007/s11199-017-0766-7
doi:https://doi.org/10.1080/00224490609552300
Ramlachan, P., & Campbell, M. M. (2014). Male sexual dysfunction. South African Medical
Journal, 104. doi:https://doi.org/10.7196/samj.8376
Sadock, B. J., & Sadock, V. A. (2008). Kaplan & Sadock's concise textbook of clinical
psychiatry (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Sakaluk, J. K., Todd, L. M., Milhausen, R., & Lachowsky, N. J. (2014). Dominant
heterosexual sexual scripts in emerging adulthood: Conceptualization and
measurement. The Journal of Sex Research, 51(5), 516-531.
doi:https://dx.doi.org/10.1080/00224499.2012.745473
Schweitzer, R. D., O'Brien, J., & Burri, A. (2015). Postcoital dysphoria: Prevalence and
psychological correlates. Sexual Medicine, 3(4), 235-243.
doi:https://dx.doi.org/10.1002/sm2.74
Serefoglu, E. C. (2017). Post-orgasmic illness syndrome: Where are we? The Journal of
Sexual Medicine, 14(5), 641-642. doi:https://doi.org/10.1016/j.jsxm.2017.03.250
Sewell, K. W. (2005). The experience cycle and the sexual response cycle: Conceptualisation
and application to sexual dysfunctions. Journal of Constructivist Psychology, 18(1),
3-13. doi:https://dx.doi.org/10.1080/10720530590522973
Slade, T., Grove, R., & Burgess, P. (2011). Kessler psychological distress scale: Normative
data from the 2007 Australian national survey of mental health and wellbeing.
Australian & New Zealand Journal of Psychiatry, 45(4), 308-316.
doi:https://dx.doi.org/10.3109/00048674.2010.543653
Stoltenborgh, M., van Ijzendoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J.
(2011). A global perspective on child sexual abuse: Meta-analysis of prevalence
19
around the world. Child Maltreatment, 16(2), 79-101.
doi:https://dx.doi.org/10.1177/1077559511403920
Strassberg, D. S., & Lowe, K. (1995). Volunteer bias in sexuality research. Archives of Sexual
Behavior, 24(4), 369-382. doi:https://doi.org/10.1007/bf01541853
Torun, F., Torun, S. D., & Özaydin, A. N. (2011). Men's belief in sexual myths and factors
effecting these myths. Dusunen Adam, 24(1), 24-31.
doi:https://doi.org/10.5350/dajpn2011240103t
Waldinger, M. D. (2016). Post orgasmic illness syndrome (POIS). Translational Andrology
and Urology, 5(4), 602-606. doi:https://dx.doi.org/10.21037/tau.2016.07.01
Waldinger, M. D., & Schweitzer, D. H. (2002). Postorgasmic illness syndrome: Two cases.
Journal of Sex & Marital Therapy, 28(3), 251-255.
doi:https://dx.doi.org/10.1080/009262302760328280
Wiederman, M. W. (2005). The gendered nature of sexual scripts. The Family Journal, 13(4),
496-502. doi:https://dx.doi.org/10.1177/1066480705278729
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Table 1
Demographic Information
Variable nPercentage
Country of residence – in order of representation
USA 318 26.3%
Australia 284 23.5%
UK 111 9.2%
Russia 55 4.6%
New Zealand 39 3.3%
Germany 38 3.1%
Other 363 30%
Education
Completed secondary school 1,154 95.5%
Years of tertiary education
0 71 5.9%
1-4 475 39.3%
5-6 295 24.4%
21
7-10 313 25.9%
Sexual Orientation
Heterosexual 1019 84.4%
Homosexual 189 15.6%
Current relationship status
Single 289 23.9%
In a relationship, but not living together 282 23.3%
Living with a partner, but not married 201 16.6%
Married 395 32.7%
Separated 20 1.7%
Other 21 1.7%
Length of current relationship
Not currently in a relationship 330 27.2%
Less than 6 months 84 7%
6 – 12 months 77 6.4%
1 – 3 years 182 15.1%
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3 – 6 years 126 10.4%
6 – 12 years 140 11.6%
12 – 24 years 133 11.0%
Greater than 24 years 136 11.3%
Sexual relationship status
Not in a sexual relationship 192 15.9%
Exclusive/Monogamous 789 65.3%
Non-exclusive/Non-monogamous 227 18.8%
Note. N = 1,208.
Table 2
Prevalence of Abuse and Current Psychological Distress
Variable nPercentage
Before the age of 16
Sexual abuse 154 12.7%
Physical abuse 296 24.5%
Emotional abuse 467 38.7%
Since the age of 16
Sexual abuse 107 8.9%
Physical abuse 176 14.6%
Emotional abuse 468 38.7%
Current psychological distress
10 – 19 664 55%
20 – 24 250 20.7%
25 – 29 132 10.9%
30 – 50 162 13.4%
Note. N = 1,208.
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Table 3
Prevalence of Sexual Dysfunctions
Frequency HSDD ED DE PE
Lifetime
Never 33.4% 38.2% 28.2% 32.4%
A little of the time 37.7% 39.0% 44.5% 40.3%
Some of the time 25.5% 18.2% 21.0% 20.3%
Most of the time 3.0% 3.8% 5.3% 6.0%
All of the time 0.5% 0.7% 1.0% 1.0%
Four week
Never 58.4% 69.6% 64.6% 74.8%
A little of the time 27.0% 18.4% 22.5% 14.9%
Some of the time 9.1% 6.7% 6.5% 6.0%
Most of the time 4.8% 4.1% 4.5% 2.8%
All of the time 0.7% 1.2% 1.9% 1.5%
Note. N = 1,208. HSDD = Hypoactive Sexual Desire Disorder, ED = Erectile Dysfunction, DE = Delayed
Ejaculation, PE = Premature Ejaculation.
24
Table 4
Prevalence of Lifetime and Four Week PCD and Odds Ratios as a Function of Sex
Male Female
Frequency n%n% Odds Ratio [95% CI]
Lifetime PCD
Never 713 59% 699 33.4%
Any experience 495 41% 1,394 66.6% 2.87* [2.48, 3.33]
A little of the time 291 24.1% 736 35.2% 1.71* [1.46, 2.01]
Some of the time 151 12.5% 506 24.2% 2.23* [1.83, 2.72]
Most of the time 48 4.0% 134 6.4% 1.65* [1.18, 2.32]
All of the time 5 0.4% 18 0.9% 2.09 [0.77, 5.64]
Four week PCD
Never 963 79.7% 1,427 68.2%
Any experience 245 20.2% 666 31.8% 1.83* [1.55, 2.17]
A little of the time 134 11.1% 370 17.7% 1.72* [1.39, 2.13]
Some of the time 61 5.0% 164 7.8% 1.60* [1.18, 2.16]
Most of the time 35 2.9% 90 4.3% 1.51* [1.01, 2.24]
All of the time 15 1.2% 42 2% 1.63 [0.90, 2.95]
Note. * p < .05. Male N = 1,208, Female N = 2,093 respondents as part of the same survey. Odds ratios are
expressed as the likelihood of females experiencing PCD when compared to males.
25
26
Table 5
Correlation Matrix of Variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1. Age -
2. Sexual orientation -.13** -
3. Current psychological distress -.31** .09** -
4. Lifetime depression -.04 .11** .37** -
5. Lifetime anxiety -.10** .11** .39** .56** -
6. Lifetime bi-polar disorder -.63*.05 .15** .15** .16** -
7. Sexual abuse (C) .04 .10** .06*.11** .13** .11** -
8. Physical abuse (C) .08** .01 .13** .22** .18** .04 .29** -
9. Emotional abuse (C) -.01 .10** .23** .28** .23** .06*.21** .50** -
10. Sexual abuse (A) -.03 .24** .16** .12** .14** .12** .25** .18** .15** -
11. Physical abuse (A) -.01 .07*.14** .18** .13** .07*.12** .40** .27** .28** -
12. Emotional abuse (A) -.03 .08** .30** .29** .25** .10** .14** .35** .53** .26** .41** -
13. Lifetime HSDD -.17** .18** .30** .21** .23** .12** .04 .06 .11** .14** .08** .13** -
14. Lifetime ED .16** .07*.17** .17** .13** .06*.04 .10** .13** .13** .09** .12** .25** -
15. Lifetime DE -.09** .05 .23** .19** .17** .10** .08** .07*.10** .10** .09** .14** .22** .33** -
16. Lifetime PE .01 -.06*.09** .02 .02 -.03 -.01 .01 .05 .06*.04 .04 .06*.15** -.18** -
17. Lifetime PCD -.16** .19** .38** .22** .20** .14** .17** .15** .17** .17** .13** .21** .24** .12** .15** .12** -
18. Four week HSDD -.05 .12** .30** .18** .14** .07*.05 .11** .12** .11** .08** .14** .51** .25** .19** .05 .33** -
19. Four week ED .22** .06 .17** .12** .13** .04 .03 .08** .08** .08** .05 .08** .17** .62** .19** .15** .13** .34** -
20. Four week DE .05 .02 .22** .22** .19** .10** .07*.08** .12** .10** .08** .14** .20** .30** .61** -.05 .17** .20** .38** -
21. Four week PE -.02 -.07*.12** .01 .05 -.01 .01 .01 .03 .06*.03 .04 .04 .11** -.19** .66** .15** .07*.13** -.06*-
22. Four week PCD -.11** .11** .36** .14** .12** .13** .14** .11** .12** .13** .08** .13** .15** .14** .10** .13** .71** .28** .19** .20** .20**
Note: * p < .05, ** p < .01. N = 1,208 except where specified. ^ n = 1015. (C) = Childhood, (A) = Adulthood. HSDD = Hypoactive Sexual Desire Disorder, ED = Erectile
Dysfunction, DE = Delayed Ejaculation, PE = Premature Ejaculation.
Table 6
Multiple Regression Analyses for Lifetime and Four Week PCD
Criterion: Lifetime PCD Criterion: Four week PCD
Variable B95% BCa CI for B SE B βsr2B95% BCa CI for B SE B βsr2
(Constant) -.604 [-1.045, -0.144] .201 -.291 [-0.734, 0.156] .189
Age -.003 [-0.006, 0.000] .002 -.057* .002 -.002 [-0.006, 0.001] .002 -.043 .001
Orientation .300 [0.159, 0.433] .064 .124** .014 .164 [0.042, 0.292] .060 .074* .005
Current psychological distress .026 [0.018, 0.033] .004 .228** .033 .028 [0.021, 0.036] .003 .268** .046
Lifetime anxiety -.033 [-0.152, 0.096] .060 -.017 .000 -.129 [-0.256, -0.002] .056 -.075* .003
Lifetime depression .070 [-0.043, 0.188] .058 .038 .001 .022 [-0.086, 0.137] .054 .013 .000
Lifetime bi-polar disorder .249 [-0.077, 0.534] .133 .048 .002 .310 [-0.033, 0.648] .125 .065 .004
Sexual abuse (C) .258 [0.109, 0.404] .071 .098** .008 .225 [0.073, 0.372] .067 .093** .007
Physical abuse (C) .089 [-0.051, 0.230] .064 .043 .001 .085 [-0.062, 0.227] .060 .045 .001
Emotional abuse (C) -.036 [-0.143, 0.076] .059 -.020 .000 -.024 [-0.136, 0.078] .055 -.014 .000
Sexual abuse (A) .047 [-0.119, 0.217] .086 .015 .000 .032 [-0.177, 0.246] .081 .011 .000
Physical abuse (A) .020 [-0.143, 0.182] .073 .008 .000 -.015 [-0.158, 0.135] .068 -.006 .000
Emotional abuse (A) .103 [-0.024, 0.228] .058 .057 .002 -.008 [-0.124, 0.115] .055 -.005 .000
Lifetime HSDD .000 [-0.064, 0.059] .031 .000 .000 -.060 [-0.116, 0.007] .029 -.064 .003
Lifetime ED -.029 [-0.100, 0.040] .034 -.030 .000 .003 [-0.066, 0.072] .032 .003 .000
Lifetime DE .017 [-0.053, 0.087] .034 .018 .000 -.063 [-0.136, 0.008] .032 -.069 .003
Lifetime PE .051 [-0.018, 0.114] .032 .053 .002 .000 [-0.054, 0.057] .030 .000 .000
HSDD four week .200 [0.130, 0.276] .031 .202** .026 .159 [0.083, 0.232] .029 .175** .020
ED four week -.008 [-0.081, 0.067] .036 -.008 .000 .029 [-0.052, 0.111] .033 .031 .000
DE four week .055 [-0.019, 0.128] .033 .059 .002 .126 [0.050, 0.202] .031 .146** .011
PE four week .091 [0.016, 0.158] .035 .087* .004 .147 [0.067, 0.228] .033 .153** .013
Note: N = 1,208. * p < .05, ** p < .01. BCa based on 1000 samples. Lifetime PCD adjusted R2 = .25. Four week PCD adjusted R2 = .21. (C) = Childhood, (A) = Adulthood. HSDD =
Hypoactive Sexual Desire Disorder, ED = Erectile Dysfunction, DE = Delayed Ejaculation, PE = Premature Ejaculation
29
