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Multiple Orgasms in Men—What We Know So Far
Erik Wibowo, PhD,
1
and Richard J. Wassersug, PhD
2,3
ABSTRACT
Introduction: There is much popular discussion on strategies to facilitate multiple orgasms in men (ie,
100,000þhits in Google), yet the topic has not received an objective comprehensive review in the literature.
Aim: To review the literature on male multiple orgasms.
Methods: We searched the literature for publications on “male multiple orgasms”and factors influencing male
multiple orgasms in Google, PubMed, and PsychINFO. This yielded 15 relevant publications.
Main Outcome Measures: A comprehensive overview on the topic of male multiple orgasms and factors that
influence the propensity of men to experience multiple orgasms.
Results: Few men are multiorgasmic: <10% for those in their 20s, and <7% after the age of 30. The literature
suggests 2 types of male multiple orgasms: “sporadic”multiorgasms, with interorgasmic intervals of several mi-
nutes, and “condensed”multiorgasms, with bursts of 2e4 orgasms within a few seconds to 2 minutes. Multiple
orgasms appear physiologically similar to the single orgasm in mono-orgasmic men. However, in a single case study,
a multiorgasmic man did not experience with his first orgasm the prolactin surge that usually occurs with orgasm in
mono-orgasmic men. Various factors may facilitate multiple orgasms: (1) practicing to have an orgasm without
ejaculation; (2) using psychostimulant drugs; (3) having multiple and/or novel sexual partners; or (4) using sex toys
to enhance tactile stimulation. However, confirmatory physiological data on any of these factors are few. In some
cases, the ability to experience multiple orgasms may increase after medical procedures that reduce ejaculation (eg,
prostatectomy or castration), but what factor(s) influence this phenomenon is poorly investigated.
Conclusion: Despite popular interest, the topic of male multiple orgasms has received surprisingly little scientific
assessment. The role of ejaculation and physiological change during the refractory period in inhibiting multiple
orgasms has barely been investigated.
Sex Med Rev 2016;-:1e13. Copyright 2016, International Society for Sexual Medicine. Published by Elsevier Inc.
All rights reserved.
Key Words: Multiple Orgasms; Male; Ejaculation; Refractory Period; Sex Toys; Psychostimulant Drugs;
Multiple Partners
INTRODUCTION
In a sexual encounter, many men achieve an orgasm accom-
panied by ejaculation and stop seeking sexual stimulation once
ejaculation occurs. However, some men report experiencing
multiple orgasms in sexual encounters. Alfred Kinsey and col-
leagues were among the first to record accounts of male multiple
orgasms.
1
Since then, many anecdotal claims have been made
about the phenomenon. In the popular literature, there has been
growing interest in Eastern traditions involving Tantric and
Taoist sex practices that have been touted as aids for men who
desire multiple orgasms.
2
A Google search in November 2015 on
the phrase “male multiple orgasms”produced over 100,000 re-
sults, suggesting great interest in this topic. However, the extent to
which the public’s understanding of the phenomenon is based on
scientific data is unclear. One previous review
3
discussed briefly
multiple orgasms in men, but the article specifically focused on
the neurobiology of post-ejaculation refractory time (PERT).
Aim
We aim here to comprehensively and objectively review the
literature on the male multiple orgasms.
METHODS
We searched key terms such as “male multiple orgasms”in
PubMed, Google Scholar, and PsychINFO. This yielded 15
Received November 9, 2015. Accepted December 23, 2015.
1
Vancouver Prostate Centre, Vancouver Coastal Health, Vancouver, Canada;
2
Department of Urologic Sciences, University of British Columbia, Vancou-
ver, Canada;
3
Australian Research Centre in Sex, Health and Society, La Trobe University,
Melbourne, Victoria, Australia
Copyright ª2016, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.sxmr.2015.12.004
Sex Med Rev 2016;-:1e13 1
relevant publications on this phenomenon. From data included
there, we distinguish 2 types of multiple orgasms in men (dis-
cussed further below). We also explore factors that have been
reported as promoters of multiple orgasms in males. These
include practicing to control ejaculation, using psychostimulant
drugs, having sex with multiple partners, and using sex toys as
stimulatory aids.
Additionally, we explore the role of ejaculation in the occur-
rence of multiple orgasms, and how PERT may impede subse-
quent orgasm(s). In the largest review to date on PERT, Levin
3
argued that ejaculation more than orgasm induced the refractory
period. Specifically, he noted that “.it is more likely that the
activation of the ejaculation mechanism per se leads to the cre-
ation of the refractory state rather than that of the orgasm.”In
this article, we revisit this topic with new observations not dis-
cussed in Levin’s review. A few reports suggest that multiple
orgasms can be achieved by avoiding ejaculation, or in some
cases, medical procedures that substantially eliminate the ejacu-
late (eg, prostatectomy in a prostate cancer patient or castration
in male-to-female transsexuals) may facilitate achieving multiple
orgasms. From our review, we confirm that there are men
who can have multiple ejaculatory orgasms (discussed further
later), and in such cases, these men may in fact have naturally
short PERT.
A major caveat from our review is that most reports on male
multiple orgasms rely on subjective accounts where multiple
orgasms were not objectively confirmed by any physiological or
neurological criteria. Despite popular interest in the topic, and as
noted by Levin in his 2009 review of PERT, there are remarkably
few experimental data on the physiological changes and neuro-
biology of male multiple orgasms.
Main Outcome Measures
A comprehensive overview on the topic of male multiple or-
gasms and factors that influence the propensity of men to
experience multiple orgasms.
RESULTS
Definitions and Properties of Multiple Orgasms
Following Masters and Johnson,
4
the male sexual response
cycle can be considered to have 4 phases: excitement, plateau,
orgasm, and resolution. Penile erection may occur from the
beginning of sexual activity up to the resolution phase. In
contrast, ejaculation happens at the orgasmic phase, and may be
accompanied by orgasm.
Orgasm and ejaculation may be sensed as synchronous and
thus experienced as a single event. However, orgasm and ejacu-
lation are not the same process. Evidence confirming this comes
from some men, who retain the capability to reach orgasm in
the absence of ejaculation. Examples include some men after
a prostatectomy,
5e7
men on ejaculation-inhibiting drugs,
8,9
men with spinal cord injuries,
10e13
and some diabetics.
14,15
Furthermore, some men with spinal cord injury can ejaculate
without orgasm through penile vibrostimulation
16
or prostate
massage.
17
During ejaculation, there are glans-vasal reflexes (ie, emission
stage: smooth muscle contraction of accessory sexual organs leads
to semen emission in the posterior urethra, increasing its internal
pressure) as well as urethromuscular reflexes (ie, expulsion stage:
external urethral sphincter relaxes and pelvic floor muscles
contraction ejects semen out of urethra
18
). After ejaculation
PERT occurs, during which further sexual stimulation will not
elicit another ejaculation. However, as noted by Levin,
19
there is
no definitive explanation for the cause of PERT. Regardless of
the cause, changes that occur during PERT may dampen men’s
ability to have subsequent orgasms. These changes may include
increased penile sensory threshold,
20
reduced electromyographic
(EMG) activity in the erectile tissues and accessory organs,
21
and
increased electroencephalographic (EEG) slow wave activity.
22,23
The function of PERT also remains unclear. One suggested
function is that PERT allows sperm to be reproduced again for
ejaculation and prevents the displacement of previously ejaculated
sperm in the vagina by the immediate sexual partner (discussed in
Levin).
3
PERT may also protect men from overstimulating their
genitalia (eg, resulting in skin abrasion/ irritation), and help men
avoid physical exhaustion. Such adaptationist arguments are not
amenable to testing, but may similarly account for why multiple
orgasms are uncommon in males.
Unlike ejaculation, there is a variation in how orgasm is
described in different studies.
24,25
Kinsey defined orgasm as “.a
sudden release [of nervous tension] which produces local spasms
or more extensive or all-consuming convulsions”(p, 158).
1
One
common theme from the various descriptions of orgasms is that
an orgasm involves an intense pleasurable sensation in response to
genital (and/or nongenital; cf, Komisaruk et al
24
) stimulation.
Physical responses (eg, changes in blood pressure, heart beat,
pelvic floor/anal contractions) occur, and psychological changes
(eg, feeling of pleasure) are also experienced during orgasm.
Various factors may influence the intensity of orgasm, such as
biological age, ejaculate volume, or comorbidities. Mah and
Binik
26
found that orgasms were rated as more pleasurable when
they are sensed as radiating beyond the genitopelvic area.
From the data we have reviewed (Table 1), multiple orgasms
have been described in 2 different ways. In both cases, we
consider a man as multiorgasmic if he can have more than one
orgasm within 20 minutes, because normal healthy mono-
orgasmic (as opposed to multiorgasmic) men on average have a
refractory period of w20 minutes.
27,28
The first type of multiple
orgasms involve more than one orgasm separated by intervals of
several minutes. For simplicity we are labeling these as “sporadic”
multiorgasms, and this type is the more commonly reported
pattern in the literature.
Those who claim to experience “sporadic”multiple orgasms
report that their erections may be maintained during the inter-
orgasmic period, but more penile stimulation is needed to reach
Sex Med Rev 2016;-:1e13
2Wibowo and Wassersug
Table 1. Details on Studies Reporting Multiple Orgasms in Males
Study Subjects Parameters Measured Key Findings
(Gay & Sheppard,
1973)
10 men on amphetamine
1 man on cocaine
Self-report 10 of 18 men on amphetamine claimed to have multiple orgasms during sex
after using intravenous amphetamine. One stated that he had 7 or 8 orgasms
with every sexual activity.
One man claimed multiple orgasms when he had intercourse after sniffing cocaine.
Three subjects (gender not specified) had multiple orgasms during sex after
having taken MDA (3,4-methylenedioxyamphetamine).
(Tobias, 1973) 1 man Self-report One man reported having multiple orgasms under the influence of cocaine.
(Parr, 1976) 2 men Self-report After using amphetamine, one man reported 7 successive orgasms, whereas the
other man claimed having 8 orgasms during sexual activity.
(Robbins & Jensen,
1978)
13 men aged 22 to 56 Self-report
One subject had his heart rate,
respiratory rate, and anal
contraction monitored while
having 3 consecutive orgasms
In a series of orgasms, subjects reported delaying ejaculation until the final
orgasm, which was the most intense one and after that they had a refractory
period. All maintained erection until the final orgasm.
Subjects had 3 to 10 multiple orgasms during a masturbatory or coitus session;
one claimed 30 orgasms in a 1-hour sexual encounter.
The 1 subject who was physiologically-monitored during orgasms showed 3 bursts of
anal contractions during orgasms, each preceded by increased respiratory rates.
His heart rate was elevated (up to 143 beats/min) and peaked with the final orgasm.
(Hartman & Fithian,
1984)
33 men Self-report Thirty-three of 282 men (12%) reported being multiorgasmic; on average the
men reported 4 orgasms in series. One subject claimed 16 orgasms in a row.
Few subjects reported multiple orgasms while having sex under the influence of
butyl nitrite (1 man) and amyl nitrite (2 men).
(Dunn & Trost, 1989) 21 men aged 25 to 69
Most reported having two to nine
orgasms [the most was 16] in
sexual encounters that ranges
from 15 minutes to 2 hours.
Self-report All reported retaining their erection after the first orgasm, but there were 2
refractory patterns to the next orgasms:
Five had a refractory period and required further penile stimulation to reach sub-
sequent orgasms.
Sixteen had minimal refractory periods, and reached another orgasm(s) within a few
minutes.
Thirteen men reported being multiorgasmic since they became sexually active as
adolescents. The rest became multiorgasmic after the age of 35 either
“fortuitously”(6 men) or by learning (2 men).
Three ejaculation patterns were reported:
Three subjects did not ejaculate until the final orgasm.
Two ejaculated at the first orgasm and had subsequent dry orgasms.
Sixteen had full, partial or no ejaculation in inconsistent sequences.
(Kothari, 1989) Exp. 1 e1 man aged 30 who
discovered multiorgasms
accidentally while masturbating
at the age of 29.
Exp. 2 e1 man
Exp. 3 e2 men [Not specified
if the man in exp. 1 is in
exp. 2 or 3].
Exp. 1 eejaculates and semen
analysis
Exp. 2 eECG
Exp. 3 eEEG
Exp. 1 eThe man had 6 orgasms in 27 minutes and 4 orgasms 17 minutes in two
separate experiments. Most of his orgasms were accompanied with ejaculations,
but sometimes he had dry orgasms. In the series of 6 orgasms, his third orgasm
was the most intense and the sixth orgasm was the least intense.
Exp. 2 eThe subject’s heart rate increased from 70 bpm to 94 bpm at the first
orgasm and to 100 bpm at the second orgasm.
Exp. 3 eNo change in EEG from arousal, preorgasmic or at orgasmic phases. [Note:
no spectral analysis was presented.]
(continued)
Sex Med Rev 2016;-:1e13
Male Multiple Orgasms 3
Table 1. Continued
Study Subjects Parameters Measured Key Findings
(Carmichael et al,
1994)
1 man Blood pressure, anal EMG, anal
APG were measured in 3
separated testing periods.
In 2 sessions, the man had multiple orgasms with the following parameters:
Inter-orgasmic intervals w3 to 7 minutes.
Durations of orgasm w20 to 47 seconds.
Numbers of anal contractions at orgasm w20 to 28 contractions.
The subject’s blood pressure and EMG amplitude, but not the APG amplitude,
were higher at ejaculation than at the preceding orgasms. He had a “low
amplitude tonic bursts of EMG activity immediately before the onset of
orgasms”in 1 ejaculation and 2 orgasms without ejaculation.
Two types of EMG patterns were observed during his orgasms:
Continuous series of contractions that subsided over time.
A series of contractions with quiescent period(s) in between.
(Whipple et al,
1998)
1 man aged 35 who reported
on average 5 orgasms with
ejaculation daily
Ejaculate parameters, heart rate,
blood pressure, pupil diameter,
and subjective sexual arousal
were measured at regular
intervals before, during, and
after a series of 6 orgasms
within an approximately 1-hour
period.
The subject’s blood pressure, heart rate, subjective sexual arousal increased
during self-stimulation, further elevated during the series of orgasms, and
decreased after the final orgasm. His pupil diameter only increased during
orgasms, but not during pre- or post-stimulation periods.
Before the final orgasm, his inter-orgasmic intervals varied from 4 to 12
minutes.
(Haake et al, 2002) 1 man aged 25, who claimed
having multiple orgasms since
adolescence.
He has on average 3 min
refractory period, 50% chance
of maintaining erection after
orgasm, and ejaculated with
every orgasm.
The subject was asked to achieve
orgasms at 30 and 60 minutes
after the onset of experiment.
Plasma prolactin levels were
measured in a 60-minute period.
The man had 2 orgasms at 30 minutes after the start of the experiment with
2-minute intervals, and another orgasm at 60 minutes. His erection and his
subjectively reported sexual desire remain unaltered between orgasm.
The subject’s prolactin levels did not change throughout the test period; unlike
the control mono-orgasmic men, who had increased prolactin levels at 30
minutes (first orgasm) and further increase at 60 minutes (second orgasm).
[The controls had refractory period of at least 10 minutes.]
(Gray & Klotz, 2004;
Warkentin et al,
2006)
1 prostate cancer patient Self-report The patient had erectile dysfunction and had previous treatments for
prostatectomy, radiotherapy and androgen deprivation therapy at the age of
52. After 1.5 years of being androgen-deprived, he started using a strap-on
dildo during intercourse with his partner.
When he penetrated his partner with the dildo, he reported 2-3 orgasms within
1e2 minutes with concurrent direct penile stimulation from his partner. [Note:
before prostate cancer treatment he could not achieve multiple orgasms.]
(Green & Halkitis,
2006)
1 man aged 40 Self-report He claimed to have 6 or 7 orgasms in one evening when he had sex while on
methamphetamine.
(Haning et al, 2007) 15 men Anonymous survey Fifteen of 179 men (8.4%) between the age of 18 and 76 reported capable of
having multiple orgasms with a “good partner.”
(Haning et al, 2008) 36 men Anonymous survey Thirty-six of 415 men (8.7%) between the age of 18 and 86 reported having
multiple orgasms with a “good partner.”
APG ¼anal photoplethysmography; bpm ¼beats per minute; ECG ¼electrocardiography; EEG ¼electroencephalography; EMG ¼electromyography.
Sex Med Rev 2016;-:1e13
4Wibowo and Wassersug
subsequent orgasms.
29e32
These orgasm(s) may be accompanied
by ejaculation(s), but the time when ejaculation occurred in the
sequence of orgasms varied among individuals.
30
For some,
ejaculation may occur with each orgasm, but the volume of
ejaculate diminishes over time, leading to what many may
perceive as nonejaculatory or dry orgasms.
30,32
For others who
experience “sporadic”multiple orgasms, ejaculation may only
happen at the last orgasm, or at any orgasm in a series of or-
gasms.
30
For those individuals who can delay ejaculation to the
end of the orgasm series, the multiple orgasms would appear to fit
the controlled pattern for climaxing that is seen as the goal of
Tantric sex.
2
The second type, which has only been described in a few
studies,
30,33
occurs when one experiences a burst of non-
ejaculatory orgasms (2e4) within seconds and up to 2 minutes.
These we have labeled as “condensed”multiorgasms. For those
who claim to experience the “condensed”multiple orgasms,
intensified penile stimulation may not be required in the short
period between orgasms.
30,33
Few studies have examined the properties of the orgasms of
multiorgasmic men. As the “condensed”multiple orgasms have
only been reported in a few studies, most physiological data are
available from those with the “sporadic”multiple orgasms. In fact,
we are aware of only 1 study that documented physiologically
“condensed”multiple orgasms.
33
At the time the subject was in
his late 50s and lacked a prostate gland because he had undergone
radical prostatectomy a decade earlier. He was also hypogonadal
from androgen deprivation therapy and his testosterone was at
castrate levels (<50 ng/dL). The raw physiological data from that
patient, though mentioned in the literature,
34
have not been
previously published. However, more recently the subject’s pelvic
floor activity was measured using perianal surface EMG to
confirm his subjective report of multiorgasms. The man mastur-
bated until he reached a burst of 4 orgasms within 2 minutes (Dr
Stacy Elliott, personal observation). Subsequently, we have
confirmed with a sexual health clinician (C.Z.) who treats patients
with iatrogenic erectile dysfunction from prostate cancer treat-
ments, that other men with medical histories similar to the patient
in the Warkentin et al
33
study have reported being multiorgasmic.
Studies on men with the “sporadic”multiple orgasmic pattern
indicate that the physiological characteristics of their orgasms are
similar to what has been described in mono-orgasmic men,
including increased breathing rate preceding each orgasm.
29
Heart rate, blood pressure, as well as subjectively reported sex-
ual arousal, are all elevated during orgasm.
29,32,35,36
In addition,
muscular spasms occur in the anal sphincter during each orgasm
as indicated by bursts of EMG activity,
29,36
and these resemble
physiologically those observed during orgasm in mono-orgasmic
men.
37
Of these various parameters, EMG activity in the anal
sphincter appears to be the most reliable way to physiologically
verify subjective reports of orgasms and could potentially be used
to confirm if more than 1 orgasm indeed occurred in claims of
“condensed”multiple orgasms.
In a study in which the EEG pattern was measured during
multiple orgasms,
35
no change in EEG pattern appeared to occur
between the preorgasmic and orgasmic periods, consistent with
what has been reported for mono-orgasmic men.
38,39
However, a
different result from mono-orgasmic men has been reported in a
separate study using surface EEG
40
as well as another study using
deep intracranial electrodes in septal and thalamic nuclei.
38
In
those studies, large-amplitude slow-wave activities in EEG ac-
tivity were observed during orgasm. The septal area—noted to be
activated after ejaculation with orgasm
41
—might contribute to
the sexually pleasure sensation.
38,42e44
We are aware of only 1 study that showed physiological dif-
ference during the orgasms experienced by a multiorgasmic man
compared to those of mono-orgasmic men.
31
Again, in that
study, the multiorgasmic man had “sporadic”multiple orgasms,
with 3 self-reported orgasms: the first 2 were separated by 2
minutes and the third occurred a half hour later. It was not noted
whether ejaculation occurred with any of these orgasms. The
researchers measured changes in the subjects’hormonal profile
for a 1-hour masturbatory period that began before the first
orgasm and extended past the last orgasm. As noted in other
studies,
28,45,46
mono-orgasmic men have a surge of plasma
prolactin levels immediately upon orgasm, and the prolactin
levels remain elevated for 30 to 60 minutes after the orgasm. In
contrast, plasma prolactin levels did not increase with any of the
orgasms in the multiorgasmic man.
31
This observation suggests
that a surge in prolactin levels at orgasm may impede successive
orgasms, possibly through the activation of PERT (if the subject
actually had ejaculatory orgasms).
Indeed, Haake et al
31
suggested that elevated prolactin levels
may dampen sexual desire and arousal, which may potentially
raise the threshold needed for most men to be motivated to strive
for or achieve subsequent orgasms in the minutes immediately
following an orgasm. The same research group, in a follow-up
study,
27
investigated how pharmacologically reduced prolactin
affects male sexual parameters. In that study, healthy male vol-
unteers were treated with a drug that indirectly inhibits prolactin
release (cabergoline, a D2-receptor agonist), then masturbated to
reach 2 orgasms w30 minutes apart. The men subjectively re-
ported enhanced sexual function with cabergoline treatment,
including better sexual release and relaxation during refractory
period. Additional support for the idea that elevated prolactin
inhibits multiple orgasms comes from studies on men with low
sexual desire associated with hyperprolactinemia
47e50
or drugs
that increase prolactin levels.
51,52
Furthermore, high plasma
prolactin can lead to a reduction in dopamine and testosterone
release.
53
As such, the surge of prolactin at orgasm in mono-
orgasmic men may contribute to the decline in sexual arousal
after orgasm.
In contrast, in the absence of prolactin surge, multiorgasmic
men may possibly retain elevated sexual arousal and thus remain
close to the threshold for subsequent orgasms. This hypothesis,
however, needs to be taken with caution because it is based on
Sex Med Rev 2016;-:1e13
Male Multiple Orgasms 5
data from only 1 man and has yet to be replicated with a larger
sample size. Levin
54
similarly expressed reservation that a pro-
lactin surge alone could account for PERT and pointed out that
other hormones, receptors, and second messengers may be
involved in the PERT process and could thus prohibit multi-
orgasms from being more common in men.
Notably, the study by Haake et al
31
did not explore other
physiological differences between mono- and multiorgasmic
men, such as plasma levels of oxytocin and catecholamines,
which are known to increase at orgasm.
28,55
Data on animal
studies suggest that oxytocin may facilitate male sexual
behavior,
56,57
but the effects in men have not been fully
resolved.
58,59
In sum, the absence of prolactin surge may not be
the only hormonal factor that contributes to or is associated with
the propensity for multiple orgasms in men.
How Common Are Multiorgasmic Men?
We identified only 3 studies that examined the prevalence of
multiorgasmic adult men: Kinsey et al
1
and a more recent survey
by Haning et al.
60,61
In these reports, the interorgasmic intervals
were not stated, so we cannot determine if the men had the
“sporadic,”“condensed,”or both types of multiple orgasms.
Kinsey et al
1
recorded accounts of 380 adolescent and adult
men who claimed to achieve more than 1 orgasm per sexual
encounter. In Table 48 of their book, Kinsey et al documented
the number of orgasms reported by men—only w8.3% to 9.1%
of 20- to 30- year-old men—affirming the relative rarity of male
multiple orgasms. Furthermore, the percentage of multiorgasmic
men appears to decline around age 30, and remains unchanged
thereafter. Kinsey’s data are matched by 2 recent surveys of men
ranging from the age of 18 to 86,
60,61
which showed that 3.3%
to 7.0% of the men claimed to be multiorgasmic (also see
Table 2 for updated data from Drs. Haning and Stroebel, per-
sonal communication). For men aged 18 to late 20s, about 5.6%
to 7.0% men reported being multiorgasmic in the Haning et al
studies, i.e. slightly fewer than the 8% to 9% of multiorgasmic
men of similar age reported by Kinsey et al. However, the
prevalence data after the age of 30 are similar in both studies
(<7%). The lower incidence of multiple orgasms in older men
could be due to global effect of aging on sexual function; eg, as
noted by Masters and Johnson, PERT is extended as men age.
4
Furthermore, compared to younger men, older men are more
likely to have comorbidities that can impede sexual function.
In terms of sampling bias, there were some notable similarities
and differences between the Kinsey et al and Haning et al studies.
In both cases, the populations were mainly college students. The
data in Kinsey’s book came from only the white population in
the United States (predominantly from urban areas in North-
eastern states), whereas the data in the Haning studies were
collected from a sexually active heterosexual population in mid-
Atlantic USA, but ethnicity was not indicated. Participants
joined the Kinsey et al study either voluntarily or with undefined
incentives, whereas Haning et al’s studies included data only
from volunteers. Furthermore, Kinsey et al conducted in-person
interviews in which participants were asked about multiple or-
gasms during partnered sex, but the authors did not specify if
participants were asked about multiple orgasms during solo
masturbation. In contrast, Haning et al used an anonymized
computer survey and their question on orgasms only asks about
multiple orgasms with a “good”sexual partner, which potentially
excludes those who had multiple orgasms during solo mastur-
bation. In sum, one can only generalize with caution from the
prevalence data from these studies.
The Kinsey et al book also presented controversial data on the
capacity for multiple orgasms in 182 preadolescent boys.
1
Kinsey
defined adolescence as the period when young males begin to
ejaculate, which usually occurs between the ages of 11 and 14.*
More than 50% of the boys (aged 15 years old) in their study
supposedly were multiorgasmic; with some 30% able to reach 5
or more successive orgasms. For these subjects, the interorgasmic
interval increased (seconds to minutes) with increasing number
of orgasms. Although some of the boys were within the age range
of adolescence,
63,64
many were younger than 10 years of age and
not capable of ejaculating. Hite
65
also stated that many boys can
achieve orgasm before they can ejaculate. It remains unclear why
a subset of preadolescent boys, who would likely have been
Tanner stage II or younger, were more likely to have multiple
orgasms than adult men. However, if these data can be trusted,
they affirm the separation of orgasm from ejaculation and suggest
that the capability for multiple orgasms may be elevated when
the potential for ejaculation is absent or low (discussed further
later).
What Factors May Promote Multiple Orgasms in
Men?
Next, we categorize different factors that have been reported to
facilitate men achieving multiple orgasms. However, most of these
are based on subjective reports and have not included physio-
logical measurements to validate the type of multiple orgasms
these men experience or whether they were experienced at all.
1. Avoiding Ejaculation
Some men claim to experience multiple orgasms without
practice, either since they became sexually mature at
* Kinsey et al’s data have been criticized for various reasons, including the
fact that how Kinsey collected detailed and systematic observations
(including speed of orgasms, time between orgasms, and duration of sexual
encounter) for what they called “prepubertal orgasms”was not clearly
stated in their publication. Only in the mid-1990s did John Bancroft, a sub-
sequent director of the Kinsey Institute (www.kinseyinstitute.org/about/
cont-akchild.html#footnote50),
62
trace back the source of the preadoles-
cents’data. Bancroft found that the data, in fact, came from 1 man who
kept a record of his sexual encounters with people of various ages, including
children and adults of both sexes. That fact alone raises the possibility that
the high number of reported multiorgasms in preadolescent boys were
biased (ie, in which the person may preferentially have had more sexual en-
counters with preadolescent boys than adult men.
Sex Med Rev 2016;-:1e13
6Wibowo and Wassersug
adolescence
30
or having discovered it by accident in adult-
hood.
6,30
However, there are mono-orgasmic men who sup-
posedly learn to be multiorgasmic and practice the skill.
30,66
Hartman and Fithian
66
offered instructions for men to achieve
successive orgasms predicated on the idea that controlling ejac-
ulation was key. Their method involved: (1) prolonging
masturbation through penile stimulation; (2) blocking ejacula-
tion by squeezing the glans penis; and (3) using Kegel exercises to
strengthen pelvic floor muscles. The authors specifically stated
that in order to control ejaculation, one would need a strong
pubococcygeus muscle. However, Hartman and Fithian’s
methodology for developing the propensity for multiple orgasms
has not been validated with any objective physiological data from
the pelvic floor musculature. As such, future studies are needed
to confirm how effective the Hartman and Fithian technique is
in helping men achieve multiple orgasms. Such studies should
verify the orgasms by correlating subjective reports of multiple
orgasms with pelvic floor EMG.
Men who can independently control ejaculation are poten-
tially interesting subjects for advancing our understanding of
the neurobiology of male orgasm. Imaging studies to date (eg,
Georgiadis JR, Holstege,
67
and Holstege et al
68
) have only
examined the brain activation during orgasms that occur with
ejaculation. Functional magnetic resonance imaging (fMRI)
studies of orgasms that are reported to occur without ejaculation
could help indicate which brain areas are activated specifically by
orgasm independent of ejaculation. In his review of PERT, Levin
independently called for more neuroimaging studies to advance
our understanding of the neurobiology of PERT itself.
3
2. Psychostimulant Drugs
Many compounds are consumed as aphrodisiacs and reported
to increase libido in some men.
69e74
In several studies in which
men had sex under the influence of cocaine (2 men),
75,76
amphetamine (total ¼16 men),
76e78
butyl nitrite (2 men),
66
and amyl nitrite (1 man),
66
multiple orgasms were claimed to
have occurred. Some of these drugs may influence the bioavail-
ability of hormones and/or neurotransmitters involved in sexual
behavior, but without any physiological measures, the reliability
of such reports need to be taken with caution. In addition, as
these drugs are known to have cognitive effects, the subjective
reports on how they influence orgasms cannot be considered
truly objective or reliable. Furthermore, some of these accounts
may be due to placebo effect from eroticizing the drugs. Coin-
cidentally, there are studies suggesting that stimulatory drugs
such as cocaine or methamphetamine can increase sexual
arousal,
79
possibly by increasing dopaminergic neurotransmis-
sion in the mesolimbic area
80
and cholinergic neurotransmission
in the basal forebrain.
38,81
Furthermore, it remains to be determined if any of the drugs
mentioned above can activate the temporal lobe and subsequently
trigger sexual aura, a phenomenon described as “erotic feelings
accompanied by sexual arousal and orgasm.”
82
Sexual aura has
been reported in individuals during or after epileptic seizures and
is thought to originate from the temporal lobe.
82
In 1 study,
83
the
temporal lobe was one of the areas with increased activation in the
brain of cocaine users who watched an erotic movie. Therefore,
there is a possibility that multiple orgasms described by some men
on these stimulants may be due to the action of drugs on the
temporal lobe, thus provoking a sexual aura.
3. Changing Sexual Partners
Multiple orgasms have been anecdotally reported by some
men, who change sexual partners in group sex venues.
66,84
However, this may be due to the “Coolidge effect,”a rearousal
phenomenon where the refractory period is reduced in the
presence of a new sex partner.
85e87
Evidence of the Coolidge
effect is best documented in animal studies.
87
Access to a new or
novel sexual partners may promote sexual desire and motivation
to orgasm, truncating the refractory period. Levin
3
also suggested
that the Coolidge effect could account for shortened PERT in
men. Joseph et al
88
recently studied ejaculatory parameters for
Table 2. Distribution of Orgasm Types During Sex With a Partner by Median Age in 6 Age Groups of Men
Median ages in years of participants for columns
20 24 31 40 45 56 21 (all ages)
Orgasm type
Single 90.6 91.1 9.3 94.1 96.7 90.9 91.2
Multiple 5.6 7.0 4.7 5.9 3.3 6.6 5.8
Sustained 3.8 1.9 1.6 0 0 2.5 2.9
Total number 818 258 129 34 30 121 1,390
The data in this table are reanalyzed from Haning et al studies
60,61
along with additional data collected through 2014. All data shown are column per-
centages. The authors defined multiple orgasms as 2 or more orgasms with inter-orgasmic intervals of 30 seconds or more. Individuals who had never
experienced an orgasm with a partner were excluded from the analysis. Logistic regression (data not shown) indicated that there was no significant
regression on age for the likelihood of either multiple or sustained orgasm during partner sex in these 1,390 men who provided data from 2002 through
2014. (Personal communication from R. Vernon Haning, MD, and Sandra S. Stroebel, PhD, Department of Psychology, Marshall University, Huntington,
West Virginia, and Department of School Psychology, Marshall Graduate College, Charleston, West Virginia.)
Sex Med Rev 2016;-:1e13
Male Multiple Orgasms 7
men who watched sexually explicit films of a heterosexual couple
several times, then followed by a different film displaying
the same male actor, but a different female actress. When
the participants watched the film with a new actress, their
ejaculate volume increased and time to ejaculate decreased.
This supports the idea that the introduction of a new sexual
stimulus increases arousal. Unfortunately, no study to date has
explicitly recorded time intervals between orgasms or if the
orgasms are accompanied by ejaculations in men during group
sex. Therefore it remains unknown if the “multiple orgasms”
reported by men during group sex should be considered as
multiple orgasms.
4. Sex Toys
Sex toys have been reported to help men have multiple or-
gasms. Aneros (www.aneros.com) is advertised by its manufac-
turer as a hands-free prostate stimulator, but it also exerts
pressure on the perineum and anus, stimulating that tissue as
well. Anecdotally, there are men who reach orgasm through anal
stimulation.
65,89
Some Aneros users (see posts on www.aneros.
com/forum) claim multiple orgasmic capacity without ejacula-
tion, resembling the “condensed”multiorgasms, by moving the
sex toy using their pelvic floor muscle contraction without direct
penile stimulation. To date, no scientific study has investigated
how effective Aneros or other vibratory sexual appliances are in
promoting multiple orgasms in men. For that reason and the
subjective nature of these claims, the veracity of those reports
must be taken with caution.
Future fMRI studies that compare male orgasm achieved
solely with perineal, rectal, prostate, or penile tactile stimulation
may help determine how brain activation varies when orgasms
occur with or without penile stimulation. By selective application
of stimuli with the Aneros or similar sex toys, it may be
possible to distinguish how different erotic fields contribute to
achieving an orgasm (eg, perianal skin, anal canal, prostate gland
proper, etc).
Two studies (ie, Gray and Klotz
6
and Warkentin et al
33
)
provide insight into how multiple orgasms may be reached in the
absence of erection and ejaculation. The man was the prostate
cancer patient described in both studies who lost his capacity for
erection as a result of a nonenerve-sparing prostatectomy. He
was encouraged by a lesbian friend to use a strap-on dildo for
penetrative sex with his partner. In these case studies, stimulation
to the man’s glans penis was provided by his partner’s hand,
which held (with lubricant) the man’sflaccid penis. What is
intriguing about this patient is that since he started using the
strap-on dildo for vaginal intercourse, he experienced a burst
of orgasms within 1 to 2 minutes, resembling a “burst”of orgasms
as described by Dunn and Trost,
30
or what we labeled
as “condensed”multiple orgasms. The narrative provided in
Warkentin et al
33
by the patient reveals a sense of empowerment
that he felt from knowing that, in using the external prosthesis, he
need not fear any erectile dysfunction. This in turn seemed
to heighten the eroticism of the sexual encounter. Again, this
observation needs to be taken with caution until more physio-
logical data are collected on the orgasms of other prostate cancer
patients, who claim to have become multiorgasmic subsequent to
having a prostatectomy.
Does Ejaculation Inhibit Multiple Orgasms?
Data from our review point to the possibility that the lack
of ejaculation (and thus subsequent absence of PERT) may
permit multiple orgasms and/or intensify orgasm. Masters et al
90
briefly mentioned that some men can have multiple orgasms
before ejaculation happens. Shere Hite,
65
who surveyed almost
7000 men about their sexuality, documented anecdotal claims
from men who reported having several “dry orgasms”or “mini-
orgasms”by avoiding ejaculation. As noted above, some men
reportedly practice avoiding ejaculation
66
or stimulating the
prostate, perineum, and anus using the Aneros sex toy (see www.
aneros.com/forum) to reach multiple orgasms without ejacula-
tion. Some exemplary quotes from Hite
65
include:
“.I.found myself capable of several [nonejaculatory
orgasms], a few minutes apart, connected by a plateau of
extremely high arousal.”
“I have.a prolonged series of very small orgasms,
without ejaculation, which may go on over a period of 1 to
15 minutes..”
“I can have more than one [orgasms without ejaculation],
sometimes within a minute or two, sometimes only after a
resting period.”
Additionally, consistent with such an idea is the report that
some men may be capable of achieving multiple orgasms after a
prostatectomy that eliminates ejaculation.
6,33
It has been inde-
pendently reported as well by others that some men (ranging
from 1.2% to 9%) claim to experience more intense orgasm
post-prostatectomy.
91e95
Similarly, some male-to-female trans-
sexuals (ranging from 30% to 40%) have reported experiencing
multiple orgasms
96e98
and 56% experienced intensified or-
gasms
99
after sex reassignment surgery, which involves castration
and thus loss of ejaculate. In 1 case report,
100
a transvestite man
claimed that his orgasmic feeling changed from being localized in
the penis to being “expanded all over his body”with tingling
sensations that lasted for 15 to 20 minutes afterward. If these
claims are valid—we know of no physiological data confirming
them—it remains to be determined what changes in these ge-
netic males intensified the orgasm and/or allows for multiple
orgasms. Possibilities include reduced ejaculate volumes (leading
to decreased internal pressure in the posterior urethra at the
emission stage).
One of us (RW) has tracked several online prostate cancer
patients’chat groups (eg, pcai@prostatepointers.org) for the past
decade and a half and has seen similarly seen posting from men
who report that they became multiorgasmic after a prostatec-
tomy. These accounts match that of the patient in the Gray and
Sex Med Rev 2016;-:1e13
8Wibowo and Wassersug
Klotz case study
6
discussed above. Although they are few and all
remained anecdotal, they further support the idea that the
absence of ejaculation (as occurs post-prostatectomy) may open
the way for multiple orgasms in some men.
The loss of testicular testosterone production after castration
also may contribute to the changes in multiple orgasmic capa-
bility. The 1 subject in the Gray and Klotz study
6
and the
subjects in the male-to-female transsexual studies
96e98
have been
castrated, so their androgen profiles might resemble those of
preadolescent boys, many of whom Kinsey et al
1
claim to be
multiorgasmic (but see footnote on page XXX). (Of note, many
male-to-female transsexuals take some form of estrogen,
101
which
also may influence their orgasmic capability. The reasoning here
comes from the fact that estrogen receptors are present in pelvic
floor muscles
102
and estrogen treatment can restore normal
electromyographic activity of pelvic floor muscles after castration
in male rodents.
103e105
)
Further anecdotal data suggesting that gonadal hormone sta-
tus—specifically low testosterone with or without supplemental
estrogen—may influence the propensity for males to be multi-
orgasmic come from modern-day voluntary eunuchs, who
participate in the online chat room at www.eunuch.org. A dis-
cussion on that website about the impact of castration on
orgasmic function (monitored by our colleague Dr. Thomas W.
Johnson) received posts from 19 self-reported castrated males. Of
these, 2 reported becoming multiorgasmic after their castration,
6 reported more intense orgasms after castration, and 5 claimed
to feel more diffused or expanded sensation at orgasm after
castration. To date, though the impact of androgen deprivation
on orgasm per se with or without supplemental estrogen has not
been systematically and thoroughly investigated.
Regardless, the ability to have orgasms (or even change to being
multiorgasmic) after being androgen deprived raises a question on
how important androgens are in the neurobiology of orgasm.
Androgen depletion results in pelvic floor muscle shrinkage in
male rodents,
106
but whether similar atrophy happens with pro-
longed androgen deprivation in human males is not yet known.
However, if such atrophy does occur, the muscle shrinkage due to
androgen deprivation alone may not be sufficient to eliminate
orgasm. Furthermore, most 46X,Y individuals with complete
androgen insensitivity have normal orgasm capability,
107,108
suggesting that a male’s current testosterone titer may not be a
single factor for facilitating orgasms, multiple or otherwise.
What Modulates PERT and Thus the Potential for
“Sporadic”Multiple Orgasms in Men?
Admittedly, PERT varies between individuals and can last
from minutes to hours.
3
Healthy young men on average
have w20-minute PERT,
27,28
although some men may have
shorter PERTs.
3
These men may represent those having
“sporadic”multiple orgasms accompanied with ejacu-
lations.
30e32,35,36
From our experience in screening rats’copu-
latory behavior,
109
approximately 10% of male rats have short
PERT (also described in another study by Olivier et al).
110
However, beyond the data from Kinsey et al
1
and Haning
et al
60,61
summarized earlier, the percentage of men with an
exceptionally short PERT representative of the capability for
“sporadic”multiple orgasms is not known.
The neurobiological basis for PERT itself is not fully under-
stood. The brainstem monoaminergic systems appear to play
some role in modulating PERT. For example, disruption in the
serotonergic
111
and the dopaminergic
112
systems produce
opposite effects on PERT. In addition, the noradrenergic system
also may regulate PERT, but there have been conflicting findings
(McIntosh et al
113
vs Walker et al, Clark, and Clark et al
114e116
).
Under experimental conditions, PERT can be shortened, for
example by electrical stimulation
117e120
or blocking GABAergic
transmission
121
in the medial preoptic area—a region known to
control male sexual behavior. Short PERT also is observed in
animals with lesion in the rostral midbrain area (medial
lemniscus and area ventral to it
122
or in the nucleus para-
gigantocellularis in the midbrain).
123
It remains to be investi-
gated how the duration of PERT is influenced by individual
differences in neuronal activities of monoaminergic neurons in
the brainstem or brain areas that control male sexual behavior.
Though not specified in any of the studies reviewed here, one
also might argue that the “sporadic”multiorgasmic men with
short PERT may have unusually high libido and arousability. In
such a case, after the first orgasm the men may retain elevated
arousal, which may further motivate them to continue sexual
stimulation until subsequent orgasm(s) are reached. A similar
idea is expressed in Hartman and Fithian,
66
who quote an un-
published work by their student Nick Konnoff suggesting that
multiple-orgasmic men may be “more functional overall”in the
sexual domain than nonemultiple-orgasmic men. However, it is
not clear what they meant by “functional,”considering that their
single study
66
did not include relevant physiological data.
CONCLUSIONS
Table 1 provides the first comprehensive compilation of in-
formation in the literature on male multiple orgasms and pro-
vides much data to support the reality of the phenomenon. Our
discussion on factors that may influence the capacity for multiple
orgasms in men goes beyond Levin’s
3
review of PERT, which
largely focused on the neurobiology of PERT.
Whereas the volume of data in Table 1 testify to the reality of
multiple orgasms in men, the data also establish that multiple or-
gasms in men are rare, and most of the accounts to date are sub-
jective reports lacking confirmatory physiological data. For
example, the number of reports on men who experience
“condensed multiple orgasms”are few (16 men in Dunn and
Trost’s study
30
and 1 man in the Warkentin et al case report).
33
Levin ended his 2009 review of PERT with a call for more
research with neuroimaging to advance our understanding of the
factors that account for the latency between orgasms in men. We
Sex Med Rev 2016;-:1e13
Male Multiple Orgasms 9
reiterate his plea and suggest that such studies will help us un-
derstand not only PERT but the physiology of orgasms in general.
Based on the physiological data available to date, most of the
properties of the orgasm in multiorgasmic men resemble those of
mono-orgasmic men. Our review of the literature suggest, how-
ever, that there are 2 types of multiple orgasms: “sporadic”ones
involving several orgasms with interorgasmic interval of several
minutes and “condensed”ones involving a burst of orgasms
within a few seconds to 1 to 2 minutes. Unfortunately, for
most studies, the time interval between the orgasms are not suffi-
ciently described and prevent us from determining which type of
multiple orgasms occurred. Furthermore, rarely have the studies
provided physiological data confirming that multiorgasms have
occurred at all. Most studies simply rely on self-reports from the
test subjects.
Although some men claim to be spontaneously multiorgasmic
without exceptional effort or learning, various factors have been
suggested to facilitate men having multiple orgasms. These
include: (1) practicing to have orgasm without ejaculation; (2)
using psychostimulant drugs; (3) changing sexual partners in a
sexual encounter; or (4) using sex toys. However, the extent to
which each factor enhances men’s ability to experience multiple
orgasms has not been examined.
There are still many unanswered questions in regard to male
multiple orgasms. Data from post-prostatectomy prostate cancer
patients, male-to-female transsexuals post-castration, and also
voluntarily castrated men collectively suggest that eliminating or
impeding ejaculation may influence the capacity for multiple
orgasms in genetic males. Imaging studies coupled with pelvic
floor EMG on individuals who can have orgasms without ejac-
ulation could help us better understand and delineate the link
between ejaculation and orgasm in men. Furthermore, future
study should explore what is the role of ejaculation and physi-
ological changes during PERT in inhibiting multiple orgasms.
The neurobiology and physiology of male multiple orgasms has
barely been explored.
ACKNOWLEDGMENTS
We thank R. Vernon Haning and Sandra Stroebel for providing
additional analysis of their data (Table 2), Stacy Elliott, Lori
Brotto, and R. Vernon Haning for critical feedbacks on the draft
versions of this manuscript, Thomas Wayne Johnson for
directing us to the discussion on orgasmic changes in voluntarily
castrated men from eunuch.org, Katherine Frank for the valuable
discussion on male multiple orgasms in group sex setting, and
Christine Zarowski for the valuable discussion on prostate cancer
patients who become multiorgasmic after treatments.
Corresponding Author: Erik Wibowo, PhD, Level 6, Gor-
don & Leslie Diamond Health Care Centre, 2775 Laurel
Street, Vancouver, British Columbia, V5Z 1M9, Canada.
Phone: 604-875-4111, ext. 62338. Fax: 604-875-4637;
E-mail: erik.wibowo@vch.ca
Conflict of Interest: The authors report no conflicts of interest.
Funding: None.
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and Design
Erik Wibowo; Richard J. Wassersug
(b) Acquisition of Data
Erik Wibowo
(c) Analysis and Interpretation of Data
Erik Wibowo; Richard J. Wassersug
Category 2
(a) Drafting the Article
Erik Wibowo
(b) Revising It for Intellectual Content
Erik Wibowo; Richard J. Wassersug
Category 3
(a) Final Approval of the Completed Article
Erik Wibowo; Richard J. Wassersug
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