(063) Insights into Orgasm Health from Anonymous Online Communities

Abstract Introduction Many patients struggle to bring up intimate concerns such as orgasm in clinical settings, and traditional medical definitions do not always capture the breadth of lived experience. In those with male anatomy, an orgasm is typically described as penile in origin, while other anatomic locations of an orgasm are rarely recognized in peer-reviewed literature. This narrow framing limits our knowledge of physiology, trajectory, and dysfunction outside of the penile model of an orgasm, and creates barriers to clinician–patient dialogue and effective care. Objective We aimed first to characterize the lived experience of orgasm among people with male anatomy. A secondary aim was to explore broader themes in sexual health discourse within an online community, including sex practices, relationships, and interactions with healthcare. Methods We conducted a qualitative study of anonymous Reddit posts published online between 2009 and 2024. Using inductive coding, we developed a codebook of 230 keywords, applied through Reddit’s API with the httr2 package in R. Mentions were aggregated and sorted into axial and thematic codes. Analyses were conducted in R (v4.4.1), and iterative coding continued until thematic saturation was achieved. Results Posts from 22,131 unique users were analyzed, comprising 133,549 keyword mentions. While penile orgasm was most frequently described, nearly half of the posts (46%) reference prostatic, anal, or non-genital orgasm. Specifically, a third of posts reference prostatic orgasms (34%), while a smaller proportion referenced anal (12%) and non-genital (1%). The most common overarching theme of discussions online was health and healthcare (55%), followed by sex practices and techniques (23%), relationships and partners (12%), natural variability of orgasm (6%), and orgasm type (4%). Within the health and healthcare theme, sexual side effects of medical conditions (45%) and orgasmic dysfunction (34%) were the most prominent sub-categories of discussion. Among posts about sex practices, discussions of sex toys and tools dominated (83%). Conclusions We identified four commonly described orgasm pathways: penile, prostatic, anal, and non-genital, underscoring the need for a more inclusive clinical framework of orgasms that reflects real patient experience. Frequent discussion of health-related issues, particularly treatment-related side effects, signals potential unmet needs in the clinical care of patients. By incorporating anonymous, patient-driven narratives, sexual medicine can move toward a more comprehensive and patient-centered understanding of orgasm. Disclosure No