I commend the authors for the effort to examine the psychological burden of post orgasmic illness syndrome (POIS) on patients [1]. Since Waldinger and Schweitzer [2] first described this syndrome and coined the term POIS, there have been several studies which have examined this phenomenon. The authors have attempted to fill this gap in knowledge about the psychological effects on the patient [1]. This study indicates that individuals experiencing these sexual difficulties predominantly attribute the cause to internal, physical factors specific to sexual activity, rather than personal traits, partner behavior, or situational factors such as lack of privacy [1]. Respondents perceive the condition as highly stable (96%) and largely beyond the control of either themselves or their partners in over eighty percent of cases. Despite this perceived lack of control, self-blame is common, and these difficulties are reported to significantly impact relationships [1].

The authors used a pragmatic internet-based questionnaire for their data retrieval, however, a previous study in women which also utilized the SDAS (Sexual Dysfunction Attribution Scale) used online advertisement and paper fliers [3]. The online nature of the survey may increase participation as there may be reduced social desirability bias particularly considering the sexual nature of the topic. Although this also introduces the issue of selection bias as the authors agreed that more than two-thirds of respondent have university degree, are employed and from the middle class living in urban communities [1]. Moreover, the SDAS used in collecting the data is known to have certain drawbacks as it depends on self-reported outcomes which suffers from subjectivity, recall bias, misinterpretation of the question and cultural influence [3,4,5,6].