We read with interest the cross-sectional study of men and women titled "Simultaneous Penile-Vaginal Intercourse Orgasm is Associated with Satisfaction (Sexual, Life, Partnership, and Mental Health)" [1], which shows an association between simultaneous penile-vaginal intercourse (PVI) orgasm and different measures of satisfaction. However, we are confused with the authors' causal inferences based on their results and look forward to their clarifications.First, in the discussion, the authors acknowledge that: "The observed associations might be due to... simultaneous PVT orgasm being the result of a variety of personal strengths in one or both partners, including sufficient satisfaction with various aspects of life" [1]. However, elsewhere in the discussion, the authors write: ". . . (simultaneous PVI orgasm) has benefits even beyond those of vaginal orgasm" [1], which clearly suggests that simultaneous PVI orgasm causes satisfaction. Furthermore, the conclusion solely advocates for "greater support for these specific aspects of sexual activity" [1].
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