Come undone: A beginner’s guide to Traumatic Masturbatory Syndrome

I’m not quite sure where I first read about it, but Traumatic Masturbatory Syndrome (TMS) appears to be a controversial phenomenon that is not widely accepted in the medical and sexological communities. According to the Healthy Strokes website:

“[Traumatic Masturbatory Syndrome] is the habit of masturbating in a face-down position against a bed or floor, which puts excessive pressure on the penis, and can interfere with sexual relations. The most common problems TMS sufferers have are inorgasmia – inability to reach orgasm during intercourse – or delayed orgasm. Many TMS sufferers also experience erectile dysfunction”. 

The term ‘Traumatic Masturbatory Syndrome’ originates from a 1998 paper in the Journal of Sex and Marital Therapy by Dr. Lawrence Sank. His paper described what he believed was “a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men”. He outlined four case studies of men who masturbated daily in a prone position over many years. I wrote to Dr. Sank and he kindly sent me his paper. Sank’s paper began by outlining the fact that there are many texts and manuals for women on how to masturbate and how to overcome being non-orgasmic, but little for men. He pointed out that problems in erectile functioning and orgasm among males appears to result, not from their inability to masturbate but from the inability to masturbate correctly (Sank’s emphasis on the word ‘correctly’). The four cases that Sank reported on were all physically healthy and there were no problems urogenitally, neurologically, hormonally or vascularly. Here are brief summaries of the four cases Dr. Sank wrote about:

  • Case 1 [Mr. A]: A 62-year old heterosexual married Black male who was referred for impotence – “He had been married over two years but the couple had not had successful intercourse…He learned at age 8, from his local priest, that any pleasure from touching his penis was the equivalent of ‘re-crucifying Jesus’…The compromise that Mr. A reached was to not use his hand but to rub his penis against his bed clothes and/or pillow without manual guidance. He believed that this would mitigate the seriousness of his sin…This method of sexual expression lasted through several decades of almost daily practice….Mr. A pursued a series of relationships with women…He would rub extremely vigorously against his partner usually to a point where any erection was lost… Mr. A’s masturbatory history is significant for the unique prone position that he engaged in daily over many years”.
  • Case 2 [Mr. B]: A 35-year old gay single Asian male referred for an inability to attain or sustain any erection and an inability to achieve orgasm during intercourse – “Mr. B’s history was significant for the absence of what he called a ‘phallic oriented puberty’…He was not able to achieve orgasm until his early 20s. At that time all masturbation was accomplished by rubbing his penis against his mattress in a prone position while fantasizing about being penetrated by a male. He would do this on a daily basis, always eventuating in orgasm. In his late 20’s he found a male lover with whom he would characteristically engage in mutual, manual masturbation…Any stimulation by his partner eventuated in mutual exhaustion since no effort was sufficient, no matter how prodigious, to trigger Mr. B’s orgasm…Mr. B reported that masturbation, while in a prone position, felt ‘more natural’, was speedier, and required far less effort. Mr. B’s explanation was that he imagined his masturbatory preference to be a logical outgrowth of his shame at not having ‘good, working equipment’…Being face down allowed him to hide his embarrassment”.
  • Case 3 [Mr. C]: A 24-year old gay white male referred for inability to reach orgasm – “When, on rare occasions, Mr. C did achieve orgasm, it was always with a flaccid penis and never accompanied by any pleasurable sensation…Positionally, Mr. C would invariably masturbate while lying on his stomach, his hands made into fists with his penis between his thumbs. He would thrust downward creating intense friction between the lateral portion of his penile shaft and the knuckles of his thumbs. There would be no erection. The frequency of masturbation was 5-7 times per week. Before treatment, when Mr. C tried masturbating in a more typical fashion he was capable of obtaining an erection but never a strong one nor was there any subsequent orgasm”.
  • Case 4 [Mr. D]: A 35-year old heterosexual single white male referred for primary erectile dysfunction – “Mr. D masturbated on a daily basis since adolescence. The quality of the erection during masturbation was reported to be of ‘poor rigidity’…but always eventuated in orgasm. Positionally, Mr. D would be prone, lying on his face and chest, using both hands – one hand grasping his penis, the other hand placed over the first…Only subtle changes in pressure from his hand served to heighten his arousal to the point of obtaining a semi-rigid, non penetrable erection and then orgasm…He has never been able to sustain his erection beyond several seconds of intercourse nor has he achieved orgasm…When asked as to why he masturbated in this statistically unusual manner, Mr. D expressed surprise that it was so unusual and hypothesized that it must have arisen out of being a shameful activity at which he wouldn’t have wanted to be caught. In addition, the tight clutching of his penis during masturbation parallels Mr. C’s traumatizing handling of his penis during masturbation and Mr. A’s vigorous, exhaustive masturbatory rubbing against his bedding or partner”.

Dr. Sank duly acknowledged that the case material presented was anecdotal and he made it clear in his paper that he wasn’t suggesting the “distinguishing variables of position plus frequency or either, alone, are necessary or sufficient for causing the erectile or orgasmic dysfunctions described in these cases”. In the cases of A, C and D:

“The punishing handling of the penis might co-occur with these two variables because a prone position, due to its awkwardness and lack of freedom of motion, would seem to require a great deal of intensity if the subject is to derive the requisite pleasurable sensations associated with masturbatory activity. The daily regimen of masturbation might also have served to raise the threshold of sensation, thus requiring even more intense stimulatory activity to enable orgasm. Unfortunately this heightened intensity would likely raise the threshold for pleasurable sensation even higher…the proverbial vicious circle”

Dr. Sank reported that all his patients were successfully treated and overcame their presenting symptoms. Sank did not describe the treatment in any detail (saying it was beyond the scope of the paper) but involved the “re-sensitizing what the patient treats as a desensitized organ through both individualized behavioral exercises and psychotherapy when appropriate”.

On the basis of his admittedly anecdotal findings, Dr. Sank recommends that pubescent teenagers should be taught proper masturbatory techniques (either by parents, by teachers, and/or by paediatricians). However, as far as I am aware, no other academic or clinical paper has followed up the work of Sank. The Wikipedia entry relating to TMS was removed in 2009 (presumably because of lack of evidence). However, according to an article on masturbation on the Right Diagnosis website, some sources, still continue to give credence to the idea of TMS. The article cites the 1994 book by sex therapist Eva Margolies (Undressing The American Male) who condemned masturbation by rubbing against a pillow or mattress. The same article also quotes the work of and Dr. Josie Lipsith and her colleagues in a 2003 issue of Sexual and Relationship Therapy that suggests masturbation could play a part in male psychogenic sexual dysfunction (although this seems to be little more than citation of Dr. Sank’s original paper).

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Go Ask Alice (2006). Traumatic Masturbatory Syndrome. November 17. Located at:

Healthy Strokes (2013). Facts about prone masturbation. Located at:

Lipsith, J., McCann, D. & Goldmeier, D. (2003). Male Psychogenic Sexual Dysfunction: The Role of Masturbation. Sexual and Relationship Therapy, 18, 448-471.

Margolies, E. (1994). Undressing the American Male: Men with Sexual Problems and What Women Can Do to Help Them. New York: Penguin.

Right Diagnosis (2013). Masturbation. Located at:

Sank, L.I. (1998). Traumatic masturbatory syndrome. Journal of Sex and Marital Therapy, 24, 37-42.

About drmarkgriffiths

Professor MARK GRIFFITHS, BSc, PhD, CPsychol, PGDipHE, FBPsS, FRSA, AcSS. Dr. Mark Griffiths is a Chartered Psychologist and Professor of Behavioural Addiction at the Nottingham Trent University, and Director of the International Gaming Research Unit. He is internationally known for his work into gambling and gaming addictions and has won many awards including the American 1994 John Rosecrance Research Prize for “outstanding scholarly contributions to the field of gambling research”, the 1998 European CELEJ Prize for best paper on gambling, the 2003 Canadian International Excellence Award for “outstanding contributions to the prevention of problem gambling and the practice of responsible gambling” and a North American 2006 Lifetime Achievement Award For Contributions To The Field Of Youth Gambling “in recognition of his dedication, leadership, and pioneering contributions to the field of youth gambling”. His most recent award is the 2013 Lifetime Research Award from the US National Council on Problem Gambling. He has published over 600 research papers, four books, over 130 book chapters, and over 1000 other articles. He has served on numerous national and international committees (e.g. BPS Council, BPS Social Psychology Section, Society for the Study of Gambling, Gamblers Anonymous General Services Board, National Council on Gambling etc.) and is a former National Chair of Gamcare. He also does a lot of freelance journalism and has appeared on over 2000 radio and television programmes since 1988. In 2004 he was awarded the Joseph Lister Prize for Social Sciences by the British Association for the Advancement of Science for being one of the UK’s “outstanding scientific communicators”. His awards also include the 2006 Excellence in the Teaching of Psychology Award by the British Psychological Society and the British Psychological Society Fellowship Award for “exceptional contributions to psychology”.

Posted on December 1, 2015, in Case Studies, Gender differences, Physiological disorders, Sex and tagged , , , , , . Bookmark the permalink. Leave a comment.

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